摘要
目的:探索肌萎缩侧索硬化症(ALS)发病的危险因素与起病部位的关系,为该病的早期诊断提供新思路。方法:选取复旦大学附属华山医院神经内科2000至2010年出院诊断为ALS患者57例,回顾性分析患者的临床资料及相关危险因素。根据不同的起病部位分为延髓起病组、颈段起病组、腰段起病组。通过单因素/多因素回归方法分析比较各组间的基本资料、危险因素与起病部位之间的关系。结果:57例患者的平均发病年龄为(51.3±13.2)岁,发病至首次诊断的平均时间为18个月。ALS功能分级量表评定可以衡量疾病对患者生活能力的影响以区分病程,所有患者的平均得分为37.0分,不同起病部位组间差异无统计学意义。单因素分析表明,颈段起病组患者年龄较另2组的患者小,最早出现肉跳症状,且实验室检查结果提示乳酸脱氢酶和肌酸激酶水平较高。发病至诊断所需时间最短的是延髓起病的患者。经ANOVA多因素分析得出,不同起病部位的ALS患者,其发病年龄及出现肉跳症状的时间有所差别。结论:不同起病部位ALS患者的临床表现、病程和实验室检查结果有一定差异,对其充分认识将有助于早期诊断。
Aim： To explore the clinical features of amyotrophic lateral sclerosis（ALS） patients with different onset. Methods： Data of clinical features and risk factors from 57 inpatients diagnosed as classic amyotrophic lateral sclerosis in Huashan Hospital from 2000 to 2010 were retrospectively analyzed. Subtypes were classified according to the onset region of ALS, including bulbar, arms and legs. Fisher＇s exact test were used to compare the features of ALS subtypes and multiple regression models were used based on demographic, vascular risk factors, and clinical variables. Results： The average age of onset of the 57 patients were 51.3 _＋ 13.2 years old. 19 of them have a history of trauma or surgery and 42 developed as a symmetrical way. The mean duration from onset to diagnosis was 18 months. The scores of ALS Functional Rating Scale-revised can be used to measure the effects of diseases on patients＇ ability of living. The average score of all patients was 37.0. There was no significant difference between the different groups of onset region. Patients of bulbar-onset were diagnosed earlier. Patients of arms-onset were younger and fasciculation happened earlier. In laboratory, their levels of CPK were higher than other two groups. All groups of patients were similar in ALSFRS-R, which suggested that patients of legs-onset developed more slowly. In multi-regression analysis, age and fasciculation were related to ALS subtypes. Conclusion： There are differences on clinical features of ALS with different onset, which help us to recognize ALS in early time.
出处
《中国临床神经科学》
2011年第6期616-620,共5页
Chinese Journal of Clinical Neurosciences
关键词
肌萎缩侧索硬化症
危险因素
诊断
amyotrophic lateral sclerosis
risk factor
diagnosis
