脊髓灰质炎综合征32例的临床与神经电生理  

Clinical and neuroelectrophysiological characteristics of 32 children with poliomyelitis syndrome

作　　者：唐容华[1] 周江堡[1] 

机构地区：[1]重庆医科大学附属儿童医院神经内科,重庆400014

出　　处：《重庆医科大学学报》2008年第6期743-744,764,共3页Journal of Chongqing Medical University

摘　　要：目的：分析非脊灰病毒（Non—poliovirus，NPV）所致急弛缓性瘫痪（Acute flaccid paralysis，AFP）即脊髓灰质炎综合征的临床特点、神经电生理改变及预后，探讨其可能发病机制。方法：对32例脊髓灰质炎综合征患儿进行临床观察、血清肠道病毒抗体测定、血清肌酶测定、脑脊夜检查、神经电生理等检查并作前后对照。结果：（1）各年龄均可发病，以1-3岁最多；全年均可发病，以夏秋季居多；病前大都有呼吸道或消化道病毒感染史；以一侧下肢弛缓性瘫痪为主，肌力大都在3-4级，少数出现双下肢不对称性弛缓性瘫痪；腱反射减弱，无感觉障碍。（2）32例病人中，10例血清柯萨奇病毒CBV—IgM阳性，12例ECHOV—IgM阳性，脑脊液检查除2例CBV—IgM阳性、蛋白轻度增高外，其余全部正常；肌酶检查32例中仅有2例病程极期CK轻度增高，恢复期降为正常。（3）神经电生理改变包括有：29例运动神经肌肉复合动作电位（Compound muscle action potential，CMAP）波幅降低、以远端波幅降低明显，或远端缺失，运动神经传导速度（Nerve conduction velocity，NCV）正常；F波出现率降低；全部病例感觉神经动作电位（Sensory nerve action potential，SNAP）波幅正常，感觉神经传导速度（Sensory nerve conduction velocity，SCV）正常；肌电图示神经源性损害。仅3例轻者神经电生理检查未见明显异常。（4）大都在2周内恢复，预后好。结论：NPV感染引起小儿AFP可能系病毒感染后诱发人体免疫反应，导致运动神经尤其是远端轴索的轻度变性。Objective：To analyze the clinical characteristics,neuroelectrophysiological changes and prognosis in children with Acute Flaccid Paralysis（AFP） caused by non-poliovirus（NPV） infections,and to explore it＇s possible pathogenesis. Methods： Clinical observation,EV-antibody（EV-Ab） detection in blood serum,creatase detection in blood serum,cerebrospinal fluid（CSF） check-up and electrophysiologic study（EPS） were done in 32 AFP cases by NPV infections;and the result were compared. Results：（1）Children at every age were involved,mostly at age of 1-3 years;it occurred in every season,mostly in summer and autumn;Before palsy,most of them were affected by viral infections in respiratory tract or digestive tract;29 cases had AFP in one side of lower extremity with 3-4 grade muscle force,only 3 cases presented dissymmetrical AFP in both lower extremities, all cases had weakened tendon reflex,and none had sensory disorder.（2）Of 32 cases,10 presented Coxsackie virus antibody （CBV-IgM）（＋） and 12 ECHOV-IgM（＋） in blood serum,2 presented CBV-IgM（＋） and slightly increased protein in CSF,and the rest were normal;2 cases had slightly increased CK in blood serum during climax,and presented normal in convalescent period. （3）Electrophysiologic changes included the following 29 cases had cutdowned compound muscle action potential（CMAP） wave amplitude in motor nerves,especially in the distal amplitude,even disappeared,and had normal nerve conduction velocity （NCV） in motor nerves,the present rate of F-wave was decreased,all cases had normal sensory nerve action potential（SNAP）, and normal sensory nerve conduction velocity （SCV）,electromyogram of 26 cases indicated neurogenic lesion,and only 3 cases had no obvious changes.（4）Majority of 32 cases recovered in two weeks,and the prognosis was good. Conclusion：The possible mechanism of AFP in children with NPV infections is that the induced immune reaction from NPV infections leaded to the motor nerve＇s axonal s

关 键 词：脊髓灰质炎综合征 临床与神经电生理 

分 类 号：R512.4[医药卫生—内科学]