以周围神经病为首发症状的6例结节性多动脉炎的临床病理特点  

Clinical and pathological characteristics of six cases of polyarteritis nodosa which begin with peripheral neuropathy

作　　者：魏妍平[1] 陈琳[1] 崔丽英[1] 郭玉璞[1] 关鸿志[1] 朱以诚[1] 高山[1] 任海涛[1] 赵燕环[1] 李本红[1] 杜华[1] 

机构地区：[1]中国医学科学院北京协和医院神经内科,北京100730

出　　处：《脑与神经疾病杂志》2009年第4期295-298,共4页Journal of Brain and Nervous Diseases

摘　　要：目的回顾性分析6例以周围神经病为首发症状的结节性多动脉炎(PAN)患者的临床和病理特点,为早期诊断提供帮助。方法总结分析6例PAN患者的临床特点,作为首发症状的周围神经病的起病方式,进展过程,症状与体征的演变,以及电生理检查与腓肠神经组织病理学特点。同时总结6例患者的其他伴随症状,血液学检查,血管超声等检查手段的诊断意义。结果6例患者多数起病较急,下肢受累早,且症状比上肢重。感觉神经受累出现早,且刺激性症状比较突出。症状与体征不对称,尤其在病程早期更明显,后期可表现为远端对称或不对称性的多发性周围神经病。本组患者神经传导以波幅下降为主,感觉和运动神经均受累。3例患者行腓肠神经活检术,仅1例患者发现血管炎的典型病理改变。结论结节性多动脉炎以周围神经病为首发症状时诊断较困难。应详细询问病史,仔细查体。实验室检查如血沉快,C反应蛋白升高,血白细胞增多,血管彩超发现小动脉瘤或血管狭窄等具有提示意义。电生理检查可明确神经病变的部位和程度,神经和肌肉活检可证实诊断。Objective 6 cases of polyarteritis nodosa which began with peripheral neuropathy were analyzed retrospectively. The clinical and pathological characteristics were summarized in order to make early diagnosis possiblely. Methods Firstly, the clinical characteristics of these six patients were summarized including how peripheral neuropathy began and progressed, the change of symptom and physical signs, the results of electrophysiological and pathological examinations. Other accompanied symptoms and accessory examinations including blood test and ultrasound of blood vessels were listed. Results In most of these six patients, the onset of the neuropathy was abrupt. The lower limbs were involved earlier and more severely. The sensory symptoms presented early and predominated, especially the irritating symptoms. The unsymmetry of both symptoms and signs was the most prominent at the very beginning, multiple peripheral neuropathy with or without symmetry would develop later. Through the electrophysiological examination of these six patients we found that the amplitude of both sensory and motor nerves＇action potentials were lowered significantly. Sural nerve biopsy was performed on three patients, and characteristic vaseulitic pathology was only found in one patient. Conclusion The diagnosis of polyarteritis nodosa which begins with peripheral nenropathy is quite difficult. Lareful history taken and through physical examination taken were both important. Accessory examinations could be helpful, such as blood sedimentation rate, c-reactive protein and ultrasound of blood vessels. Electrophysiological examinations could identify the site and extent of peripheral neuropathy while nerve and muscle biopsy could confirm the diagnosis.

关 键 词：结节性多动脉炎 周围神经病 腓肠神经活检 

分 类 号：R747.9[医药卫生—神经病学与精神病学]