多发性骨髓瘤周围神经病变临床特征分析

Clinical characteristics analyses of multiple myeloma with peripheral neuropathy

目的探讨多发性骨髓瘤周围神经病变(MMPN)患者的临床和神经电生理异常表现。方法回顾性分析2010年3月至2018年6月山西省人民医院诊断的35例MMPN患者的临床资料。所有患者均进行神经电生理检测,包括神经传导速度(NCV)及皮肤交感反应(SSR)。结果 MMPN患者最常见周围神经受累的表现为感觉异常(25例,71%),包括根性疼痛(3例,9%)、双下肢或上肢痛觉减弱(18例,51%)、运动障碍(15例,43%)、双下肢膝反射或踝反射减低或消失(13例,37%)以及自主神经障碍症状(20例,57%)。感觉神经传导速度(SCV)异常和(或)运动神经传导速度(MCV)异常共29例(83%)。上肢NCV异常13例,上肢潜伏期延长5例,波幅降低10例;下肢NCV异常8例,下肢潜伏期延长6例,波幅降低4例。SSR检查发现17例(49%)异常。仅上肢SSR异常8例,上肢潜伏期延长2例,波幅降低7例,波形消失1例;仅下肢SSR异常6例,下肢潜伏期延长1例,波幅降低4例,波形消失2例;上下肢SSR均异常3例。结论 MM最常见的周围神经系统损害表现为"袜子和手套样"分布的感觉减退,自主神经也可累及;NCV检查是诊断MMPN的一种基本方法,SSR对于检测MMPN自主神经障碍有重要作用。

Objective To investigate the clinical manifestations and nerve electrophysiological abnormalities of the patients with multiple myeloma peripheral neuropathy (MMPN). Methods The clinical data of 35 patients with MMPN diagnosed in Shanxi Provincial People's Hospital from March 2010 to June 2018 were retrospectively analyzed. All patients received nerve electrophysiology examination, including nerve conductive velocity (NCV) and skin sympathetic response (SSR). Results The most common symptoms of peripheral nerve involvement for MMPN patients were sensory abnormalities (25 cases, 71%), including root pains (3 cases, 9%), pain ablation of the upper or lower limbs (18 cases, 51%), dyskinesia (15 cases, 43%), disappeared or reduced knee or ankle reflex (13 cases, 37%) and automatic sympathetic disorders (20 cases, 57%). Nerve electrophysiological tests showed 29 cases (83%) were involved in abnormal sensory nerve conduction velocity (SCV) or motor nerve conduction velocity (MCV), including 13 cases of upper limb abnormality in NCV, 5 cases of prolonged incubation in upper limb, and 10 cases of decreased amplitude;8 cases of lower limb abnormality in NCV, 6 cases of prolonged incubation in lower limb, and 4 cases of decreased amplitude. SSR test showed abnormalities were found in 17 patients (49%), including 8 cases of upper limb abnormality in SRR, 2 cases of prolonged incubation in upper limb, and 7 cases of decreased amplitude, 1 case of disappeared waveform;6 cases of lower limb abnormality in SRR, 1 case of prolonged incubation in lower limb, and 4 cases of decreased amplitude, 2 cases of disappeared waveform;3 cases of abnormal upper and lower limbs. Conclusions The most common peripheral nerve damages of MM are "sock and glove-like" sensory ablation, accompanied with the involvement of automatic nerve damage. NCV is the major method to diagnose MMPN, and SSR plays an important role in the detection of sympathetic nerve damage of MMPN.