摘要
目的 报道COVID-19(新冠病毒)感染后急性脊髓炎的临床,影像及治疗效果。方法 收集5例复旦大学附属华山医院2022年12月至2023年3月收治的临床诊断为新冠病毒感染后急性脊髓炎患者的临床和影像学资料以及药物治疗反应。统计(截至2023年2月10日)Pubmed及万方数据库新冠病毒感染后急性脊髓炎病例的临床信息并结合文献进行回顾分析。结果 5例患者中,男性4例、女性1例,年龄38~85岁。3例患者脑脊液白细胞升高,以淋巴细胞为主,脑脊液寡克隆区带均阴性;2例患者24 h鞘内合成率增加。MRI检查发现有脊髓病灶2例,无病灶3例;经免疫治疗后,3/4例改善、1/4例无明显改善、1例未接受免疫治疗。回顾47篇新冠病毒感染后脊髓炎的相关文献,共纳入53例患者,平均发病年龄(47.61±18.40)岁。潜伏期1 d至3~4个月,中位数10 d。男性57.69%,女性41.51%。75.47%(40/53例)有肢体无力、感觉障碍和尿便功能障碍的脊髓病变三联征。MRI检查示84.91%(45/53例)有脊髓异常信号。经免疫治疗后81.13%(43/53例)有不同程度改善,9.43%(5/53例)完全改善,1.9%(1/53例)预后不详,7.55%(4/53例)未改善,9.43%(5/53例)死亡。结论 新冠病毒感染后急性脊髓炎以长节段脊髓病变为主,有少部分患者为短节段及无病灶。早期免疫治疗及积极的康复治疗有助于改善预后。
AimTTo report the clinical,imaging and therapeutic effects of acute myelitis after COVID-19 virus infection in 5 cases,and to analyze them with literature reviews.Methods Clinical data,imaging data and treatment response were collected from patients with acute myelitis after COVID-19 virus clinically diagnosed at Huashan Hospital,Fudan University from December 2022 to March 2023.The clinical information of cases of acute myelitis after COVID-19 virus infection in PubMed and Wanfang databases were counted and analyzed up to February 10,2023.Results Five patients were reported in this study,four males and one female,aged 38-85 years,elevated cerebrospinal fluid leukocytes were found in three patients with lymphocytes predominance.Oligoclonal band was negative,and 24-hour intrathecal synthesis was elevated in two patients.MR showed spinal cord lesion in two cases and no lesion in three cases.One patient improved without immunotherapy,three of the four patients treated with immunotherapy improved,and one case showed no significant improvement.A total of 53 patients with a mean age of onset of 47.61±18.40 years were included in 47 articles related to post-COVID-19 myelitis,with the incubation period ranged from 1 day to 4 months,and a median of 10 days.Males accounted for 57.69%and females for 41.51%.75.47%(40/53)had myelopathy triad of limb weakness,sensory disturbance,urinary and stool dysfunction.On MR,84.91%(45/53)had abnormal signals in the spinal cord and 15.09%(8/53)had no abnormal signals.After immunotherapy,81.13%(43/53)had varying degrees of improvement(16.28),9.43%(5/53)had complete improvement,1.9%(1/53)had an unknown prognosis and 7.55%(4/53)had no improvement,9.43%(5/53)died.Conclusion Acute myelitis after COVID-19 virus infection is predominantly characterized by longsegment spinal cord lesions,with a small number of patients with short-segment even no lesions.Early immunotherapy and aggressive rehabilitation may improve outcome.
作者
麻姣姣
奚剑英
孙一忞
杨仕林
李虹岐
赵重波
MA Jiao-jiao;XI Jian-ying;SUN Yi-min;YANG Shi-lin;LI Hong-qi;ZHAO Chong-bo(Department of Neurology,Xi'an Gaoxin Hospital,Xi'an 710075,China;Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China)
出处
《中国临床神经科学》
2023年第4期418-424,431,共8页
Chinese Journal of Clinical Neurosciences
作者简介
麻姣姣,硕士研究生,主治医师,主要从事神经肌肉疾病,神经免疫性疾病的相关研究;通信作者:赵重波,E-mail:zhao_chongbo@fudan.edu.cn。
