中国人视神经脊髓炎的临床特征和诊断分析

摘要

Objective To observe the clinical feature of neuromyelitis optica ,improve the understanding of the disease . Methods The clinical data of 56 patients with NMO during January 2012 and September 2016 in Henan Province People's Hospi-tal was collected ,including sex ,age ,causes ,clinic characteristics ,laboratory examination ,imaging features ,and so on .Results There were 52 confirmed cases and 4 suspected cases ,in which 24 cases were attacked firstly ,32 cases were relapse including 18 cases were more than two times .20 patients showed the initial symptom of optic neurititis ,7 patients showed abnormal sensation and/or muscle strength ,5 patients showed vomiting and/or fever ,the remaining showed multiple symptom at the same time .The ratio of bilateral/unilateral was 36:14 and the ratio of male/female was 11:45 ,most of them are between the ages of 20 and 30 years .The MRI results showed brain was involved in 12 cases ,optic nerves in 40 cases ,and spinal cord in 46 cases .Abnormal hu-moral immune function was found in 18 patients .The positive anti-aquaporin-4 (AQP4) antibodies were detected in 16 cases . There were 42 cases with abnormal VEP (visual evoked potential) and 26 cases with abnormal Orbital MRI (Magnetic Resonance Imaging) .Conclusion Neuromyelitis optica is more common in female patients with the age between 20-30 years .The most com-mon initial symptom is bilateral optic neuritis ,the vast majority of patients were associated with spinal cord pathological signs , most of them are accord with the criteria of NMO with the disease development .MRI was not as sensitive as VEP .The positive of anti-AQP4 antibodies are important both for the diagnosis and prognosis .%目的 观察中国人视神经脊髓炎的起病情况及临床特点,提高对该病的认识.方法 回顾性分析2012-01—2016-09河南省人民医院收治的56例视神经脊髓炎患者发病情况及临床表现、治疗结果 ,包括性别、年龄、诱因、疾病特征及实验室和影像学检查.结果52例患者确诊为视神经脊髓炎,4例高度怀疑视神经脊髓炎;单次发病者24例,二次复发者14例,三次以上者18例;20例患者首发症状为眼部视神经炎,7例首发症状为四肢感觉或肌力异常,5例首发症状是呕吐或发热,剩余病例两者或三者同时出现.男女发病比例为11:45,年龄20～30岁者居多.具有眼部症状的患者中,双眼累及与单眼累及的比例为36:14;磁共振检查发现12例头颅异常改变,40例视神经异常改变,46例脊髓异常改变;实验室血清免疫指标异常者18例,NMO-IgG阳性者16例;我院首诊患者中视觉诱发电位检查异常35例,磁共振检查阳性26例.结论 视神经脊髓炎多见于女性,高发年龄为20～30岁,最常见的首发症状是双眼视神经炎,同时伴有脊髓病理体征,随病程进展绝大部分可符合视神经脊髓炎的诊断,视觉诱发电位较眼眶MRI具有更高敏感性,NMO-IgG阳性对其诊断及预后均有重要意义.