| Objective:MSA is a sporadic neurodegenerative disease,the cause is unknown,and it accounts for the majority of middle-aged and elderly motor dysfunction diseases.The annual incidence rate of people over 50 years old is about 3/10 million,and it is on the rise.The characteristics of lethal disability severely shorten and reduce the patient’s lifespan and quality of life.In China,the MSA-C type is its main subtype,which is worthy of in-depth study.The clinical manifestations of MSA-C are diverse,mainly composed of different combinations of cerebellar motor symptoms,autonomic dysfunction symptoms,and pyramidal beam symptoms.Due to the multi-system involvement of the disease,the diagnosis in the clinic is extremely difficult.The latest progress in the diagnosis of the disease is the determination of the presence of α-synuclein in the central nervous system and cerebrospinal fluid,but the conditions of many hospital biomarker tests are limited and the economic difficulties caused by the disease to patients The problem makes it difficult to diagnose and diagnose the disease early in the clinic.Research on VNG has sprung up in recent years,and it has unique features for identifying the function of brain stem motor nuclei.Traditional Chinese medicine has been talking about "wind dysentery" since ancient times.Historically,the understanding of the etiology and pathogenesis of the disease has different opinions.The treatment and effects are uneven.Obviously improve the patient’s symptoms,but due to the strong subjectivity of traditional Chinese medicine diagnosis and treatment,and currently still lacks an objective basis for recognized efficacy.Therefore,we try to find more objective evidence from the clinical symptoms and auxiliary examinations such as VNG.Starting from the progress of the disease,we can understand and summarize the characteristics of western medicine clinical symptoms and auxiliary examinations in different stages of the disease as much as possible.Provide help for the early diagnosis and treatment of the disease.The purpose of this study is to understand the clinical symptoms and ophthalmology of traditional Chinese and Western medicine by investigating and statistically analyzing the characteristics of VNG,limb dyskinesia,pyramidal beam symptoms,autonomic nerves,cognitive function,TCM syndromes,and correlation with disease course in patients with MSA-C.The relationship between earthquakes and disease progression and the different characteristics at different stages of the disease provide early diagnosis and differential diagnosis for MSA-C patients,distinguish between primary and secondary,and establish targeted treatments to provide a reference basis,so as to intervene as early as possible to delay disease progression,Improve the patient’s quality of life.Methods:In this study,a cross-sectional study was used to collect 35 cases of MSA-C patients diagnosed in the outpatient department and ward of the department of brain diseases,Dongzhimen Hospital,Beijing University of Chinese Medicine from 2016 to 2020,which were divided into long course(36 months to 120 months)and short(2 Months to 35 months)in two groups,including 17 cases in the long course group and 18 cases in the short course group.Establish a questionnaire,collect basic data,clinical symptoms,relevant examination results(nystagmus electrocardiogram,upright tilt test,UMSARS,cognitive function),symptoms and signs of traditional Chinese medicine,and record.The data was sorted and statistical analysis was performed using SPSS 21.0 to draw conclusions.Results:1.The age range of patients with MSA-C is between 30 and 79 years old,with an average age of 59.06 ± 11.66 years old.Among the patients with the disease,the middle-aged and the elderly(77%)account for the main population,and the gender distribution in age is no obvious difference.2.All patients with MSA-C have central eye movement dysfunction,about 89%are abnormal in saccade test,and about 63%are abnormal in eye tracking eye movement response,and there is a positive correlation with the course of disease,that is,the longer the course of disease the severity and scope of nervous system damage gradually increase,making eye movement damage mediated by multiple pathways in the cerebellum,brainstem,and cerebral cortex areas more severe,and the more severe the abnormal eye tracking response.3.Use the unified multi-system atrophy assessment scale to conduct a comprehensive evaluation of dysfunction in patients with MSA-C,with an average score of 29.06 ± 10.16 points,and there is a positive correlation with the course of disease in the total score,medical history,and exercise examination.It is believed that with the extension of the course of the disease,the pathological damage is aggravated,the body’s overall function and exercise ability are worse,the scores of each part of the scale are increased accordingly,and the condition is aggravated.4.About 77%of patients with MSA-C have pyramidal beam symptoms,and the positive manifestation is significantly related to the course of disease.That is,in the early stage of the disease,the pyramidal beam signs are mostly negative,and as the course of disease prolongs and the disease progresses,the pyramidal beam the rate of positive signs gradually increased.We believe that the disease has undergone transformation of pyramidal beam signs during the course of the disease,usually from about 21 to 51 months,that is,from the middle to the late stage of the disease,the central nervous system damage has changed from the extrapyramidal system to the pyramidal system.As the disease progresses,the extrapyramidal system and the cone system are simultaneously affected,the pyramidal beam is degenerated,and pyramidal beam signs appear.5.MSA-C patients have a certain degree of autonomic dysfunction and cognitive dysfunction.Cognitive disorders mainly involve visual spatial structure,memory,and language repetition;autonomic symptoms are mainly orthostatic hypotension and urinary frequency,urgency,increased nocturia,urinary incontinence and other urinary symptoms.It is believed that the impairment of cortical function such as cognitive dysfunction in patients with MSA-C is due to the scope of the lesion involving the frontal lobe,cerebral cortex and other regions,combined with the results of VNG and pyramidal beam signs,that is,as the course of disease is prolonged,damage to the central nervous structure occurs evolution from extrapyramidal system to cone system to cerebral cortex.6.According to the statistics of TCM syndrome classification,all patients present with a deficiency syndrome,of which Yin deficiency wind dynamic syndrome accounts for the majority.It is divided into two groups of yin and yang deficiency using the eight-stage syndrome differentiation.The distribution of yin and yang syndromes has a significant correlation with the course of disease.In the early stage of the disease,patients with yang deficiency are more.Reflected in different stages of the disease,based on the change of clinical symptom group,the characteristics of syndromes have shifted from mainly Yang deficiency to Yin deficiency,and this transformation occurred in the course of 29-44 months.And Yin deficiency syndrome was significantly correlated with visual tracking eye movement response,UMSRS score,and pyramidal beam sign,that is,as the course of the disease prolonged,Yin deficiency syndrome was more prominent,the scope of lesions expanded,the degree of disease increased,motor function and eye movement function The level of obstacles has increased.Conclusion:1.MSA-C patients are more common in middle-aged and older people,males are more ill than females,and the onset time is usually between 2 and 5 years.There is no difference in the proportion of men and women at different stages of the disease course,which is a chronic progressive disease.2.Patients with MSA-C have saccades of central nervous system dysfunction such as saccade,visual tracking eye movement response,and limb movement.As the course of the disease prolongs,damage to the central nervous system affects the cone system from the extrapyramidal system,and visual tracking eye movement disorders gradually Aggravated,the limb motor function gradually increased,the UMSARS score gradually increased,and the pyramidal beam symptoms gradually increased.3.Patients with MSA-C have varying degrees of autonomic dysfunction and cognitive dysfunction.The damage to the central nervous structure involves the cerebral cortex.From about 21 to 51 months of the course of the disease,the cognitive impairment mainly involves visual spatial structure,memory,language repetition;autonomic symptoms are mainly orthostatic hypotension and urinary frequency,urinary urgency,nocturia,urinary incontinence and other urinary symptoms.4.MSA-C patients’ TCM pathogenesis is mainly based on deficiency syndrome,and Yin deficiency wind syndrome is more common.Analysis of the pathogenesis of the disease is closely related to liver and kidney,kidney is congenital,liver and kidney are homologous,and kidney essence is deficient,Insufficiency of the brain marrow,loss of the spirit,loss of the magical machine,visceral dysfunction,long-term deficiency leads to phlegm and blood stasis.With the prolongation of the course of the disease,the characteristics of the syndrome have changed from mainly Yang deficiency to mainly Yin deficiency,which occurred from 29 to 44 months of the course.And as the Yin deficiency syndrome becomes more prominent,the degree of disability of the lesion gradually increases,the abnormality of eye tracking eye movement response gradually increases,and the symptoms of pyramidal tract gradually increase. |
