论文部分内容阅读
目的探讨腹壁反射在鉴别多发性硬化(MS)和视神经脊髓炎疾病谱(NMOSD)中的临床意义。方法收集作者医院确诊的MS(30例)和NMOSD(55例)患者的一般临床资料,并对其进行脊髓MRI、腹壁反射及巴宾斯基征检查,分析各组患者腹壁反射、巴宾斯基征以及脊髓MRI影像学特点。结果 MS患者腹壁反射正常者15例(50.0%),腹壁反射消失者7例(23.3%),巴宾斯基征阴性者12例(40.0%),NMOSD患者腹壁反射正常者5例(9.1%),腹壁反射消失者44例(80.0%),巴宾斯基征阴性者7例(12.7%),两组间比较差异均有统计学意义(均P<0.01)。视神经脊髓型多发性硬化(OSMS)患者腹壁反射减弱5例(41.7%),NMOSD患者6例(10.9%),两组间比较差异有统计学意义(P<0.05)。腹壁反射正常预测MS的特异度为90.91%(95%CI:79.29~96.60),腹壁反射减弱预测OSMS的特异度为87.67%(95%CI:77.39~93.86),腹壁反射消失预测NMOSD的特异度为76.67%(95%CI:57.30~89.37),巴宾斯基征阴性预测MS的特异度为87.27%(95%CI:74.91~94.31)。脊髓MRI分析结果提示脊髓横断面损伤越严重,越容易出现腹壁反射异常。结论腹壁反射消失提示NMOSD可能性大,腹壁反射正常提示MS可能性大,腹壁反射减弱为OSMS的可能性较NMOSD大。
Objective To investigate the clinical significance of abdominal wall reflex in differentiating multiple sclerosis (MS) and optic neuromyelitis disease spectrum (NMOSD). Methods The clinical data of MS patients (30 cases) and NMOSD (55 cases) diagnosed in our hospital were collected. The spinal cord MRI, abdominal wall reflex and Babinski’s syndrome were examined. Abdominal wall reflex, Basal signs and spinal MRI imaging features. Results Fifteen patients (50.0%) had abdominal wall reflexes in MS patients, seven patients (23.3%) had disappeared abdomen reflexes, twelve patients (40.0%) had negative Papanicolates, five patients (9.1% ), 44 cases (80.0%) with disappearance of abdominal wall reflex and 7 cases (12.7%) with negative Papanicolagia. There was significant difference between the two groups (all P <0.01). There were 5 cases (41.7%) of abdomen reflexes and 6 cases (10.9%) of NMOSD patients with optic nerve spinal cord multiple sclerosis (OSMS). There was significant difference between the two groups (P <0.05). The specificity of normal prediction of abdominal wall reflex was 90.91% (95% CI: 79.29 ~ 96.60). The specificity of OSM was 87.67% (95% CI: 77.39 ~ 93.86) Was 76.67% (95% CI: 57.30-89.37). The specificity of Papinsky’s negative predictive value was 87.27% (95% CI: 74.91-94.31). Spinal cord MRI analysis results suggest that the more serious spinal cord cross-section damage, the more prone to abdominal abnormalities. Conclusions The disappearance of abdominal wall reflex suggests the possibility of NMOSD is large, and the normal reflex of abdominal wall suggests the possibility of MS. The possibility of weaning of abdominal wall to OSMS is more than that of NMOSD.