CAJ | 학술논문

目的：分析脊髓亚急性联合变性的临床特点，评估不同治疗方案的效果。方法：34例 SCD 患者随机分为常规组和鞘内组,均给予常规治疗，鞘内组还予鞘内注射药物，对其临床资料及疗效进行分析。结果：32.4%（11/34）的 SCD 患者有贫血，58.8%（20/34）的患者 MCV、MCH、RDW-SD 均升高，67.6%（23/34）的患者血清VitB12水平降低，34.4%（11/32）颈髓后部斑片状或长条状异常信号，25.0%（7/28）胸髓后部有异常信号，肌电图阳性率85.7%（24/28），体感诱发电位阳性率87.0%（20/23）。治疗后2组的神经功能评分较治疗前均有明显提高（P<0.05），且鞘内组较常规组提高更显著（P<0.05）。结论：VitB12水平可以作为诊断 SCD 的有力证据， MCV、MCH 及 RDW 可以作为 SCD 诊断的参考指标。脊髓 MRI 阳性率较低；肌电图及 SEP 等检查可协助诊断。静脉补充 VitB12是治疗 SCD 的有效手段，且静脉给药联合鞘内注射治疗 SCD 疗效更为显著。
목적：분석척수아급성연합변성적림상특점，평고불동치료방안적효과。방법：34례 SCD 환자수궤분위상규조화초내조,균급여상규치료，초내조환여초내주사약물，대기림상자료급료효진행분석。결과：32.4%（11/34）적 SCD 환자유빈혈，58.8%（20/34）적환자 MCV、MCH、RDW-SD 균승고，67.6%（23/34）적환자혈청VitB12수평강저，34.4%（11/32）경수후부반편상혹장조상이상신호，25.0%（7/28）흉수후부유이상신호，기전도양성솔85.7%（24/28），체감유발전위양성솔87.0%（20/23）。치료후2조적신경공능평분교치료전균유명현제고（P<0.05），차초내조교상규조제고경현저（P<0.05）。결론：VitB12수평가이작위진단 SCD 적유력증거， MCV、MCH 급 RDW 가이작위 SCD 진단적삼고지표。척수 MRI 양성솔교저；기전도급 SEP 등검사가협조진단。정맥보충 VitB12시치료 SCD 적유효수단，차정맥급약연합초내주사치료 SCD 료효경위현저。
Objective:To analyze the clinical characteristics of subacute combined degeneration of the spinal cord (SCD),and to assess the clinical effectiveness of different therapies. Methods: Thirty-four patients diagnosed to have SCD were randomly divided into routine group and intrathecal group. The 2 groups were given routine treat-ment,and the intrathecal group was given intrathecal injection. The clinical data and effectiveness were analyzed. Results: Anemia was detected in 32.4%(11/34)patients. Increase of MCV, MCH, RDW-SD was seen in 58.8% pa-tients(20/34). Low serum levels of VitB12 were observed in 67.6% patients(23/34). Abnormal changes in the cervi-cal spinal segments on MRI was present in 34.4% patients (11/32), and abnormal thoracic signal in 25.0% patients (7/28). The decrease of nerve conduction velocity was observed in 85.7% patients (24/28). Somatosensory evoked potentials (SEP) was showed abnormalities in 87.0% patients (20/23). All the patients showed improved clinical symptoms as revealed by increased FDS scores (P< 0.05). The intrathecal group improved much better effects than the routine group (P< 0.05). Conclusion: Vitamin B12 level can be used as a powerful marker for the diagnosis of SCD. MCV, MCH and RDW can be used as references for diagnosis. Abnormal signals on MRI of the spinal cord are occasionally seen. Intravenous injection of VitB12 is effective, and intrathecal injections in combination with in-travenous administration increase the efficacy.