糖尿病-慢性炎性脱髓鞘性多发性神经根神经病的神经病理特点研究

Neuropathological studies of chronic inflammatory demyelinating polyradiculoneuropathy with diabetes mellitus

目的比较糖尿病-慢性炎性脱髓鞘性多发性神经根神经病(diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy,DM-CIDP)、糖尿病周围神经病(diabetic peripheral neuropathy,DPN)及慢性炎性脱髓鞘性多发性神经根神经病(CIDP)3组疾病的神经病理改变特点。方法收集2009年1月至2015年12月海军总医院、北京大学第一医院神经内科确诊的DM-CIDP、DPN和CIDP共32例患者的临床资料,对3组患者的腓肠神经病理结果进行对比分析。结果 DM-CIDP、DPN和CIDP3组患者的神经病理改变在洋葱球、薄髓鞘、轴索变性、有髓神经纤维再生簇、血管基底膜增厚、炎细胞浸润出现率的差异有统计学意义(P<0.05)。CIDP组出现薄髓鞘较DM-CIDP组常见,差异有统计学意义(P<0.05);DM-CIDP组出现轴索变性显著高于DPN组(P<0.05)和CIDP组(P<0.001),差异有统计学意义;DPN组出现有髓神经纤维再生簇较DM-CIDP组常见,差异有统计学意义(P<0.05);DM-CIDP组血管基底膜增厚较CIDP组常见,差异有统计学意义(P<0.05);DM-CIDP组炎性细胞浸润较DPN组多见,差异有统计学意义(P<0.001)。结论 DM-CIDP的神经病理改变与DPN及CIDP的病理改变均存在差异。与CIDP相比,DM-CIDP出现薄髓鞘神经纤维较少,而轴索变性及血管基底膜增厚较多;与DPN相比,DM-CIDP出现神经纤维轴索再生簇较少,而轴索变性及炎性细胞浸润多见。

Objective To investigate the characteristics of nerve pathology of three different groups of diseases： diabetes mellitus -chronic inflammatory demyelinating polyradiculoneuropathy （DM-CIDP）, diabetic peripheral neuropathy （DPN） and chronic inflammatory demyelinating polyradiculoneuropathy （CIDP）. Methods Data of 32 patients with DM-CIDP, DPN and CIDP, hospitalized from January 2009 to December 2015 in Department of Neurology of Navy General Hospital and Peking University First Affiliatied Hospital were retrieved. Characteristics of nerve pathology were compared and analyzed among the three groups of patients, and the similarities and differences were explored. Results Statistic analysis showed that there were significant differences among DPN, DM-CIDP and CIDP patients in ＂onionskin change＂, thin myelin, non-medullated nerve decrease, axon degeneration, myelinated nerve fiber regeneration cluster, vessel basement membrane thickening and compositional proportion of inflammatory cells （P〈0.05）. Comparsions between DM-CIDP and the other two groups revealed that thin myelin was more common in CIDP than in DM-CIDP （P〈0.05）; axon degeneration was more common in DM-CIDP than DPN （P〈0.05） and CIDP （P〈0.001）; myelinated nerve fiber regeneration cluster was more common in DPN than DM-CIDP （P〈0.05）; vessel basement membrane thickening was more common in DM-CIDP than CIDP （P〈0.05）; and inflammatory cell infiltration was more common in DM-CIDP than DPN （P〈0.001）. Conclusion Thin myelin nerve fiber is less common in DM-CIDP than in CIDP, while axon degeneration and vessel basement membrane thickening are more common in DM-CIDP than in CIDP. Compared to DPN, myelinated nerve fiber regeneration cluster is less common in DM-CIDE while axon degeneration and inflammatory cell infiltration are more common in DM-CIDP.