神经电生理在儿童Miller-Fisher综合征中的特征

The features of nerve electrophysiology in children with Miller-Fisher syndrome

目的探讨儿童Miller-Fisher综合征(Miller-Fisher syndrome,MFS)中神经电生理特征。方法选取34例MFS患儿,分别进行常规运动感觉神经传导检查,比目鱼肌H反射以及正中神经和胫神经F波检查。选择同期同年龄健康儿童33例为健康对照组,同年龄典型吉兰–巴雷综合征(Guillain-Barre syndrome,GBS)患儿30例为GBS对照组,与MFS患儿进行对比。结果在MFS患儿中,常规运动神经传导速度和波幅,感觉神经传导速度均在正常范围,12例(35.29%)感觉神经电位波幅(SNAP)降低,5例(14.71%)有腓肠神经SNAP保留现象(即正中神经或尺神经SNAP波幅下降程度大于腓肠神经SNAP下降程度),22例(64.71%)H反射异常,12例(35.29%)SNAP下降。与健康对照组比较,MFS患儿感觉神经传导速度、腓肠神经SNAP的差异均无统计学意义(P>0.05);但MFS患儿正中神经、尺神经SNAP明显下降,差异均有统计学意义(P均<0.05)。与GBS对照组比较,MFS患儿的运动感觉传导波幅均较高、速度较快,差异均有统计学意义(P均<0.01)。结论在MFS对照患儿中,可以见到末端感觉神经传导波幅降低,但SNAP影响有限,H反射异常是MFS最常见神经电生理异常。

Objective To explore the features of nerve electrophysiology in Mifler-Fisher syndrome （MFS） in children. Methods Thirty-four children with MFS were selected. The examinations of routine motor sensory nerve conduction, H reflexes of soleus muscle and F wave of median and tibial nerevs were performed. At the same time, 33 healthy children of the same age were selected as control group and 30 children with typical Guillain-Barre syndrome （GBS） selected as GBS group, which were compared with children with MFS. Results In children with MFS, routine motor nerve conduction velocity and amplitude, and sensory nerve conduction velocity were in normal range. Twelve cases （35.29%） showed a decrease in sensory nerve amplitude potential （SNAP）, 5 cases （14.71%） showed sural sparing phenomena （the decline degrees of SNAP in median or ulnar nerve greater than in sural nerve）, 22 cases （64.71%） showed abnormality of H reflex, and 12 cases （35.29%） showed the decline of SNAP. Compared with control group, there was no difference in sensory nerve conduction velocity and SNAP in sural nerve in children with MFS （P〈0.05）; While there were significant decreases in SNAP in both median nerve and ulnar nerve （P〈0.05）. Compared with GBS group, children with MFS had significantly higher sensory conduction amplitude and faster velocity （P〈0. 01）. Conclusion A decrease of terminal sensory nerve conduction amplitude could be found in children with MFS, but, the SNAP had limited impact on it. H reflex abnormality is the most common electrophysiologic abnormalities in MFS.