急性与慢性炎性脱髓鞘性多发性神经根神经病临床与神经电生理特征分析

Analysis of clinical and neuroelectrophysiological characteristics in acute and chronic inflammatory demyelinating polyneuropathies

目的回顾性分析急性炎性脱髓鞘性多发性神经根神经病(AIDP)与慢性炎性脱髓鞘性多发性神经根神经病(CIDP)的临床及神经电生理特点。方法收集2017-06—2020-06就诊于驻马店市第一人民医院的23例患者的临床资料,其中AIDP患者16例,CIDP患者7例,分析其临床及神经电生理特点。结果(1)AIDP组正中神经运动支、CIDP组胫后神经总异常率均为100%;AIDP组正中神经远端复合肌肉动作电位(dCMAP)下降,CIDP组胫后神经运动传导速度(MCV)减慢、F波潜伏期延长及出波率下降均呈现更高的下降比例;CIDP组尺神经末端运动潜伏期(DML)延长,下肢腓总、胫后神经dCMAP下降,胫后神经MCV减慢、F波潜伏期延长等组间比较差异均有统计学意义(P<0.05)。(2)2组H反射异常率均显著;(3)传导阻滞在CIDP组尺神经(57.1%)、F波异常在CIDP组胫后神经(85.7%)中发生率均为最高,2组胫后神经均呈现较高比例的波形离散(68.8%vs78.6%);(4)2组感觉传导总异常率接近(68.8%vs73.2%),CIDP组无真正感觉传导速度(SCV)减慢患者。CIDP组感觉神经动作电位(SNAP)未引出率更高,与腓浅神经SNAP高未引出率相关,尺神经SNAP在AIDP组降低更明显,组间比较差异有统计学意义(P<0.05)。结论神经电生理测定在AIDP和CIDP诊断中均具有不可替代的重要作用,其在神经传导研究方面仍存在差异。建议在有条件的医院及时检测、定期监测,为临床提供更多的支持和帮助。

Objective To retrospectively analyze the clinical and neuroelectrophysiological characteristics between acute inflammatory demyelinating polyneuropathies(AIDP)with chronic inflammatory demyelinating poly⁃neuropathies(CIDP).Methods The results of 16 patients with AIDP and 7 patients with CIDP from June 2017 to June 2020 were collected for retrospective analysis.Results(1)The total abnormal rates of median motor branches of AIDP group and posterior tibial nerve of CIDP group were 100%.The median nerve dCMAP de⁃creased in AIDP group and the posterior nerve MCV slowed down in CIDP group,the latency period of F wave extended,and the rate of F wave decreased,all of which showed a higher proportion of decrease.In CIDP group,DML of ulnar nerve was extended,and dCMAP of common peroneal nerve and posterior tibial nerve of lower limbs was decreased,MCV of posterior tibial nerve was slowed down and latency of F-wave was prolonged.In these as⁃pects,the differences between the two groups both had statistical significance(P<0.05).(2)The abnormal rate of H reflex in both groups was very significant.(3)The incidence of CB in the ulnar nerve(57.1%)and F wave ab⁃normality in the posterior tibial nerve(85.7%)in CIDP group was the highest.The posterior tibial nerve in both groups presented a high proportion of temporal dispersion(68.8%vs 78.6%).(4)The total abnormal rate of sen⁃sory conduction was similar between the two groups(68.8%vs 73.2%).None of the patients in the CIDP group had true SCV reduction.In the unelicited cases of SNAP,the incidence of CIDP group was higher,which was relat⁃ed to the high unelicited rate of SNAP in superficial peroneal nerve.The reduction of ulnar nerve SNAP was more obvious in AIDP group.The differences between groups both had statistical significance(P<0.05).Conclusion Neuroelectrophysiological determination is of irreplaceable importance in AIDP and CIDP diagnosis.There are still differences between the two types in the study of nerve conduction.In order to provide more support and help for clini⁃cal treatment and patients,timely detection and regular monitoring should be carried out in qualified hospitals.