多发性硬化周围神经损害的临床与电生理研究  

Peripheral neuropathy in multiple sclerosis:a clinical and electrophysiologic study

作　　者：李军[1] 沈志梅[2] 朱艳[1] 赵海宁[1] 曹珍兰[3] 许俊[1] 

机构地区：[1]扬州大学医学院附属医院神经内科,225001 [2]扬州大学医学院附属医院老年科,225001 [3]扬州大学医学院附属医院电生理室,225001

出　　处：《临床神经病学杂志》2006年第5期333-335,共3页Journal of Clinical Neurology

摘　　要：目的研究多发性硬化(MS)患者周围神经损害的临床特点与电生理改变。方法84例MS患者中,对其中16例有周围神经损害的MS患者(PNMS组)和68例无周围神经损害的MS患者(NPNMS组)的临床及电生理资料进行分析。结果本组MS患者中周围神经损害的发生率为19.0%(16/84)。表现为肢体麻木14例(87.5%),肢体无力12例(75.0%),神经根性疼痛4例(25.0%);腱反射减低15例(93.7%),末梢型感觉障碍13例(81.2%),肌萎缩5例(31.2%)。PNMS组患者的平均年龄[(44.6±12.5)岁]、病程[(39.3±18.3)个月]与NPNMS组[(32.2±11.5)岁、(31.6±17.2)个月]比较差异有显著性(P<0.01,P<0.05)。PNMS组以脊髓型MS(11例,68.7%)多见,NPNMS组以脑型MS(49例,72.1%)多见(均P<0.01)。PNMS组运动神经传导速度(MCV)、感觉神经传导速度(SCV)减慢者分别为79.7%、68.7%,F波异常为75.0%;NPNMS组MCV、SCV减慢者分别为7.9%、5.5%,F波异常为5.9%;两组相比差异有极显著性(均P<0.01)。经皮质类固醇等治疗PNMS组除2例无效外,其余患者均随病情好转而恢复。结论MS合并周围神经损害者年龄偏大,病程较长,脊髓型MS多见;MS出现周围神经损害不影响患者的预后;部分临床上无周围神经损害症状的MS患者神经电生理也有异常,神经电生理检查对MS周围神经损害的诊断有重要意义。Objective To study the clinical and electrophysiological characteristics of peripheral neuropathy in patients with multiple sclerosis（MS）. Methods As a total of 84 MS patients, the clinical and electrophysiological data were analyzed in 16 MS patients with the symptoms of peripheral neuropathy（ PNMS group）and in 68 MS patients without peripheral neuropathy（NPNMS group）. Results The incidence of peripheral neuropathy was 19.0% （ 16/ 84） in this group. The clinical symptoms included extremity numbness in 14 cases（ 87.5% ） ,limb inertia in 12 cases （75.0%） ,and radieular pain in 4 cases（ 25.0% ）. Signs included decrease of tendon reflex in 15 cases （93.7%） , periphery sensory disability in 13 cases（81.2% ） ,and myatrophy in 5 cases（31.2% ）. The mean age in the PNMS group was （44.6 ± 12.5 ） years vs. （32.2 ±1.5 ） years in the NPNMS group, The course of disease was （39.3 ±18.3 ） months vs. （ 31.6 ±17.2） months in the NPNMS group,there were significant differences in two groups（ P 〈 0.01 ,P 〈0. 05 ）. PNMS group was more frequently in the spinal cord MS （ 11 cases,68.7% ） vs. NPNMS group was more frequently in brain lesion MS （49 cases,72. 1% ,all P〈0.01 ）. Reduction of MCV,reduction of SCV and F waves abnormality were found 79. 7% ,68.7% and 75.0% in PNMS group vs. 7, 9% ,5.5% and 5.9% in NPNMS group. There were significant differences between two groups（all P〈0. 01 ）. The symptoms improved by treatment with eortieosteroid in the all patients except two, Conclusions Older age,long duration of disease and spinal cord MS may be associated with the peripheral neuropathy of MS. The prognosis of PNMS is similar to NPNMS. Eleetrophysiologieal examination may play an important role in diagnosis of peripheral neuropathy in patients with MS.

关 键 词：多发性硬化 周围神经病变 临床特征 神经电生理 

分 类 号：R744.51[医药卫生—神经病学与精神病学]