MRI阴性急性脊髓炎临床特点分析.docVIP

MRI阴性急性脊髓炎临床特点分析 　　【摘要】 目的 研究MRI未发现病灶的急性脊髓炎(acute myelitis，AM)的临床特点。方法 观察并分析6例MRI阴性的AM患者(研究组)和25例MRI发现责任病灶的AM患者(对照组)的临床特点，所有患者符合急性横贯性脊髓炎协作组公布的AM诊断标准。结果 研究组有前驱感染的比例显著高于对照组，从前驱感染到AM发病的潜伏期显著短于对照组，脊髓休克期出现的比例显著低于对照组，脊髓完全性横贯性损伤的比例显著低于对照组，治疗效果显著优于对照组，转化为多发性硬化或视神经脊髓炎的比例显著低于对照组。结论 与MRI发现责任病灶的AM相比，MRI阴性的AM有其不同的临床特点，对其及时的识别和治疗具有重要的临床意义。 　　【关键词】 MRI；急性脊髓炎；临床特点 　　Analyse for characters of MRI negative acute myelitis 　　 　　ZHANG Lei，WANG Jun-feng，LIU Han-wei. Department of Neurology，The 5th Affliated Hospital of Sun Yat-sen University，Zhuhai 519000，China 　　【Abstract】 Objective 　　 To evaluate the clinical characters of MRI negative acute myelitis(AM). Methods Observed and analyzed the clinical characters of 6 AM cases with negative MRI finding(studied group)and 25 AM cases with responsible foci shown by MRI(controlled group). All the cases accorded with Transverse Myelitis consortium Working Group proposed diagnostic criteria. Results The percentage of prodromal infections in studied group was significantly higher than controlled group. The latent period between prodromal infections and AM attacks in studied group was significantly shorter than controlled group. The percentage of spinal shock in studied group was significantly higher than controlled group. compared with controlled group, the percentage of 　　complete transverse spinal damages was significantly lower in studied group. The curative effects were significantly better and the percentage of tramsformed to multiple sclerosis or neuromyelitis optica was significantly lower in studied group compared with controlled group. Conclusion The clinical characters of MRI negative AM are different from those of responsible foci shown by MRI. Early recognition and therapy were of great importance. 　　【Key words】 MRI;Acute myelitis; Clinical characters 　　 　　急性脊髓炎(acute myelitis, AM)是一组病因未明的脊髓白质脱髓鞘或坏死性??变,导致急性脊髓横贯性损害。以往诊断AM主要依靠临床表现，有条件的可做脊髓造影，但该检查具有一定危险性。自临床应用核磁共振成像(MRI)以来，AM的诊断有了突破性进展，但MRI正常不能排除本病［1］。国内外均有报道MRI阴性的AM［2-4］，但未对