危重症多发性周围神经病患者的脑脊液及神经电生理特征  

Characteristics of cerebrospinal fluid and neuroelectrophysiology in patients with critical illness polyneuropathy

作　　者：马玉宝[1] 石强[1] 李婉君 李杨 敖然[1] MA Yubao;SHI Qiang;LI Wanjun;LI Yang;AO Ran(Department of Neurology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经内科,北京100853

出　　处：《解放军医学院学报》2020年第6期551-554,共4页Academic Journal of Chinese PLA Medical School

基　　金：解放军总医院扶持基金(2017FC-TSYS-3019)

摘　　要：目的分析危重症多发性神经病(critical illness polyneuropathy,CIP)患者的脑脊液及神经电生理特征。方法选取我中心2017年9月-2019年3月诊断为CIP且发病7~10 d的29例患者作为研究对象,分析其病因、脑脊液改变和肌电图电生理改变。结果29例中,男性16例,女性13例,平均年龄(50.4±19.3)岁。原发病因包括蛛网膜下腔出血8例(27.6%),病毒性脑炎14例(48.3%),重症肺部感染4例(13.8%),肿瘤晚期3例(10.3%)。选取21例脑脊液进行分析,其中9例(42.9%)存在脑脊液蛋白-细胞分离现象,提示周围神经病变可能有免疫因素参与。肌电图显示运动和感觉神经均有受损,神经轴索受损明显,上肢与下肢相比,运动神经波幅降低(30/58 vs 42/58,P=0.022)、传导速度减慢(12/58 vs 27/58,P=0.003)的神经条数有明显差异,下肢运动神经受损较上肢明显。上肢28条骨骼肌(28/44),下肢49条骨骼肌(49/73),早期针极肌电图可测得自发电位,差异无统计学意义(P=0.700)。5例CIP患者上肢运动神经波幅和传导速度均正常,而所支配的肌肉有90%出现明显自发电位,提示骨骼肌细胞膜电位改变早于神经轴索的损害。结论CIP患者脑脊液有蛋白细胞分离现象,可能存在免疫介导作用;CIP以轴索损害为主,运动神经下肢受累明显;早于轴索病变的自发电位是CIP早期特征性改变。Objective To explore the characteristics of cerebrospinal fluid and neuroelectrophysiology in patients with critical illness polyneuropathy(CIP).Methods Twenty-nine patients with CIP who developed the disease within 7 to 10 days treated in our hospital from September 2017 to March 2019 were selected as the subjects of the study.The causes,changes of cerebrospinal fluid and electromyographic electrophysiology were analyzed.Results Among the 29 cases,there were 16 males and 13 females,with an average age of(50.4±19.3)years.The primary causes included subarachnoid hemorrhage(8/29,27.6%),viral encephalitis(14/29,48.3%),severe pulmonary infection(4/29,13.8%),and advanced tumor(3/2910.3%).Cerebrospinal fluid analysis showed protein cell separation(9/21,42.9%),suggesting that immune response might be involved in peripheral neuropathy.Electrophysiological examination showed that both motor and sensory nerves were damaged,nerve axons were obviously insulted.And there were significant differences in motor nerve response amplitude(51.7%vs 72.4%,P=0.022)and conduction velocity(20.7%vs 46.6%,P=0.003)between upper and lower limbs,indicating the injuries of the lower limbs were more severe.The spontaneous potential was captured by needle pole electromyography in 28 muscles of upper limb(28/44)and 49 muscles of lower limb(49/73)in the early stage,with no significant difference(P=0.700).The response amplitude and conduction velocity of upper limbs’motor nerve in 5 patients with CIP were normal,nevertheless,90%of the muscles innervated showed obvious spontaneous potential,suggesting that the change of membrane potential of skeletal muscle cells was earlier than the damage of nerve axons.Conclusion In patients with CIP,there is protein cell separation in cerebrospinal fluid,which may be mediated by immunity;Axonal damage in CIP is dominant,and the motor nerve injury is more obvious in lower limbs;The spontaneous potential onset earlier than axonal lesion is the specific change in the early stage of CIP.

关 键 词：危重症多神经病 神经电生理 自发电位 脑脊液 蛋白细胞分离 

分 类 号：R745[医药卫生—神经病学与精神病学]