| Subjects and methods:We collected 52 inpatients, all diagnosed with ATM in accordance with 2002 TMCWG criteria, in department of Neurology of China-Japan Union Hospital of Jilin University during February 1st, 2010 to November 30 st, 2015.All of patients were divided into 4 groups according to causes; 28 cases were idiopathic ATM(IATM), 10 cases were MS related-ATM(MS-ATM), 12 cases were NMO related-ATM(NMO-ATM), 2 cases were other type of ATM. 39 of all cases were first onset ATM.We reviewed the clinical data(demographic, clinical manifestations, laboratory tests and imaging findings)for all the 52 cases, and analyzed clinical feature of every subgroup patients. Data about clinical outcome, long-term disability and relapse frequency of 39 first onset ATM patients were collected by follow-up method through medical records and telephone calls.The mean of measurement data with normal distribution were compared by t test(two independent samples)or one-way ANOVA test(multiple samples);Measurement data without normal distribution were compared by Wilcoxon rank sum tests. Ratio Was analyzed by chi-square tests. P<0.05 is considered as statistical significance. P<0.01 is considered as significant statistical significance. All of statistical analysis was accomplished on SPSS 22.0 software.Result:1.Comparison of clinical features in IATM, MS-ATM and NMO-ATM:Three groups had no statistically significant difference in gender, whereas MS-ATM and NMO-ATM group had female predominance. AQP-4 positive rate in NMO-ATM group was significantly higher than IATM and MS-ATM groups, and the difference has statistical significance. The signs of IATM group often had the symmetry, but the signs of MS-ATM and NMO-ATM group had the asymmetry, andthe difference has statistical significance; Although all the three groups had CSF oligoclonal bands positive cases, the positive rate of MS-ATM group was obviously higher than that of the rest of the two groups; Although all the three groups had spinal cord lesions longer than 3 spinal segments, the spinal cord lesions of NMO-ATM group were longest. The peak incidence of IATM group patients is between 36 to 45 years old in this study, none of them lies in the peak incidence between 10 and 19 years old.2. Clinical outcomes and prognosis of 39 first onset ATM patients:Clinical outcomes analysis: 39 first onset ATM patients were followed up.16(41.03%)patients had no relapses, 12(30.77%) patients had relapses, 4(10.26%)patients developed to MS, 7(17.95%) patients developed to NMO.The prognosis of first onset ATM with different outcomes: m-IATM, NMO group had worst recovery during hospitalization, meanwhile r-IATM, MS group had better recovery during hospitalization; r-IATM group get best long-term disability, MS and NMO had worst long-term disability. Total relapse events in NMO group were greatest. r-IATM group were least.3. The clinical features of other types of ATM:One case was ATM patient with SLE, who had spread spinal cord lesions, severe symptoms and poor recovery. One case of tuberculous radiculomyelitis complicating tuberculous meningitis, had specific clinical featureand CSF changes and radicular pain.Conclusion:1.Although there are many similarities in pathogenesis, clinical manifestation,auxiliary examination between IATM, MS-ATM and NMO-ATM groups, the difference of sex, serum AQP-4, CSF oligoclonal bands and spinal cord MRI may help.2.First onset ATM patients have different clinical outcomes. Prognosis is distinct in first onset ATM with different outcomes. |
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