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目的探讨内因子抗体和,或抗胃壁细胞抗体对脊髓亚急性联合变性(Subacute combined degeneration of spinal cord,SCD)的诊断价值。方法回顾性分析宣武医院2014年8月至2015年1月收治的8例内因子抗体和(或)抗胃壁细胞抗体阳性患者的临床资料、血清维生素B_(12)、血红蛋白和血同型半胱氨酸、神经电生理及影像学资料结果。结果 8例患者均为亚急性或慢性起病,进行性加重,仅有3例出现了典型的脊髓后索、侧索和周围神经均受累的体征;血清维生素B_(12)低于正常者5例;血红蛋白低于正常者2例;同型半胱氨酸高于正常者4例。4例患者行肌电图神经传导速度检查,均提示肢体周围神经损害;脑脊髓MRI异常者4例。内因子抗体及抗胃壁细胞抗体均阳性者3例,仅内因子抗体阳性者3例,仅抗胃壁细胞抗体阳性者2例。8例患者均给予维生素B_(12)1000μg/d肌肉注射,1个月后对其进行随访,症状均有不同程度好转。结论有不完全脊髓后索、侧索、周围神经受累表现的患者,应该考虑到SCD可能,即便是脊髓影像学和血清维生素B_(12)水平正常,也应该进行血内因子抗体和抗胃壁细胞抗体检查。内因子抗体和(或)抗胃壁细胞抗体阳性SCD患者需要长期肌肉注射维生素B_(12)进行治疗。
Objective To investigate the diagnostic value of endogenous and / or parietal cell antibodies for subacute combined degeneration of spinal cord (SCD). Methods The clinical data of 8 patients with antibody positive and / or gastric parietal cell antibody positive who were treated in Xuanwu Hospital from August 2014 to January 2015 were analyzed retrospectively. Serum vitamin B 12, hemoglobin and blood homocysteine Acid, neuroelectrophysiology and imaging results. Results All 8 patients were subacute or chronic with progressive exacerbations. Only 3 cases showed typical signs of spinal cord posterior, lateral and peripheral nerves. Serum vitamin B 12 was lower than normal 5 Cases; hemoglobin lower than normal in 2 cases; homocysteine higher than normal in 4 cases. Four patients underwent EMG nerve conduction velocity examination, all showed limb nerve injury; abnormalities of brain spinal cord in 4 cases. 3 were positive for both internal factor antibodies and gastric parietal cell antibodies, 3 were positive for endogenous antibody alone, and 2 were positive for anti-parietal cell antibodies only. Eight patients were given vitamin B_ (12) 1000μg / d intramuscular injection, 1 month after follow-up, the symptoms were improved to varying degrees. Conclusion In patients with incomplete posterior spinal cord, lateral cord and peripheral nerve involvement, SCD may be considered. Even if spinal cord imaging and serum vitamin B 12 levels are normal, serum factor and anti-gastric parietal cells should be considered Antibody test. Long-term intramuscular injection of vitamin B 12 is required for the treatment of patients with positive SCD and / or anti-parietal cell antibodies.