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目的评价急性播散性脑脊髓炎(ADEM)的诊断与治疗。方法对47例符合诊断标准的 ADEM 的临床特征、实验室及 MRI,以及单用甲基强的松龙(MPPT)组和甲基强的松龙+丙种球蛋白(IVIG)组之间的疗效关系进行分析。结果 47例ADEM 中有29例(61.7%)有先驱感染性疾病,服驱虫药4例(8.51%),不明原因14例(29.79%),症状和体征数天之内进展达高峰。认知功能损害为最常见的症状,有26例(55.32%)。MRI 最常见双侧脑白质不对称类圆形病灶,而深部脑灰质核团亦见累及。单用甲基强的松龙治疗与甲基强的松龙联用丙种球蛋白两组之间的疗效有显著差异。结论 ADEM 是一种急性中枢神经系统脱髓鞘疾病。MRI 是诊断 ADEM 的重要手段,大剂量应用皮质激素与丙种球蛋白可取得较好的疗效。
Objective To evaluate the diagnosis and treatment of acute disseminated encephalomyelitis (ADEM). Methods The clinical features of 47 ADEM-matched diagnoses, laboratory and MRI, and the efficacy of methylprednisolone (MPPT) and methylprednisolone + gammaglobulin (IVIG) groups were compared Relationship analysis. Results Among the 47 ADEs, 61 (61.7%) had pioneer infectious diseases. Among them, 4 (8.51%) were anthelmintic agents and 14 (29.79%) had unexplained causes. The symptoms and signs peaked within several days. Cognitive impairment is the most common symptom, 26 cases (55.32%). MRI is the most common bilateral white matter asymmetry round lesions, while deep gray matter nuclei also see involvement. There was a significant difference between the two groups in the treatment of methylprednisolone alone and in combination with methylprednisolone. Conclusion ADEM is an acute central nervous system demyelinating disease. MRI is an important means of diagnosis of ADEM, high-dose corticosteroids and gamma globulin can achieve better results.