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早发型和晚发型多发性硬化的临床特点分析

  • 摘要: 目的 探讨早发型多发性硬化(EOMS)和晚发型多发性硬化(LOMS)的临床特点。方法 收集临床确诊为多发性硬化(MS)患者的临床资料,对EOMS和LOMS患者进行随访,分析EOMS和LOMS患者一般状况、临床表现、临床分型、不同时期扩展残疾功能状态量表(EDSS)评分、影像学表现及治疗情况。结果 EOMS患者25例和LOMS患者20例纳入分析。首发表现中EOMS组主要表现为感觉障碍和视力障碍,LOMS组主要表现为运动障碍;临床分型EOMS组以复发缓解型为主,LOMS组以原发进展型为主;两组患者目前恢复情况与急性期残疾程度(即EDSS评分)、病程长短无相关性;首次发病时采用大剂量激素冲击治疗后EOMS组缓解率明显高于LOMS组。结论 EOMS和LOMS在临床表现和发病类型上有不同的特点,但更深层次的结论尚需大规模的临床研究证实。

     

    Abstract: 【Abstract】 Objective To determine the clinical value of dual-source CT angiography (DSCTA) in the diagnosis of postoperative aortic intramural hematoma (AIMH) in patients with endovascular stent-graft exclusion (EVE) surgery. Methods Between Oct 2008 and May 2013, thirty-six patients were diagnosed with AIMH by DSCTA, and 12 of these patients with type B underwent EVE. The 12 patients were followed up with DSCTA, which included imaging reconstruction (multi-plane reconstruction, MPR), maximum intensity projection (MIP) and volume rendering technique (VRT). The extent and type of AIMH, aortic ulcers and the outcomes and complications of AIMH were observed. Results The 36 cases of AIMH included 11 Stanford type A and 25 type B. No tearing intimal flap or contrast materials within the hematoma were observed. The maximum aortic diameter of the hematoma areas varied from 3.8 to 5.4 cm (average 4.3 cm) and the maximum thickness of the hematoma ranged from 0.5 cm to 1.3 cm (average 0.9 cm). The ratio between the minimum and the maximum diameter of the aortic lumen in the hematoma areas ranged from 0.74 to 0.98 (average 0.85). Aortic ulcers were revealed in 3 patients with type A AIMH and 8 patients with type B AIMH. Intimal tearing of distal abdominal aorta was found in 3 patients with type B AIMH. In the 12 patients underwent EVE surgery, hematoma shrank in all cases with 4 cases almost resolving and aortic ulcers in the area of stent-graft exclusion disappeared in 3 cases. The form of stent-graft appeared normal in 9 cases and slightly abnormal in 3 cases. Fluent main branches of aortic arch and none existence of stent endoleaking were observed. Conclusion DSCTA with handy, effective and non-invasive advantages is one of the important imaging methods in the diagnosis of AIMH in patients with EVE surgery.

     

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