丙烯酰胺中毒性周围神经病患者的临床和电生理特征及治疗

Clinical and electrophysiological features and treatment of acrylamide-induced toxic peripheral neuropathy

目的探讨丙烯酰胺中毒性周围神经病的临床特征、电生理检查结果、治疗和预后。方法收集2015年1月至2018年8月金华市中心医院9例丙烯酰胺中毒性周围神经病患者资料,对患者的临床表现、神经电生理结果等进行回顾性研究。结果患者以肢体远端麻木为主要特征,伴有痛觉减退或过敏,深感觉减退,腱反射减弱或消失、脱皮等表现,其中1例存在肌力减退,1例存在小脑性共济运动障碍。肌电图检查1例患者存在自发电位。神经传导速度检查波幅下降34条(38.6%),传导速度下降2条(2.3%)。感觉神经波幅下降30条(57.7%),运动神经波幅下降4条(11.1%),感觉神经波幅下降的比例明显多于运动神经(P<0.01)。经维生素B类药物、鼠神经生长因子、激素等治疗后,患者麻木有减轻,但是未完全消失,痛觉、深感觉、腱反射恢复差,其中3例复查肌电图结果较前进展加重。结论丙烯酰胺中毒性周围神经病以肢体远端麻木和感觉神经轴索损害为主,缺乏有效的治疗药物,做好防护至关重要。

Objective To investigate the clinical manifestations,electrophysiology results,treatment and prognosis of acrylamide-induced toxic peripheral neuropathy.Methods The clinical data of 9 patients with acrylamide-induced toxic peripheral neuropathy,who were collected in Jinhua Municipal Central Hospital from January 2015 to August 2018,were retrospectively reviewed.Results This disease was characterized by distal limb numbness,some patients with hypoalgesia or allergy,deep sense loss,reduction or disappearance of tendon reflexes,and peeling.One case had muscle weakening and another case had cerebellar ataxia.Examination of electromyography showed only one case had spontaneous potential.Examination of nerve conduction showed that the amplitude decreased by 34(38.6%)and the velocity decreased by 2(2.3%),the percentage of amplitude decreased was significantly higher than that of velocity decreased.The amplitude of sensory nerve decreased by 30(57.7%)and motor nerve decreased by 4(11.1%),the percentage of sensory nerve amplitude decreased was significantly higher than that of motor nerve.After the treatment of nutrition,circulation improvement,numbness relief,glucocorticoid and other drugs,the numbness of the patients was relieved,but it did not completely disappear.Poor recovery of pain,deep sensation and tendon reflex in all patients.The results of reexamination of electromyography in 3 cases were worse than before.Therefore,it is suggested that peripheral nerve damage is irreversible.Conclusion This disease is characterized by distal limb numbness.Electrophysiological results suggest that the damage of sensory nerve axon is the main cause of the disease.Up to now,there is no effective drug to treat this disease,therefore,it is very important to do a good job of protection.