慢性1-烯丙基氯-3中毒性周围神经病神经肌肉组织电生理及超微结构改变的研究

STUDY OF CHANGES OF ELECTRONEUROMYOPHYSIOLOGY AND ULTRASTRUCTURE OF TOXIC PERIPHERAL NEUROPATHY DUE TO 3-CHLOROPROPENE-1 CHRONIC INTOXICATION

中毒组为已确诊的慢性1-烯丙基氯-3中毒性周围神经病患者31例,对照组为健康者25例。中毒组肌电图在静息状态时,插入电位降低,部分病例出现自发性失神经电位(正锐波及纤颤电位);轻度收缩时,单个运动单位电位多相电位增多、电压降低、时限延长;最大收缩时,出现混合型。刺激腓总神经诱发胫前肌、腓骨长肌及伸趾短肌反应性肌电位出现多相电位、低电压及时限延长。腓总神经运动传导速度减慢及远端潜伏时延长,腓肠神经感觉传导速度及远端潜伏时无明显改变。腓肠神经髓质内微管及神经微丝变性,线粒体嵴脱落成变性空泡,光面内质网扩张和肿胀,髓鞘未见异常改变。腓肠肌肌原纤维部分断裂及间隙扩大并且内充满肌质网及线粒体变性空泡,Z线弯曲、断裂及崩解。

Thirty-one cases of patients,11 males and 20 females at the age of 20 to 40,diagnosed with chronic peripheral neuropathy caused by 3-chloro-propene-1 were investigated as study group.25 healthy workers,10 males and 15 females at the age of 20 to 38,were listed as control group.In study group electro-myogram showed decreased inserting potential and spontaneous denerve potential (positive sharp waves and fibrallation voltage)in some cases at the resting state;increased multiphase potentials,reduced amplitude and prolonged duration at slight innervation;and mixed potentials at maximum innervation.After stimula-tion of common fibular nerves reactive potential became multiphase induced from anterior tibial muscle,long peroneal muscle and long extensor muscle of toes,reduced amplitude and prolonged duration were also presented;motor nerve fibre conduction velocity(MCV)of common fibular nerve became slow and distal latence delayed;sensory nerve fibre conduction velocity(SCV)and distal latence of sural nerve had no remarkable change.In axoplasm of sural nerve denatured microtubules and neurofilaments,vacuoles from denatured mitochondria,dilited and swollen smooth endoplasmic reticula could be seen,but myelin sheath was normal.Myofibril of gastrocnemius muscle was broken partially and the clearance was dilited and filled with myoplasmic reticula and vacuoles from denatured mitochondria,Z lines were curved broken and destroyed