多发性硬化症的病程、诊断和治疗特点

O. Potapov, Oleksiy Kmyta, O. Tsyndrenko, Iryna Makeyenko, Kateryna Sumtsova, Yana Nikolaenko
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摘要

介绍。多发性硬化症(Multiple sclerosis, MS)是一种慢性进行性中枢神经系统疾病,以神经纤维脱髓鞘和变性为特征,临床表现多形性,并有不良病程倾向[1]。该病通常影响年轻人和工作年龄人群,导致早期残疾和生活质量差,这使其成为我们这个时代的一个重大社会问题[2]。主要目的是通过对发病和病程的临床-神经学、精神诊断和神经影像学特征的综合分析,提高多发性硬化症患者的诊断和治疗效率。材料与方法:采用功能系统评分(FSS)和扩展残疾状态量表(EDSS)对患者进行临床和神经学检查;认知功能测验采用简易心理状态测验(MMSE)、钟画测验、五字测验;脑磁共振成像;36项简短健康调查(SF-36)据统计,全球约有300万多发性硬化症患者。在乌克兰,大约有2万人患有多发性硬化症。目前有一种假设认为多发性硬化症是一种多因素疾病,在很大程度上与遗传易感性(即免疫反应的特点)和外界因素的影响有关[1]。多发性硬化症主要影响12至55岁的年轻人和成年人。虽然多发性硬化症有时会在青春期首次出现,但随着年龄的增长,发病率逐渐增加,直到30岁左右,随后下降到50-60岁[3]。最近,观察到多发性硬化症有复元的趋势。大约3%的多发性硬化症患者是16岁以下的儿童。出现于较晚年龄的多发性硬化症没有得到充分的研究,也很少被诊断出来,尽管在大约20%的患者中,这种病理的第一个迹象出现在40岁以后[4,11]。
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PECULIARITIES OF THE COURSE, DIAGNOSIS, AND TREATMENT OF MULTIPLE SCLEROSIS
Introduction. Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system, which is characterized by demyelination and degeneration of nerve fibers and has a polymorphic clinical picture and a tendency to an unfavourable course [1]. The disease usually affects young and working-age people, leading to early disability and poor quality of life, which makes it a socially significant problem of our time [2]. The main objective was to increase the efficiency of diagnosis and treatment of patients with multiple sclerosis based on a comprehensive analysis of clinical-neurological, psychodiagnostic, and neuroimaging features of the onset and course of the disease. Materials and Methods: Clinical and neurological examination of patients using the Functional System Score (FSS) and Expanded Disability Status Scale (EDSS); cognitive functions examination using the Mini-Mental State Examination (MMSE), the clock-drawing test, the five-word test; brain magnetic resonance imaging; the 36-Item Short Form Health Survey (SF-36). According to statistics, there are about 3 million patients with multiple sclerosis worldwide. In Ukraine, about 20,000 people have multiple sclerosis. Currently, a hypothesis has been made about multiple sclerosis as a multifactorial disease that is, to a great extent, attributable to genetic predisposition (i. e., features of the immune reaction) and the influence of external factors [1]. Multiple sclerosis mainly affects young and mature people – 12 to 55 years old. Although multiple sclerosis can sometimes make its debut in puberty, however, the frequency of the disease gradually increases with age up to the middle of the third decade of life, with a subsequent decrease up to the age of 50–60 [3]. Recently, a trend toward the rejuvenation of multiple sclerosis has been observed. About 3% of all patients with multiple sclerosis are children under 16. Multiple sclerosis debuting at a later age is not sufficiently studied and is rarely diagnosed, although in about 20% of patients, the first signs of this pathology appear after age 40 [4, 11].
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