急性运动轴索神经病的临床和电生理特点及其与预后的相关性研究

Clinical and electrophysiological characteristics of acute motor axonal neuropathy and its correlation with prognosis

目的研究急性运动轴索神经病(acute motor axonal neuropathy,AMAN)的临床和电生理特点及其与预后的相关性。方法分析我院神经科自2015年1月—2018年1月收治的54例AMAN患者的临床资料和神经电生理检查结果,探讨40例获随访者的临床和电生理特点与预后的相关性。结果预后较好组患者腹泻、上呼吸道感染、肝功能障碍、延髓功能障碍的发生率,住院时间、发病至入院时间及Hughes评分均显著低于预后较差组,差异具有统计学意义(P <0. 05)。预后较好组dCMAP异常、F波异常发生率显著低于预后较差组,正中神经MCV、尺神经MCV、胫神经MCV及腓总神经MCV显著高于预后较差组,差异具有统计学意义(P <0. 05)。AMAN患者预后与腹泻、上呼吸道感染、肝功能障碍、延髓功能障碍、dCMAP异常及F波异常呈负相关(P <0. 05)。结论 AMAN患者电生理改变主要为dCMAP及F波异常,而腹泻、上呼吸道感染、肝功能障碍、延髓功能障碍、dCMAP异常及F波异常可作为判断AMAN患者预后的观察项目。

Objective: To study the clinical and electrophysiological characteristics of acute motor axonal neuropathy and its correlation with prognosis. Methods: The clinical data and electrophysiological examination of 64 patients with AMAN from January 2016 to January 2018 in Neurological Department of our hospital were analyzed. The correlation between clinical and electrophysiological characteristics and prognosis of 40 patients were investigated. Results: The incidence of diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction,hospitalization time,time from onset to admission and Hughes score in patients with better prognosis were significantly lower than those in patients with poor prognosis( P < 0. 05). The incidence of abnormal dCMAP and F wave in the better prognosis group was significantly lower than that in the worse prognosis group. The Median nerve MCV,ulnar nerve MCV,tibial nerve MCV and common peroneal nerve MCV were significantly higher than those in the worse prognosis group( P < 0. 05). The prognosis of AMAN patients was negatively correlated with diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction and abnormal F wave( P < 0. 05). Conclusion: The main electrophysiological changes in AMAN patients are abnormal dCMAP and F wave,while diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction,abnormal dCMAP and F wave can be used as prognostic observation items.