慢性炎症性脱髓鞘性多发性神经病的误诊分析

Analysis of the Misdiagnosis in Chronic Inflammatory Demyelinating Polyradicul Oneuropathy

目的 探讨慢性炎症脱髓鞘性多发性神经病 (CIDP)的临床特点、误诊原因及对策。方法 对误诊的 12例CIDP病例进行回顾性分析。结果 本组患者的临床表现主要有 :首发症状 :双下肢无力及足底感觉异常 (6 8% )。共有症状 :不同程度的对称性四肢无力及腱反射减弱或消失 (10 0 % )。特殊症状 :深感觉障碍性共济失调 2例 ;治疗中出现缓解、复发 5例次 ;单纯运动障碍 1例。12例中先后误诊为 :未梢神经炎、共济失调、多发性硬化、肌病、脊髓病变、急性炎症性脱髓鞘性多发性神经病 (AIDP)。结论 对 CIDP认识不足是误诊的主要原因。加强对本病的了解及认识 ,详尽的神经系检查、尤其是腱反射的检查、腰穿查有无脑脊液蛋白 -细胞分离现象以及电生理检查 ,必要时行神经活检是提高

Objective To explore the clinical features,misdiagnostic reasons and countermeasure of chronic inflammatory demyelinating polyradiculo neuropathy (CIDP).Methods 12 patients with CIDP who were misdiagnosed were analyzed retrospectively.Results Clinical symptoms and signs of the cases included: first symptom was weakness in both legs and paraesthesia in the sole of feet (68%);the common Symptoms: symmetrical limbs weakness and attenuation or absence of tendon reflex with different degree(100%);and special symptoms:deep sensation dysesthesia ataxia(one patient),remission and recurrence in the treatment period(six cases), and simple dyskinesia (one case).12 cases were misdiagnosed successively as peripheral neuritis, ataxia, multiple sclerosis,myopathy,myeleterosis and acute inflammatory demyelinating polyneuropathy (AIDP).Conclusion The major reason leading to misdiagnose was lack of knowledge of CIDP. To increase the diagnostic rate of CIDP, performing detailed and completed nervous system physical examination, especially tendon reflexes, lumbar puncture to find abnormal appearance in cerebrospinal fluid, electrophysiological examination, and biopsy of nerve if necessary are important.