不同病因致脊髓亚急性联合变性的临床及影像学对比分析

程忱; 俞文恪; 陈勇; 余鑫峰; 卢晓东

doi:10.16766/j.cnki.issn.1674-4152.002809

不同病因致脊髓亚急性联合变性的临床及影像学对比分析

doi: 10.16766/j.cnki.issn.1674-4152.002809

程忱¹,
俞文恪²,
陈勇³,
余鑫峰⁴,
卢晓东^1, ,

1.
杭州师范大学附属医院神经内科, 浙江杭州 310015
2.
浙江大学附属邵逸夫医院放射科, 浙江杭州 310016
3.
杭州师范大学附属医院放射科
4.
浙江大学附属第二医院放射科, 浙江杭州 310009

基金项目:

浙江省中医药科技计划项目 2021ZB224

详细信息

通讯作者:
卢晓东，E-mail：xdlu668@qq.com

中图分类号: R745.4
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- 被引次数: 0
出版历程
- 收稿日期: 2022-07-11
- 网络出版日期: 2023-04-07

Clinical and radiological analysis of subacute combined degeneration caused by different etiologies

1.
Department of Neurology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的分析一氧化二氮(nitrous oxide, N₂O)滥用致脊髓亚急性联合变性(subacute combined degeneration, SCD)和非N₂O相关性SCD临床、影像学及预后间的差异。方法回顾性分析2017年1月—2021年4月在杭州师范大学附属医院、浙江大学附属邵逸夫医院及浙江大学附属第二医院确诊的43例SCD患者的临床资料。根据病因分为N₂O滥用组(23例)及非N₂O滥用组(20例)。比较2组在临床表现、影像学检查、实验室检查及预后间的差异。结果 N₂O滥用组的发病年龄[21(19，25)岁]显著低于非N₂O滥用组[69(62，74)岁, P < 0.001]。N₂O滥用组出现尿便功能障碍的概率(34.78%，8/23)较非N₂O滥用组低(65.00%，13/20, P=0.048)。N₂O滥用组出现脊髓肿胀的概率(56.52%, 13/23)较非N₂O滥用组高(20.00%，4/20, P=0.015)。N₂O滥用组入院时的改良Rankin评分量表(mRS)评分[3.0(2.5，4.0)分]较非N₂O滥用组低[4.0(3.5，4.0)分, P=0.033]；治疗3个月后的mRS评分[2.0(1.0，2.0)分]也较非N₂O滥用组低[3.0(3.0，4.0)分，P < 0.001]。结论与非N₂O滥用组相比，N₂O滥用致SCD的神经功能损伤程度低，发生脊髓肿胀概率高，预后较好。
- 亚急性联合变性 /
- N₂O滥用 /
- 影像学表现 /
- 临床预后
Abstract: Objective This study aims to compare the clinical, radiological features and outcomes between patients with subacute combined degeneration (SCD) induced by recreational nitrous oxide (N₂O) abuse and patients with N₂O-unrelated SCD. Methods From January 2017 to April 2021, the clinical data of 43 patients with SCD diagnosed at Affiliated Hospital of Hangzhou Normal University, Sir Run Run Shaw Hospital Zhejiang University and Zhejiang Second Hospital were retrospectively analysed. According to the etiology, case data were divided into 23 patients with recreational N₂O-induced SCD and 20 patients with N₂O-unrelated SCD. The clinical and MRI features, laboratory tests and prognosis were compared between the two groups. Results Of the 23 patients with recreational N₂O-induced SCD, the mean age of onset was lower than those with N₂O-unrelated SCD [21 (19, 25) vs. 69 (62, 74) years, P < 0.001]]. The incidence of urinary and stool dysfunction was lower in the N₂O-induced SCD group (34.78%, 8/23) than in the N₂O-unrelated SCD group (65.00%, 13/20, P=0.048). MRI examinations indicated the N₂O-induced SCD cases presented a higher incidence of cord swelling [56.52% (13/23) vs. 20.00% (4/20), P=0.015]. The mRS scores for patients with N₂O-induced SCD [3.0 (2.5, 4.0)] were lower than those with N₂O-unrelated SCD [4.0 (3.5, 4.0), P=0.033] at admission. Moreover, patients with N₂O-induced SCD presented significantly lower mRS [2.0 (1.0, 2.0)] scores than those with N₂O-unrelated SCD [3.0 (3.0, 4.0), P < 0.001] at the last follow-up visit 3 months later. Conclusion These findings indicated that patients with N₂O-induced SCD have less severe neurological function deficit, an increased incidence of cord swelling and better prognosis.
- Subacute combined degeneration /
- Nitrous oxide abuse /
- Radiological features /
- Clinical Prognosis

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图 1 2组SCD患者特征性脊髓病灶

注：N₂O滥用致SCD患者, A为矢状位C_2~5水平(红箭头)脊髓后缘异常信号, 伴脊髓肿胀; B为横轴位“倒V征”。N₂O非滥用组SCD患者, C为矢状位T_1~5水平(红箭头)脊髓后缘条状高信号, 伴脊髓萎缩, D为横轴位“倒V征”。

Figure 1. Characteristic spinal cord lesions in 2 groups of SCD patients

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表 1 2组SCD患者一般情况及临床症状比较

Table 1. Comparison of general conditions and clinical symptoms of SCD patients in 2 groups

组别	例数	年龄[M(P₂₅, P₇₅)，岁]	性别(男/女，例)	肢体无力[例(%)]	四肢麻木[例(%)]	步态不稳[例(%)]	尿便功能障碍[例(%)]	认知障碍[例(%)]	精神症状[例(%)]
N₂O滥用组	23	21(19，25)	7/16	11(47.83)	20(86.96)	17(73.91)	8(34.78)	7(30.43)	5(21.73)
非N₂O滥用组	20	69(62，74)	6/14	15(75.00)	18(90.00)	14(70.00)	13(65.00)	1(5.00)	0
统计量		-5.609^a	0.001^b	3.305^b	＜0.001^b	0.081^b	3.909^b	3.045^b	3.032^b
P值		＜0.001	0.975	0.069	0.999	0.775	0.048	0.081	0.082
注：^a为Z值，^b为χ²值。

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表 2 2组SCD患者神经系统体征的比较[例(%)]

Table 2. Comparison of neurological signs between two groups of patients with SCD [Case (%)]

组别	例数	深感觉障碍	肌力下降	深反射消失或降低	深反射增高	Romberger征(+)	Babinski征(+)	浅反射消失	Lhermitte征(+)
N₂O滥用组	23	10(43.48)	14(60.87)	15(65.22)	4(17.39)	13(56.52)	5(21.74)	2(8.69)	1(4.35)
非N₂O滥用组	20	15(75.00)	17(85.00)	15(75.00)	3(15.00)	14(70.00)	7(35.00)	3(15.00)	0
χ²值		4.368	3.096	0.485	＜0.001	0.832	0.935	0.028
P值		0.037	0.078	0.486	0.999	0.362	0.334	0.868	0.999^a
注：^a为采用Fisher精确检验。

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表 3 2组SCD患者脊髓磁共振特点比较

Table 3. Comparison of spinal magnetic resonance characteristics between two groups of SCD patients

组别	例数	脊髓受累人数[例(%)]	矢状位					冠状位
组别	例数	脊髓受累人数[例(%)]	病灶节段数[M(P₂₅, P₇₅)，个]	颈髓[例(%)]	胸髓[例(%)]	颈胸均受累[例(%)]	病灶≥3个脊髓节段[例(%)]	脊髓肿胀[例(%)]	脊髓萎缩[例(%)]	侧索[例(%)]	后索[例(%)]	倒V征[例(%)]
N₂O滥用组	23	16(69.57)	2(0，4)	14(60.87)	3(13.04)	3(13.04)	12(52.17)	13(56.52)	4(17.39)	3(13.04)	7(30.43)	7(30.43)
非N₂O滥用组	20	16(80.00)	3(0，5)	11(55.00)	8(40.00)	4(20.00)	8(40.00)	4(20.00)	5(25.00)	7(35.00)	5(25.00)	5(25.00)
统计量		0.621^a	-0.509^b	0.151^a	4.083^a	0.041^a	0.637^a	5.969^a	0.056^a	1.790^a	0.157^a	0.157^a
P值		0.434	0.611	0.697	0.043	0.840	0.425	0.015	0.813	0.181	0.692	0.692
注：^a为χ²值，^b为Z值。

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表 4 2组SCD患者实验室检查比较

Table 4. Comparison of laboratory examination between 2 groups of patients with SCD

组别	例数	血清VB₁₂浓度[M(P₂₅, P₇₅), g/mL]	Hcy [M(P₂₅, P₇₅), μmol/L]	红细胞计数[M(P₂₅, P₇₅), ×10⁹/L]	平均红细胞体积[M(P₂₅, P₇₅), fL]	血红蛋白[M(P₂₅, P₇₅), g/L]	大细胞性贫血[例(%)]
N₂O滥用组	23	160.00(150.24，218.00)	27.00(12.90，39.8)	3.84(3.57，4.21)	95.60(92.20，101.10)	126.00(117.00，139.00)	10(43.48)
非N₂O滥用组	20	84.00(63.43，94.75)	28.00(10.90，60.25)	3.07(2.34，3.50)	110.00(100.90，118.85)	111.00(93.00，117.50)	16(80.00)
统计量		-4.288^a	-0.280^a	-3.959^a	-3.508^a	-3.364^a	5.969^b
P值		＜0.001	0.779	＜0.001	＜0.001	0.001	0.015
注：^a为Z值，^b为χ²值。

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表 5 2组SCD患者mRS评分比较[M(P₂₅, P₇₅)，分]

Table 5. Comparison of mRS scores between two groups of patients with SCD [M(P₂₅, P₇₅), points]

组别	例数	mRS评分
组别	例数	入院时	治疗3个月后
N₂O滥用组	23	3.0(2.5，4.0)	2.0(1.0，2.0)
非N₂O滥用组	20	4.0(3.5，4.0)	3.0(3.0，4.0)
Z值		-2.133	-4.133
P值		0.033	＜0.001

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