CIDP与脊柱退行性疾病的临床特点分析

Analyzing the clinical characteristic of CIDP and spine degeneration diseases

目的探讨慢性炎症性脱髓鞘性多发性神经炎(chronicinflammatorydemyelinatingpolyneuritis,CIDP)和脊柱退行性疾病的临床特点,为正确的诊断和治疗提供参考。方法自2000年12月至2003年12月共收治CIDP患者16例,男11例,女5例;年龄38～58岁,平均49.1岁。从发病到就诊的时间为2个月～2年8个月,平均10.6个月。通过对16例误诊为脊柱退行性疾病的CIDP患者进行分析,比较其临床表现、物理检查、脑脊液蛋白质含量和四肢电生理检查结果,归纳其临床特点,并与颈、胸和腰椎退行性疾病进行比较。结果16例CIDP患者都存在肢体感觉障碍或异常,行走困难,上肢和(或)下肢同时受累,呈对称性;四肢腱反射减弱或消失;四肢肌肉萎缩不明显。X线片示16例患者脊柱均存在不同程度的退变;MRI显示脊柱不同部位存在椎间盘膨出或硬膜囊轻度受压。脑脊液检查结果显示所有患者的CSF蛋白水平均明显升高,平均为479.9mg/L(449～523mg/L),与正常脑脊液蛋白含量差异有统计学意义。电生理检测发现部分患者感觉神经动作电位波幅下降;运动神经传导速度减慢。结论通过详细询问病史、查体、脑脊液蛋白含量和四肢电生理检查,能够准确区分CIDP与脊柱退行性疾病。

Objective To prevent wrong diagnosis and treatment of chronic inflammatory demyelinating polyneuritis （CIDP） by analyzing the clinical characteristics of CIDP and spine degeneration disorders. Methods In order to distinguish CIDP from spine degeneration diseases, we retrospectively reviewed 16 CIDP patients from December 2000 to December 2003 （male 10, female 6; range 38-58 years old, mean 49.1 years old） who were misdiagnosed as spine degeneration diseases. The duration of the disease was 2 months to 2 years and 8 months, with an everage of 106 months. All clinical data of the 16 patients were analyzed. The data included clinical manifestation, physical examination, protein content of cerebrospinal fluid （CSF） and upper-lower extremity electrophysiologic study （EPS）. Comparing the clinical charateristics of CIDP with those of spine degeneration disease. Results All 16 patients of CIDP sufferred limbs sensory disturbance or abnormality, walking difficulty. Upper or lower extremity were involved at equal pace and symmetry; limb tendon reflexes weakened or dissappeared, but limbs muscular atrophy were not significant. X-ray showed degeneration of cervical or thoracic and lumbar spine; MRI showed that there were disc herniation in different intervertebral. The content of protein of CSF remarkably increased （mean 479.9 mg/L）. There were significant deviation compare to normal. Electrophysiology study found that sensory nerve action potential （SNAP） wave amplitude were descending; motor nerve conduction velocity（MNCV） were slower. Conclusion We could rightly diagnose and distinguish CIDP from spine degeneration diseases by analyzing clinical manifestation, physical examination, cerebrospinal fluid and electrophysiological study.