感觉神经元病的临床和神经电生理研究

Clinical and neurophysiologic profiles of sensory neuron disease

目的探讨感觉神经元病的临床和神经电生理特点。方法回顾分析2007年11月至2012年11月北京大学第三医院57例感觉神经元病（SND）和95例感觉神经病患者，对其临床表现和神经电生理特点进行分析、比较。神经电生理研究主要包括四肢神经传导、肌电图、体感诱发电位（SEP）、接触性热痛诱发电位（CHEP）等检测。结果SND患者中，50例表现为感觉神经动作电位（SNAP）波幅广泛降低，7例SNAP测不出；SEP和CHEP参数有异常。其中，正中神经和尺神经SNAP波幅低于腓肠神经[（0．6±0．2）μV，（0．7±0．2）μV比（1．5±0．5）μV；t=2．42，2．38；均P〈0．05）；SEP各波潜伏期、波间期比感觉神经病组延长（t=1．99，1．99，2．00，2．07，1．99；1．98，1．99，2．02，1．98，1．99；均P〈0．05）；周围段CHEP起始峰潜伏期SND组比感觉神经病组延长（t=2．01，2．00，2．02；均P〈0．05），中枢段CHEP起始峰潜伏期2组差异无统计学意义（t=0．97，0．68；均P〉0．05）。结论感觉神经元病表现为感觉障碍，感觉性共济失调等，感觉神经动作电位波幅下降或消失，上肢重于下肢，体感诱发电位和痛觉诱发电位异常。

Objective To explore the clinical and electrophysiological characteristics of sensory neuron disease （SND）. Methods The clinical and electrophysiological characteristics were analyzed from November 2007 to November 2012 in 57 patients with sensory neuron disease and another 95 with sensory polyneuropathy. Nerve conduction studies of median nerve, ulnar nerve, tibial nerve, peroneal nerve and sural nerve and electromyogram （EMG） of bulbar, cervical, thoracic and lumbosacral region, somaosensory evoked potential （SEP） and contact heat evoked potential （CHEP） were performed. Results The amplitude of sensory nerve action potential （SNAP） decreased in 50 SND patients and disappeared in another 7. The parameters of SEP and CHEP were abnormal. The amplitude of SNAP was lower in median and ulnar nerve than in sural nerve （ （0. 6 ± 0. 2） μV, （0. 7 ± 0. 2 ） μV vs （ 1.5 ± 0. 5 ） μV ; t = 2. 42, 2. 38 ; P 〈 0.05 ）. The latencies of SEPs were longer in SND patients than in those with sensory polyneuropathy （ t = 1.99, 1.99, 2. 00, 2. 07, 1.99 ; 1.98, 1.99, 2.02, 1.98, 1.99 ; P 〈 0. 05）. Comparing with those with sensory polyneuropathy, the latencies of CHEP were longer in SND patients when the stimuli was applied at hand dorsum, proximal volar forearm and anticus tibialis（ t = 2. 01, 2. 00, 2.02 ; P 〈 0. 05 ）. No difference existed in latencies between 2 groups when the stimuli was at the levels of C7 and T12 （ t = 0. 97, 0. 68 ; P 〉 0. 05）. Conclusion Sensory neuron diseases usually present with sensory symptoms and ataxia. The amplitude of SNAP decreases or disappears especially in upper extremities. Both SEP and CHEP are abnormal.