视神经脊髓炎临床特点分析

目的分析视神经脊髓炎患者的发病过程，以减少临床误诊和漏诊。方法回顾性分析2000年1月-2008年10月解放军总医院收治的36例视神经脊髓炎患者的临床资料，对患者的性别、年龄、首发症状、脊髓炎和视神经炎的体征以及误诊情况进行分析总结。结果21例患者首发症状为眼部视神经炎。36例患者中，双眼发病与单眼发病的比例为7：2，男女发病比例为1：3，年龄30～50岁者居多。视神经炎病程在1～3个月的患者中视神经萎缩的发病率为72．7％，病程〉3个月的患者中视神经萎缩的发生率为91．4％。病程在1～3个月和〉3个月组视神经萎缩的发病率均明显高于病程〈1个月组（P=0．009，P〈0．01）。2例无眼部表现的患者经视觉诱发电位（VEP）检查后确诊。22例磁共振检查结果显示，颈髓异常者14例（63．3％），胸髓异常者9例，腰髓异常者1例。结论视神经脊髓炎多见于女性，首发症状为视神经炎者占多数，高发年龄为30～50岁，易累及双眼，视神经萎缩发生率高。脊髓炎症以累及颈髓和胸髓较常见。

Clinical characteristics of Devic's disease

Background Neuromyelitis optica,term of Devic's disease,is characterized by the symptoms of both optic neuritis and myelitis.In clinic,misdiagnosis rate of neuromyelitis is too high to ignore because of the unsynchronous exsist of both optic neuritis and myelitis.Objective This study aims to analyze the clinical characteristics of Devic's disease in order to reduce the misdiagnosis rate.Methods Thirty six patients diagnosed as Devic's disease in General Hospital of PLA from January 2000 through October 2008 were included in this study.The clinical data including sex,age,initial events,clinical signs of optic neuritis and myelitis,misdiagnosis status were analyzed.Results The 21 patients showed the initial events of eye and were diagnosed as neurititis.In all of the 36 patient,the ratio of the patients was from 30 to 50 years.The prevalence of atrophy of optical nerve within 1-3 months was 72.7% and that of above 3 months was 91.4% in these patients.The incidence rate was obviously increased in 1-3 months course group (χ~2=7.59,P=0.009) and ＞3 months course group(χ~2= 20.29,P＜0.001) in comparison with ＜1 month course group.Two patients without clinical signs were determined the diagnosis by visual evoked potential.In 22 patients received magnetic resonance imaging of spinal cord,the lesions of 14 patients located in cervical cord and that of 9 patients was in thoracic cord and only 1 patient in lumbar cord.Conclusion Devic's disease is more common in female patients with the age between 30-50 years.Most patients visit ophtalmologist firstly due to initial events of eye.Occurrence of optic atrophy is associated with disease course.MRI suggest that the lesions of spinal cord are often in cervical cord and thoracic cord.