多发性硬化症36例临床分析_临床医学论文.docVIP

多发性硬化症36例临床分析_临床医学论文 多发性硬化症36例临床分析_临床医学论文 作者：雷建明，黎朝茂，江先娣，廖耿 【摘要】 目的：探讨多发性硬化（MS）的临床特点。方法：从临床、神经生理学、影像学等对MS病例进行回顾性分析。结果：36例MS中，男10例，女26例，发病年龄6~67岁，多见于青壮年女性，91.7%病例是急性或亚急性发病，复发~缓解型占51%，病变部位中大脑半球19例（52.8%），小脑5例（13.9%），脑干5例（13.9%）脊髓21例（58.3%），视神经12例（33.3%），其中视神经脊髓炎占27.1%。结论：MS起病急，病程短，脊髓、视神经、大脑易受侵犯，小脑、脑干相对少受累，临床症状多样化，以视力障碍、肢体无力较为突出，致残率较高，MRI对除视神经外的MS病灶有高度敏感性，并可显示无临床症状的亚临床病灶。急性、亚急性期应用糖皮质激素疗效显著。 【关键词】 多发性硬化；临床分析；磁共振成像 　　Clinical Analysis on 36 Cases Multiple Sclerosis 　　　Abstract: Objective： To analyse the clinical characteristics of multiple sclerosis(MS). Method： The characteristics of 36 MS cases were retrospectively studied on clinic, neurophysiology and imaging. Result： Among 36 MS cases, 10 in male and 26 in female. The first onset age was from 6 to 67 years old. MS mainly consisted of young and middle-aged women. 91.7% had acute and subacute onset and 51% had relapses. Nineteen cases had lesions in cerebral hemisphere, 5 cases in cerebellum, 5 cases in brain stem, 21 cases in spinal cord, and 12 cases in optic nerve. The diagnosis of 27.1% patients was Devic disease. Conclusion： The onset of MS is urgent, and the course is short. Spinal cord, optic nerve and cerebrum are easy to be invaded, but cerebellum and brain stem are relatively seldom to be involved. Clinical symptoms are various, but eyesight damage and weakness are prominent, which cause the high disability rate. MRI is highly sensitive to lesions except optic nerve, and it can show subclinical lesions. Treatment of acute and subacute MS with corticosteroids is effective. 　　Key words: Multiple sclerosis; Clinical analysis; Magnetic resonance imaging 　　多发性硬化（multiple sclerosis, MS）是以中枢神经系统（CNS）白质脱髓鞘性病变为主。目前认为与病毒感染、自身免疫有关。其病理特点是局灶性，多个部位受累，常位于白质散在的脱髓鞘斑块，伴反应性神经胶质增生，也可有轴突损伤，病变可累及大脑白质、脊髓、脑干、小脑和周围神经［1］。磁共振应用前，这些病灶不易被发现。随着MR的应用，国内报道亦趋增加。为了解MRI对MS诊断意义及激素治疗的疗效，现收集我科住院经临床确诊36例MS病人完整资料进行回顾性分析。 　　1 临床资料 　　1.1 诊断标准及病例资料： 　　根据1982年美国华盛顿MS诊断专题会议及1983年Poser等MS诊断标准［2］。收集1999年至2004年间收治的36例病例。全部为临床确诊病例，实验室支持确诊18例。其中男10例（27.88%