Clinical Analysis Of 60 Cases Of Subacute Combined Degeneration Of Spinal Cord

Objective:Through retrospective analysis,to summarized the clinical characteristics of subacute combined degeneration of spinal cord.Providing assistance for clinical diagnosis and treatment.Methods:Continuous collected the cases of subacute combined degeneration of spinal cordhospitalized in the Department of Neurology of the Second Hospital of Jilin University from November 2011 to December 2020.Record the patient’s general clinical information(age,gender,current medical history,past history,personal history,physical examination,etc.),blood routine(RBC,Hb,MCV,MCH,MCHC,PCV,RDW-CV),anemia routine,and thyroid function test,Hcy and other blood laboratory examinations,neuroelectrophysiological examinations,spinal MRI examinations.Analyze the characteristics of each index and its correlation with neurological impairment.According to their vitamin B12 levels,they are divided into normal vitamin B12 group(group A)and low vitamin B12 group(group B).Compare the characteristics of the above-mentioned index changes between A and B groups,and further analyze the correlation between serum vitamin B12 and disease diagnosis.SPSS 23.0 software was used for statistical analysis,and p<0.05 was considered statistically significant.Results:A total of 60 SCD patients were collected,including 33 males and 27 females.The average age of onset was 61.87(61.87±11.2)and the average course of disease was10.9 weeks.1.Clinical features:(1)Past and personal history characteristics:There were 23vegetarians(38.33%),18 cases(30%)with a history of alcoholism,16 cases(26.67%)with a history of stomach diseases,12 cases(20%)with a history of thyroid disease,of which 6 cases were clearly diagnosed as thyroiditis or Hypothyroidism.Past history and personal history are different between the two groups(X~2)=10.524,p=0.022),The main cause of group A is alcoholism,but in the group B is vegetarian food.(2)The clinical onset is diverse,with the main first symptoms(Figure 4.1):22 cases of limb numbness(36.7%),12 cases of limb weakness(20%),9 cases of limb numbness with weakness(15.0%),and 12 cases of simple walking instability(20%),5 cases of dizziness with numbness and weakness of limbs(8.3%).Of the 60 cases,18 cases had urinary and/or defecation disorders,4 cases had visual disturbances,5 cases had mental disturbances,only 1 case had orthostatic hypotension.Symptoms of neurological deficits are more severe when accompanied by two bowel disorders(Z=-3.324,p=0.001)。There is no difference in the form of onset between the A and B groups(X~2)=1.136,p>0.05).(3)Sensory impairment is more serious than sports injury(X~2)=37.786,p<0.001).There is no difference between A and B groups.2.Blood test:(1)There were 25 patients(41.67%)with reduced Hb levels in 60patients,of which the predominantly mild anemia(84%);21 patients(84%)with giant cell anemia;37 patients(61.66%)with lower RBC and lower PCV 32 cases(53.33%),37 cases(61.66%)with increased MCV,35 cases(58.33%)with increased MCH,and17 cases(28.33%)with increased RDW-CV.There were 31 cases with decreased RBC,increased MCV,and increased MCH at the same time.Among the 50 patients without Vit B12 supplementation,16 patients(32%)had normal Vit B12 levels(group A),and34 patients(68%)had reduced Vit B12 levels(group B);no individuals with low folate levels were found.The abnormal rates of Hcy,anti-intrinsic factor antibodies,and EPO were 73.33%,51.61%,and 25%,respectively.The abnormal rates of TSH,T3,T4 and TPOAb were 23.08%,15.38%,12.82%and 44.44%,respectively.The performance of various blood tests in SCD patients is shown in Table 3.(2)Only RDW-CV is correlated with neurological deficit score(r=-0.392,p=0.002).(3)There is a strong correlation between Vit B12 and Hcy(r=-0.667,p<0.001).(4)Spearman correlation analysis was performed between TSH,T3,T4,and TPOAb,and no statistically significant correlation was found(p>0.05)(5)The levels of RBC,Hb,hematocrit,folic acid,Vit B12,and ferritin decreased,and the levels of MCV and MCH increased.This change was statistically different between the A and B groups(see Table 4.4).3.Neuroelectrophysiological examination:Forty-one of the 60 patients underwent neuro-electrophysiological examination.A total of 460 nerves were tested,including328 motor nerves and 264 sensory nerves,all with abnormal detection results.(1)Peripheral sensory nerve damage is more common than motor nerve damage(X~2)=13.960,p<0.001)(See Table 4.5).(2)The deep sensory pathways in SCD patients are more vulnerable to damage than the shallow sensory pathways(X~2)=13.553,p<0.001)(See Table 4.5).(3)Peripheral sensory nerve damage is not different between the upper and lower limbs(X~2)=3.141,p=0.076)(See Table4.5).The deep sensory pathway is mainly damaged in the lower limbs(X~2)=21.819,p<0.001)(See Table 4.5).(4)The abnormal rate of CMAP and MNCV is statistically significant(X~2)=4.307,p=0.038)(see Table 4.6);The abnormal rate of SNAP and SNCV is also statistically significant(X~2)=23.535,p<0.001)(see Table 4.6).(5)In the comparison between the A and B groups,only motor nerve damage is different between the two groups(X~2)=5.132,p=0.023)(see Table 4.7);there is no difference between the peripheral sensory nerves and deep sensory disorders between the two groups(See Table 4.7).4.MRI examination:(1)54 of the 60 patients underwent MRI examination of the cervical spine and/or thoracic and lumbar spine.Among them,40 patients showed no obvious abnormalities,9 had atypical anti-rabbit ears,and 5 had typical Anti-rabbit ear sign,the abnormal rate of MRI results was 25.93%.The results showed that there was no significant difference between cervical spinal cord and thoracic spinal cord(X~2)=2.876,p=0.252)(see Table 4.8).(2)RBC,Hb,hematocrit,MCV,MCH,RDW-CV,EPO,and Hcy are different in the normal group and abnormal group in cervical and thoracic spinal examination,and the neurological damage is more serious in patients with abnormal nuclear magnetic field(see Table4.9).However,no relevant risk factors were found during the logistics regression analysis.(3)There was no difference in cervical and thoracic spinal cord MRI results between A and B groups(X~2)=2.209,p=0.373)(see Table 4.10).Conclusion:1.Vegetarian diet,gastrointestinal diseases,and history of drinking are the most common triggers for the onset of SCD.People with normal Vit B12 level are mainly drinking alcohol,and those with low value are mainly vegetarian.2.Regarding the lack of Vit B12 in human cells,it should be combined with changes in red blood cell parameters and blood Hcy to comprehensively determine,and cannot rely solely on serum Vit B12 levels;RDW can be used as an index to predict the severity of SCD neurological impairment.3.Electroneurophysiological examination has high sensitivity for SCD diagnosis,but relatively low specificity;MRI has low sensitivity for SCD diagnosis,but high specificity.