神经活检在周围神经疾病诊断中的意义及与电生理检查相关性分析

The diagnostic value of nerve biopsy in peripheral nervous system diseases and the correlation between pathology and electrophysiology

目的探讨神经活检在周围神经病诊断中的意义,并分析病理检查与神经电生理检查结果的一致性。方法收集2009-2011年作者医院行腓肠神经活检的16例周围神经病患者的临床诊断、电生理诊断和病理诊断资料;分析电生理诊断、光镜诊断和电镜诊断在判断轴索损害或/合并髓鞘损害的一致性,并分析其结果不一致的可能原因。结果电生理检查结果示异常12例(12/16),其中表现为轴索损害为主5例(5/16),髓鞘损害为主7例(7/16);病理检查结果示15例(15/16)患者有不同程度的髓鞘或轴索损害;4例(4/16)患者经神经活检后原有的诊断得到了补充或修改;进一步分析神经病理对于周围神经损害的诊断与电生理诊断无统计学差异。结论 (1)神经活检能够发现一些间质改变和亚临床、亚电生理的神经损害,从而对疾病的认识和治疗提供帮助。(2)神经病理对于周围神经损害的诊断与电生理诊断相关性较好,但当电生理表现为轴索损害时其一致的趋势欠佳,可能与轴索损害的多样性有关。

Objective To detect the diagnostic value of nerve biopsy in peripheral nervous system diseases and analyze the correlation between pathological findings and nerve conduction velocities. Methods 16 patients with peripheral neuropathy, who performed electrophysiology and sural nerve biopsy from 2009 to 2011, were collected. The consistency and discrepancy in judging axonal and myelin sheath injuries by diagnosis of electrophysiology, optical and electron microscope were analyzed. Results 12/16 patients showed abnormalities in electrophysiological examination, 5 of them presented axon loss and 7 myelin sheath disorders. 15/16 patients showed different levels of axon or myelin sheath injury in pathological examinations. The diagnosis of 4 patients was corrected or complemented. Further analysis indicated that no significant difference was present between nerve pathology and electrophysiology for the diagnosis of peripheral nerve damage. Conclusions （1） Some information about interstitial tissue, sub-clinical and sub-electrophysiological changes can be provided by nerve biopsy, and this is important for the disease understanding and treatment. （2） There is relatively consistence between pathology and electrophysiology findings. The decreased consistent trend in axonal damages revealed by electrophysiology may be due to the diversity of axonal damages