中国多发性硬化临床特点及诊断难点分析

doi:10.3969/j.issn.1006-7795.2021.03.004

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (3): 360-366.doi: 10.3969/j.issn.1006-7795.2021.03.004

中国多发性硬化临床特点及诊断难点分析

刘翕然¹, 徐雁², 王维治³, 王丽华³, 张美妮⁴, 李春阳⁵, 董会卿⁶, 李国忠⁷, 刘洪波⁸, 付锦³, 金涛⁹, 管阳太¹⁰, 檀国军¹¹, 郭力^11*, 张星虎^1*

1.首都医科大学附属北京天坛医院神经病学中心神经感染与免疫病区,北京 100070;
2.北京协和医院神经内科,北京 100140;
3.哈尔滨医科大学附属第二医院神经内科,哈尔滨 150001;
4.山西医科大学第一医院神经内科,太原 030001;
5.内蒙古医科大学附属医院神经内科,呼和浩特 010030;
6.首都医科大学宣武医院神经内科,北京 100053;
7.哈尔滨医科大学附属第一医院神经内科,哈尔滨 150007;
8.郑州大学第一附属医院神经内科,郑州 150007;
9.吉林大学白求恩第一医院神经内科,长春 130031;
10.上海交通大学医学院附属仁济医院神经内科, 上海 200001;
11.河北医科大学第二医院神经内科, 石家庄 050061

收稿日期:2021-03-01 出版日期:2021-06-21 发布日期:2021-06-16
通讯作者: *E-mail:guoli6@163.com;xhzhtiantan@hotmail.com
基金资助:
北京市自然科学基金(7212029)。

Clinical features and difficulties in diagnosis of multiple sclerosis in China

Liu Xiran¹, Xu Yan², Wang Weizhi³, Wang Lihua³, Zhang Meini⁴, Li Chunyang⁵, Dong Huiqing⁶, Li Guozhong⁷, Liu Hongbo⁸, Fu Jin³, Jin Tao⁹, Guan Yangtai¹⁰, Tan Guojun¹¹, Guo Li^11*, Zhang Xinghu^1*

1. Department of Neuroimmunology and Neuroinfectious Diseases, Neurology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;
2. Department of Neurology, Peking Union Medical College Hospital, Beijing 100140, China;
3. Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, China;
4. Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan 030001, China;
5. Department of Neurology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, China;
6. Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
7. Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150007, China;
8. Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 150007, China;
9. Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun 130031, China;
10. Department of Neurology, Renji Hospital, Medical School, Shanghai Jiaotong University, Shanghai 200001, China;
11. Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050061, China

Received:2021-03-01 Online:2021-06-21 Published:2021-06-16
Contact: *E-mail:guoli6@163.com;xhzhtiantan@hotmail.com
Supported by:
Natural Science Foundation of Beijing (7212029).

摘要/Abstract

摘要： 目的总结中国多发性硬化(multiple sclerosis,MS)的临床特点以及诊断难点。方法基于中国多发性硬化调研项目结果,回顾性分析557名多发性硬化患者。分组对比人口学特征、临床特点、扩展残疾状况评分量表评分(Kurtzke Expanded Disability Status Scale,EDSS)、诊断类型、发病后就诊及确诊时间等。结果 557名患者中,女性与男性比例为2.09∶1,平均发病年龄为(34.9±11.2)岁。平均病程(66.8±61.5)个月。复发缓解型多发性硬化(relapsing-remitting multiple sclerosis, RRMS)是主要诊断类型(69.3%)。最常见的临床表现为运动症状(62.1%)。EDSS评分中位数2.5分。发病频率集中在每年发作1次(23.9%)和每2~4年发作1次(21.9%)。83.9%的患者在发病后立即就诊,发病到就诊的平均时间为(0.28±1.11)年。55.1%的患者首次就诊即确诊,首诊到确诊的平均时长为(0.91±2.36)年。与RRMS相比,进展型MS的病程长度、感觉症状、括约肌障碍比例及EDSS显著增加。结论中国人群MS的临床特点与高加索人种部分相似,如发病年龄、性别、症状构成及比例,同时中国人群MS也具有自己的特征,如较低的RRMS比例、较低的疾病严重程度。对于多发性硬化这种疾病的知晓率低、发病后未及时就诊、首次发作不能确诊是诊断的难点,今后需通过提高普通人群和基层医生对MS的认识来缩短就诊及确诊时间。

关键词: 多发性硬化, 临床特点, 诊断

Abstract: Objective To summarize the clinical features and diagnostic difficulties of multiple sclerosis(MS) in China. Methods Totally 557 patients with MS were retrospectively studied, and the data including analyzed demographic characteristics, clinical characteristics, Kurtzke Expanded Disability Status Scale (EDSS) score, diagnosis type, diagnosis time were collected and analyzed. Results Among the 557 patients, the ratio of female to male was 2.09∶1. The average age of onset was (34.9±11.2) years. The mean duration of disease was (66.8±61.5) months. Relapsing-remitting multiple sclerosis (RRMS) was the main subtype (69.3%). The most common clinical manifestation was motor symptoms (62.1%). Median EDSS score was 2.5. The recurrence frequency was one episode per year in 23.9% patients and one episode in 2 to 4 years in 21.9% patients. 83.9% patients visited the doctor immediately after the onset of the disease, and the average time (0.28±1.11) years. 55.1% patients were diagnosed at their first visit, and the average time being diagnosed was (0.91±2.36) years. Compared with RRMS, the duration, sensory symptoms, sphincter dysfunction and EDSS of progressive MS were significantly increased. Conclusion The clinical characteristics of MS in Chinese population are partly similar to those of Caucasians, such as the age of onset, gender ratio, the composition and proportion of symptoms. Meanwhile, MS in Chinese population showed its own characteristics, such as a lower RRMS proportion and a milder disease severity. The time to diagnosis is still slightly longer than that in some western countries. It is necessary to reduce the time to diagnosis by raising the awareness of the general population and primary care doctors about MS.

Key words: multiple sclerosis, clinical characteristics, diagnosis

中图分类号:

R741.04

刘翕然, 徐雁, 王维治, 王丽华, 张美妮, 李春阳, 董会卿, 李国忠, 刘洪波, 付锦, 金涛, 管阳太, 檀国军, 郭力, 张星虎. 中国多发性硬化临床特点及诊断难点分析[J]. 首都医科大学学报, 2021, 42(3): 360-366.

Liu Xiran, Xu Yan, Wang Weizhi, Wang Lihua, Zhang Meini, Li Chunyang, Dong Huiqing, Li Guozhong, Liu Hongbo, Fu Jin, Jin Tao, Guan Yangtai, Tan Guojun, Guo Li, Zhang Xinghu. Clinical features and difficulties in diagnosis of multiple sclerosis in China[J]. Journal of Capital Medical University, 2021, 42(3): 360-366.

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中国多发性硬化临床特点及诊断难点分析

Clinical features and difficulties in diagnosis of multiple sclerosis in China

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