感觉轴索神经病的临床与神经生理特点

<title>nsory axonal neuropathy: a clinical and electrophysiological study

目的探讨感觉轴索神经病的临床和神经生理特点。方法选择24例感觉轴索神经病患者及88名年龄匹配的健康人,电生理检查用皮肤表面电极超强刺激,表面电极记录,测试尺神经、正中神经和胫神经不同节段的运动潜伏期、运动传导速度及其CMAP波幅、时限,感觉传导速度及其波幅等。结果22例患者表现为肢体麻木和感觉性共济失调,18例患者远端的痛觉和(或)音叉振动觉减退或消失,17例以下肢为著,所有患者均不伴肌无力和肌束震颤。病因包括肺癌、糖尿病、遗传性脊髓小脑共济失调、酒精中毒和药物中毒等。神经传导显示感觉神经动作电位波幅明显下降,感觉神经传导速度减慢,两者与年龄匹配的健康人相比,差异有非常显著性意义(P<0.001、0.01);运动神经传导速度和波幅两组差异没有显著性意义(P>0.05)。结论感觉轴索神经病是一类多因素造成的临床综合征,以感觉纤维轴索损害为主,临床表现为以下肢为著的感觉症状体征,神经传导检测主要的改变是感觉神经动作电位(SNAP)波幅的减低或消失、伴或不伴感觉传导速度的改变,其常见病因有肿瘤、中毒、代谢性疾病、神经系统遗传病等。

<abstract>jective To study the clinical and electrophysiological characteristics of sensory axonal neuropathy (SAN). Methods Clinical data in 24 patients with SAN and 88 age-matched normal controls were examined. Sensory and motor nerve conduction were evaluated with supramaximal stimulation and surface electrodes in 180 nerves at different nerve segments of normal subjects, and compared with that of 90 nerves with sensory axonal neuropathy. Results Sensory symptoms of numbness and sensory ataxia were seen in 91. 6% of the patients, 70. 8% of them were mainly involved in the lower extremities. No weakness and fasciculation were found in our patients. Nerve conduction studies showed a normal MCV and CMAP amplitude, but the decreased amplitude of SNAP and slowed SCV in our patients had significant differences as compared with that of the normal subjects (P < 0.001 , P <0. 01 respectively). The major causes found in our patients included lung cancer, diabetes mellitus, hereditary spinal cerebellar ataxia, alcoholism and furazolidone intoxication. Conclusions Sensory axonal neuropathy is a heterogeneous clinical syndrome, in which selective involvement of sensory axon, more prominent in the lower limbs, should be associated with sensory symptoms and clinical findings. In the nerve conduction study, it showed a significant decrease of SNAP amplitude with or without changes in sensory conduction velocity. The most common causes might include the paraneoplastic, intoxication, metabolic and hereditary neuropathy.