| Abstract | Cilj istraživanja: Cilj ovog istraživanja bio je prikazati kliničku sliku i etiologiju mijelopatija u pacijenata hospitaliziranih u Klinici za neurologiju KBC Split u periodu od 1.siječnja 2012. do 31. prosinca 2016. godine te njihove demografske karakteristike.
Materijal i metode: Provedeno je retrospektivno istraživanje koje je obuhvatilo 307 pacijenata hospitaliziranih u Klinici za neurologiju od 1.siječnja 2012. do 31. prosinca 2016. godine. Uvidom u protokol i arhivu povijesti bolesti prikupljeni su sljedeći podatci o pacijentima: osnovne demografske karakteristike (dob i spol), simptomi i znakovi bolesti, vrsta neurološkog deficita, etiologija i dijagnoza bolesti te ishod bolničkog liječenja. U statističkoj obradi korištene su metode deskriptivne statistike i Hi kvadrat (χ2 test) test.
Rezultati: Od ukupnog broja oboljelih bilo je 44,3% muškaraca i 55,7% žena. Pronađena je statistički značajna razlika u postavljanju dijagnoze mijelopatije s obzirom na spol ( P = 0,0458). Medijan dobi u kojoj se postavljala dijagnoza iznosi 52 godine (min-maks: 17-89 godina). Najčešći oblik neurološkog deficita bio je isključivo motorni neurološki ispad (37,13%) dok je najčešći obrazac motornog ispada bio parapareza (43,84%). U pogledu etiologije, od ukupnog broja ispitanika, najveći broj pacijenata (41,04%) je kao uzrok mijelopatije imao neku demijelinizacijsku bolest. Od sveukupno broja pacijenata s mijelopatijom kao posljedicom demijelinizacijske bolesti, u 91,27% pacijenata postavljena je dijagnoza multiple skleroze, u 4,76% pacijenata dijagnoza optičkog neuromijelitisa te u 3,97% pacijenata dijagnoza akutnog diseminiranog encefalomijelitisa. Medijan dobi oboljelih od demijelinizacijske mijelopatije je 37,5 godina (min-max: 17-71). Drugi najčešći uzrok mijelopatije u oboljelih je bila spondiloza (18,89%) dok je treći najčešći uzrok bio tumorski proces (15,64%). Ekstraduralnu lokalizaciju tumora imalo je 59,57% pacijenata, intramedularnu lokalizaciju imalo je 21,28% pacijenata dok je 19,15% pacijenata imalo intraduralnu ekstramedularnu lokalizaciju tumora. Kada promatramo trend kretanja broja oboljelih od tri glavna uzroka oštećenja kralježničke moždine kroz period od 5 godina, primjećujemo pad broja oboljelih od spondilotične mijelopatije, porast broja oboljelih od mijelopatije kao posljedice tumorskog procesa te smanjen broj hospitaliziranih pacijenata s mijelopatijom kao posljedicom demijelinizacijske bolesti na račun liječenja u dnevnim bolnicama.
Zaključak: Istraživanje je pokazalo da su mijelopatije češće u žena te da se najčešće manifestiraju kliničkom slikom motornog deficita. Najčešći uzrok bolesti kralježničke moždine su demijelinizacijske bolesti, a prosječna dob svih oboljelih 52 godine, odnosno 37,5 godina kod oboljelih od demijelinizacijske mijelopatije. Ono što je posebno važno naglasiti jest pad u broju hospitalizacija pacijenata s demijelinizacijskim mijelopatijama na račun liječenja u dnevnim bolnicama što je u skladu s Nacionalnim planom razvoja kliničkih bolničkih centara, kliničkih bolnica, klinika i općih bolnica u Republici Hrvatskoj 2015.– 2016. |
| Abstract (english) | Objective: The aim of this study was to present the clinical picture and etiology of myelopathy in patients hospitalized at the Department of Neurology, KBC Split in the period from 1 January 2012 to 31 December 2016 and their demographic characteristics.
Patients and methods: This retrospective study was conducted at the Department of Neurology, Clinical Hospital Center Split. 307 patients, with the diagnosis of myelopathy, first diagnosed in the period from 1st January 2012 to 31st December 2016, were included. The following patient data was collected in the protocol and in the archives of the history of the disease: basic demographic characteristics (age and sex), symptoms and signs of the disease, types of neurological deficits, etiology and diagnosis of the disease and outcome of hospital treatment. In the statistical analysis, the methods of descriptive statistics and the Hi squared (χ2 test) test were used.
Results: Out of the total number of patients with myelopathy, there were 44.3% of men and 55.7% of women. There was a statistically significant difference in the diagnosis of myelopathy with regard to sex (P = 0.0458). The median age of the diagnosis is 52 years (min-max: 17-89 years). The most common form of neurological deficit was the motor neurological deficiency (37.13%), while the most common form of motor deficiency was paraparesis (43.84%). In terms of etiology, of the total number of patients with myelopathy, the largest number had a demyelinating disease as a cause of myelopathy (41.04%). Of the total number of patients with myelopathy as a consequence of demyelinating disease, 91.27% had multiple sclerosis as a diagnosis, 4.76% diagnosis of optic neuromyelitis, and 3.97% of patients were diagnosed with acute disseminated encephalomyelitis. The median age of demyelinating myelopathy is 37.5 years (min-max: 17-71). The second most common cause of myelopathy was spondylosis (18.89%), while the third most common cause was a tumor (15.64%). In 59.57% of patients the tumor was located extradurally, intramedular localization had 21.28% of patients while 19.15% of patients had intradural extramedular localization of the tumor. When we observe the trend of the number of patients with three major causes of spinal cord disease over a period of 5 years, we notice a decrease in the number of patients with spondylotic myelopathy, an increase in the number of patients with myelopathy as a consequence of a tumor and a decreased number of hospitalized patients with myelopathy as a consequence of demyelinating disease, as a result of treatments in daily hospitals.
Conclusion: Research has shown that myelopathy is more common in women and is most commonly manifested in a clinical picture of a motor deficiency. The most common cause of spinal cord disease is demyelinating disease. The average age of all patients with myelopathy was 52, while the average age of those with demyelinating myelopathy was 37,5 years. What is particularly important to emphasize is the decline in the number of hospitalization of patients with demyelinating myelopathy as a result of treatment in daily hospitals, which is in line with the National Plan for the Development of Clinical Hospital Centers, Clinical Hospitals, Clinics and General Hospital in the Republic of Croatia 2015.-2016. |
