职业性慢性正己烷中毒患者神经肌电图观察及营养状况对疾病康复的影响

Observation of electromyography and the impact of nutritional status on disease recovery in patients with occupational chronic n-hexane poisoning

目的随访分析职业性慢性正己烷中毒患者神经肌电图检查结果,并分析患者的一般临床指标及相关营养状况,探讨营养状况对疾病恢复的影响。方法回顾分析2008—2021年苏州市第五人民医院收治的62例职业性慢性正己烷中毒患者,并将其作为病例组,选取同期健康检查者62例作为对照组,比较2组的临床资料和神经肌电图检查结果。对病例组内的每个患者治疗前、治疗3和6个月后的神经肌电图检查结果进行随访比较。在病例组内进行分组,将诊断为轻度中毒的患者分为1组(轻组),诊断为中、重度中毒的患者分为另1组(中重组),比较两组的体质量指数(body mass index,BMI)、血红蛋白、总胆固醇、三酰甘油、血糖、血清白蛋白等营养情况。结果病例组的运动神经潜伏期均比对照组延长(均P<0.05),病例组在运动神经传导速度(motor nerve conduction velocity,MCV)和感觉神经传导速度(sensory nerve conduction velocity,SCV)中均比对照组减慢(均P<0.05)。在病例组中,治疗3个月后尺神经近端潜伏期[6.95(6.38,7.98)ms]缩短(P<0.05),其他神经潜伏期改善不明显。在MCV中尺神经传导速度[53.80(46.34,57.95)m/s]加快(P<0.05),正中神经、腓总神经传导速度改善不明显。在SCV中尺神经传导速度[43.08(38.83,47.79)m/s]加快(P<0.018),正中神经传导速度改善不明显。治疗6个月后正中神经远端潜伏期[3.36(2.89,3.82)ms]、正中神经近端潜伏期[7.28(6.54,8.35)ms]、尺神经远端潜伏期[2.60(2.39,3.06)ms]、尺神经近端潜伏期[6.78(6.29,7.81)ms]较入院均缩短(均P<0.018),腓总神经远端、腓总神经近端潜伏期改善不明显,MCV、SCV均明显加快(均P<0.018)。病例组中,轻组的血红蛋白[(135.85±10.87)g/L]、红细胞[(4.52±0.55)×10^(12)/L]、血清白蛋白[(44.51±4.65)g]均显著高于中重组(均P<0.05)。多因素logistic回归分析显示,血红蛋白(OR=0.99,95%CI:0.93~1.05)、红细胞(OR=0.21,95%CI:0.03~1.47)、血清白蛋白(OR=0.78,95%CI:0.64~0.95)均是发生中重度中毒的保护因子,空腹血糖(OR=18.42,95%CI:2.14~159.01)是发生中重度中毒的危险因子。结论正己烷中毒患者神经肌电图检查结果在治疗3个月后改善不明显,治疗6个月后可见明显好转。早期改善患者的营养状况,可使正己烷中毒患者周围神经功能更快恢复。

Objective To follow up and analyze the results of neuro electromyography(EMG)in patients with occupational chronic n-hexane poisoning,and to analyze the general clinical indicators and related nutritional status of patients,and to explore the impact of nutritional status on disease recovery.Methods A retrospective analysis was conducted on 62 patients with occupational chronic n-hexane poisoning admitted from 2008 to 2021,and they were selected as the case group.Totally 62 healthy examiners during the same period were selected as the control group,and the clinical data and electromyography results of the two groups were compared.Follow up and compare the electromyographic examination results of each patient in the case group before treatment and 3 and 6 months after treatment.Grouping within the case group,patients diagnosed with mild poisoning were divided into one group(mild group),and patients diagnosed with moderate to severe poisoning were divided into another group(moderate to severe group).The nutritional status of the two groups,such as body mass index(BMI),hemoglobin,total cholesterol,triglycerides,blood glucose,and serum albumin were compared.Results The motor nerve latency in the case group was delayed than in the controls(all P<0.05),and the motor nerve conduction velocity(MCV)and sensory nerve conduction velocity(SCV)of the case group were all slowed down compared to the control group(both P<0.05).In the case group,the proximal latency of the ulnar nerve[6.95(6.38,7.98)ms]was shortened after 3 months of treatment(P<0.05),while the rest of the nerve latency did not improve significantly.In MCV,the conduction velocity of the ulnar nerve[53.80(46.34,57.95)m/s]increased(P<0.05),while the improvement in conduction velocity of the median nerve and common peroneal nerve was not significant.In SCV,the conduction velocity of the ulnar nerve[43.08(38.83,47.79)m/s]increased(P<0.018),while the improvement in the conduction velocity of the median nerve was not significant.Six months after treatment,the distal latency of the median nerve[3.36(2.89,3.82)ms],the proximal latency of the median nerve[7.28(6.54,8.35)ms],the distal latency of the ulnar nerve[2.60(2.39,3.06)ms],and the proximal latency of the ulnar nerve[6.78(6.29,7.81)ms]were all shortened compared to admission(all P<0.018),while the improvement in the distal and proximal latency of the common peroneal nerve was not significant.MCV and SCV were significantly accelerated(all P<0.018).In the case group,the hemoglobin[(135.85±10.87)g/L],red blood cells[(4.52±0.55)×10^(12)/L]and serum albumin[(44.51±4.65)g]in the mild group were significantly higher than those in the moderate to severe group(all P<0.05).Multivariate logistic regression analysis showed that,hemoglobin(OR=0.99,95%CI:0.93-1.05)、red blood cells(OR=0.21,95%CI:0.03-1.47),serum albumin(OR=0.78,95%CI:0.64-0.95)were protective factors for moderate to severe poisoning,while fasting blood glucose(OR=18.42,95%CI:2.14-159.01)was a risk factor for moderate to severe poisoning.Conclusion The neuroelectromyographic examination results of patients with n-hexane poisoning did not show significant improvement after 3 months of treatment,but showed significant improvement after 6 months of treatment.Early improvement of the patient's nutritional status can accelerate the recovery of peripheral nerve function in patients with n-hexane poisoning.