487例眼肌麻痹的病因分析

摘要

目的 了解眼肌麻痹的常见病因.方法 回顾性系列病例研究.收集2005年1月至2010年9月首都医科大学附属北京同仁医院487例眼肌麻痹患者的临床资料,包括患者病史、临床表现以及相应的神经科、眼科、内分泌科和影像学等检查.相应数据分别采用方差分析和卡方检验进行统计学分析.结果 487例患者中,明确病因19种.发病年龄方面,微血管缺血性(MVI)病变眼肌麻痹患者平均年龄最大(60.38±11.16)岁,与重症肌无力(MG)和局部非特异性炎症患者年龄差异有统计学意义(F =24.46,P=0.000).眼肌麻痹特点方面,双眼不对称性眼球运动障碍是MG患者(114例)的主要特点；所有MVI病变患者均表现为单侧单个眼动神经病变；局部非特异性炎症则多表现为单眼多个神经或肌肉病变.伴随症状方面,局部非特异性炎症患者(60例)均有局部疼痛,MVI病变也不少见(44例),差异有统计学意义(x2=36.346,P=0.000)；二者均有近50％的患者伴有轻度瞳孔改变,差异无统计学意义(x2=0.026,P=0.875).结论 眼肌麻痹病因复杂.MG、MVI病变和局部非特异性炎症为最常见原因.约半数以上为神经病变,神经-肌肉接头病变约占1/3,肌肉病变最少见.%Objective To study the etiology of ophthalmoplegia cases.Methods A retrospective case series study.We summarized and analyzed etiological diagnosis of 487 ophthamloplegia patients from January 2005 to September 2010 in Beijing Tongren Hospital of Capital Medical University and Beijing Tongren Eye Center. Clinical data included the case history,clinical manifestations,and results of examinations of neurology, ophthalmology, endocrinology and iconography. The analysis of variance (ANOVA) and Chi-Square test were used in our study.Results Nineteen different kinds of causes were indentified.In terms of age onset,microvascular ischemic (MVI) patients were the oldest (60.38 ± 11.16)in all groups.It significantly distinguished from myasthenia gravis (MG) and local non-specific inflammation ( F =24.46,P =0.000).From the view of ophthamloplegia characters,bilateral asymmetry ophthamloplegia was the character of MG. We also found that all MVI patients had lesions in unilateral single ocular movement nerve. Unilateral multiple nerves or muscles lesions were the main feature of local non-specific inflammation.In addition,from the view of concomitant symptoms,local aching was very frequent in local non-specific inflammation (all 60 cases) and MVI (44 cases) patients( x2 =36.346,P =0.000).The mild pupil changing could be found in about one half patients of the two diseases ( x2 =0.026,P =0.875 ).Conclusions The causes of ophthalmoplegia are very complicate. MG,MVI and local non-specific inflammation are the most frequent causes. In more than half of pateins,the lesions are located in neurological system,about one third located in neuromuscular junction and the least in the muscles.