伴周围神经病的结核患者临床与电生理特点分析

Analysis of clinical and electrophysiological characteristics of tuberculosis patients with perip heral neuropathy

目的 探讨伴周围神经病的结核病患者临床与电生理特点,分析参与周围神经损伤可能的机制。方法 选取2020年1月至2022年1月解放军总医院第八医学中心收治的经肌电图检测证实伴周围神经病的结核病患者20例,对所有病例的临床资料和肌电图结果进行总结和分析。结果 20例患者中有13例表现为双下肢麻木、疼痛或双足麻木,1例四肢麻木,1例四肢麻木、无力,1例双下肢乏力,1例双手指尖麻木,3例无症状。口服抗结核药物后出现周围神经损伤时间为11~1 096 d,中位发病时间为113 d。上肢受检神经共160根,36根(22.5%)存在传导减慢、波幅降低或波形未引出,下肢受检120根神经中有64根(53.3%)存在异常,感觉神经17根(14.2%)、运动神经3根(2.5%)传导波形未引出,下肢感觉神经波幅下降更明显,表现为以轴索损害为主的感觉运动周围神经病。所有患者的MCV、CMAP波幅、SCV及SNAP波幅均明显降低。结论 伴周围神经病的结核病患者常以双下肢麻木、疼痛为首发症状,部分患者电生理改变早于临床表现,因此电生理检查可作为本病早期诊断及神经损伤评价的敏感指标,推测周围神经损伤可能有不同机制参与。

Objective To investigate the clinical and electrophysiological characteristics of tuberculosis patients with peripheral neuropathy, and to analyze the possible mechanisms involved in peripheral nerve injury.Methods Twenty patients with tuberculosis with peripheral neuropathy confirmed by electrophysiology who were admitted to the Eighth Medical Center of PLA General Hospital from January 2020 to January 2022 were selected, and the clinical data and electrophysiology results of all cases were summarized and analyzed. Results Thirteen patients presented with numbness, pain or numbness of both lower extremities, one patient with numbness of limbs, one patient with numbness and weakness of extremities, one patient with weakness of both lower extremities, one patient with numbness in the tips of both fingers, and three patients were asymptomatic. The time to peripheral nerve injury after oral administration of anti-tuberculosis drugs was 11-1 096 days, and the median onset time was 113 days. A total of 160nerves were examined in the upper extremity, of which 36(22.5%) had slow conduction, reduced amplitude or no waveform extraction. Among the 120 nerves examined in the lower extremity, 64(53.3 %) had abnormalities, the conduction waveforms of 17(14.2%) sensory nerves and 3(2.5%) motor nerves were not elicited. The lower limb sensory nerve amplitude decreased more obviously, which manifested as sensorimotor peripheral neuropathy mainly with axonal damage. The MCV, CMAP amplitude, SCV and SNAP amplitude were significantly reduced in all patients.Conclusions Tuberculosis patients with peripheral neuropathy often have numbness and pain in both lower extremities as the first symptoms, and electrophysiological changes in some patients occur more early than clinical manifestations.Therefore, electrophysiological examination can be used as a sensitive index for the early diagnosis of the disease and the evaluation of nerve damage. It is speculated that peripheral nerve damage may be involved in different mechanisms.