| Objective: To analyze and summarize the clinical characteristics of 68 patients with subacute combined degeneration of the spinal cord(SCD)in order to improve the diagnostic level of SCD.Methods: The clinical data of 68 patients with SCD diagnosed in our hospital from September 1,2011 to September 1,2017 were retrospectively analyzed.The demographic data,blood routine,anemia,VitB12 level,folic acid level,homocysteine(HCY)level,imaging examination and neuroelectrophysiological examination were analyzed statistically.SPSS22.0statistical software was used for data analysis: Counting data were expressed as constituent ratio(%)and the differences between groups were processed by?2 test.The measurement data were expressed as mean(sx ±).The differences between the two groups were compared and processed by t test.There was no statistical significance in the analysis of the differences;Pearson correlation coefficient of two variables was calculated by Pearson correlation analysis.P < 0.05 had statistical difference,P < 0.01 had significant statistical difference.The clinical characteristics of SCD patients were analyzed and summarized to improve the diagnostic level of SCD.Results: Among 68 SCD patients,74%(50/68)were male and 26%(18/68)were female.The age group accounted for 45.6% of the patients,followed by the elderly group(44.1%)and the younger group(10.3%).There was no significant difference in age distribution between male and female patients(?2=1.412,P=0.461).The proportion of peasants occupied the highest(57.35%),followed by freelancers(16.18%).Other occupations included workers(11.76%),retirees(7.35%),in-service cadres(4.41%)and in-service teachers(2.94%).There were significant differences among different occupations(?2=5.801,P<0.05).In the study,there were 41 patients withinducements,the most of which were gastrointestinal diseases(34.15%),the rest were long-term drinking(26.83%),vegetarians(29.27%)and fasting(9.76%).There was no significant difference in the distribution of Different Inducements(?2=1.415,P=0.614).Considering the various inducements of SCD.The main clinical manifestations of SCD nervous system were dizziness in 3 cases(4.41%),limb weakness in 2 cases(2.94%),limb numbness in 8cases(11.76%),limb numbness with walking instability in 5 cases(7.35%),bilateral lower limb weakness in 6 cases(8.82%),bilateral lower limb numbness in 12 cases(17.65%),walking instability in 9 cases(13.24%)and bilateral lower limb weakness with walking instability in 23 cases(33.82%).According to the composition ratio,the manifestations of weakness of both lower limbs with walking instability were mostly,but there was no statistical difference between the clinical manifestations(?2=1.352,P=0.524).There were 39 cases(57.4%)in the lowered plasma VitB12 level group,with an average of(83.49±32.5)pmol/L;29 cases(42.6%)in the non-lowered group,with an average of(372.56±195.14)pmol/L.The results of independent t-test showed that there were significant differences in RBC and HGB levels between the two groups(P<0.05),but no significant differences in HCT and MCV levels(P>0.05).Folic acid increased in 19 cases(27.9%)with an average of(39.20±6.38)nmol/L.Among them,40 cases(58.8%)were normal,with an average of(14.60±3.71)nmol/L,9 cases(13.2%)were decreased,with an average of(5.79±1.75)nmol/L,and 40 cases(58.8%)were increased with HCY,with an average of(88.30 ± 77.94)umol/L.Among them,28 cases(41.2%)were normal,with an average of(10.41 ±1.48)umol/L.There was a negative correlation between plasma VitB12 level and folic acid level and high HCY level in 0 cases(P<0.05).36 cases(76.6%)had peripheral nerve damage and 12 cases(25.5%)had abnormal SCV.There were 8 cases(17%)with abnormal MCV,14 cases(29.8%)with abnormal MCV and SCV.There were2 cases(4.3%)with abnormal EMG of the needle pole,and there was no statistical difference among the involved nerves in the electromyogram of the needle pole(?2=1.456,P=0.429);24 cases(35.3%)with posterior cord lesionsand 22 cases(32.35%)with lateral cord lesions.The cervical spine was examined by MRI in 59 cases,17 cases(28.8%)were abnormal,8 cases(13.6%)were posterior cord lesions,5 cases(8.5%)were posterior cord lesions with lateral cord lesions,and 46 cases(77.9%)were normal.There were 51 cases of thoracic vertebra examined by MRI,24 cases(47.1%)were abnormal,16 cases(31.3%)were posterior chordae lesions,17 cases(33.3%)were posterior chordae lesions combined with lateral chordae lesions.18 cases(35.3%)were normal.No lesion was found in 18 cases of lumbar spine by MRI.There was a significant difference between the involved parts of spinal cord(?2=5.806,P<0.05).Cervical and thoracic spinal cord involvement was the most common.Conclusion:1.The majority of SCD patients are farmers.Considering the relative unequal economic level,unbalanced dietary structure and poor awareness of healthy diet of some farmers,vitamin B12 deficiency is caused and eventually the disease occurs.Therefore,good economic conditions and reasonable diet structure play a certain role in the prevention of SCD;2.History of gastrointestinal diseases,long-term vegetarian diet and long-term anemia are the main causes of SCD;3.The increase of serum homocysteine level is an indicator of VitB12 deficiency.Serum homocysteine level can be used as a more sensitive laboratory indicator for the diagnosis of SCD;4.Needle electromyography can detect abnormal changes of peripheral nerves earlier and play a major role in the diagnosis of SCD;5.Spinal MR imaging can determine the location and extent of SCD.Spinal cord lesions in SCD were mainly in the upper thoracic spinal cord,followed by the lower cervical spinal cord,first in the posterior cord and then in the lateral cord;6.For the diagnosis of SCD,we need to combine the inducement of SCD,the decrease of VitB12 concentration,the increase of homocysteine concentration,deep sensory pathway conduction disorder and MRI examination. |
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