典型与不典型CIDP患者的临床与电生理特点  

Retrospective study of clinical and electrophysiological features in patients with typical and atypical chronic inflammatory demyelinating polyneuropathy

作　　者：韩亚[1,2] 王家华[1,3] 卢祖能[1] 

机构地区：[1]武汉大学人民医院神经内科,430060 [2]武汉市红十字会医院 [3]湖北省襄阳市第一人民医院神经内科

出　　处：《卒中与神经疾病》2017年第2期126-129,135,共5页Stroke and Nervous Diseases

基　　金：湖北省卫计委重点项目(WJ2015MA007);武汉市科技局2015年应用基础研究计划项目(2015060101010047)

摘　　要：目的回顾性分析慢性炎性脱髓鞘性多发性神经病(CIDP)患者临床及神经电生理特点。方法收集2012年1月~2014年12月的临床拟诊CIDP患者,对其临床和电生理资料进行回顾性分析;并按2010年EFNS/PNS指南推荐,将患者分为典型CIDP组与不典型CIDP组。结果 (1)符合纳入标准的46例患者中男27例;发病年龄12~77岁,平均年龄(52±15)岁;病程>2个月33例、≤2月13例,其中6例以急性形式起病;(2)典型CIDP患者28例(61%),不典型者18例(39%)。典型组脑脊液蛋白含量为(1.17±0.77)g/L,不典型组(0.92±0.53)g/L(t=2.39,P=0.01)。典型与不典型CIDP患者组正中、尺、胫神经的远端运动波幅分别为(5.30±3.34)mV vs(7.18±2.60)mV(t=2.14,P=0.04)、(4.74±3.00)mV vs(7.99±3.62)mV(t=3.17,P=0.003)、(2.89±2.58)mV vs(7.18±4.71)mV(t=3.20,P=0.004);正中神经感觉传导速度分别为(49.82±11.68)、(56.81±7.27)m/s(t=2.11,P=0.04);腓肠神经感觉波幅分别为(6.08±2.62)、(10.40±5.62)μV(t=2.63;P=0.01)。结论典型CIDP仍是临床常见类型;与不典型者相比,典型CIDP患者脑脊液蛋白含量更高,运动与感觉传导速度更慢且波幅更低;这些生物学标志物可能具有一定的鉴别意义。Objective To retrospectively analyze the clinical and electrophysiological features of patients with chronic inflammatory demyelinating polyneuropathy（CIDP）.Methods Fourty-six consecutive patients who were referral to Department of Neurology,Renmin Hospital of Wuhan University,from January 2012 to December 2014,with clinical probable diagnosis of CIDP,were enrolled.The patients were divided into two groups,i.e.typical and atypical CIDP,according to the recommendations of European Federation of Neurological Societies（EFNS）/Peripheral Nerve Society（PNS）guidelines in 2010.The clinical and electrophysiological data were retrospectively analyzed.Results（1）Among 46 patients who conformed with the inclusion criteria,there were 27 males and 19 females,onset aged from 12-77（52±15）years old.There were 33 patients with illness duration of more than 2months,and 13 cases with illness duration of 2months or less than2months;in which there were 6patients with acute-onset,i.e.A-CIDP.（2）There were 28patients（61%）with typical and 18cases（39%）with atypical CIDP.The protein content of cerebrospinal fluid was（1.17±0.77）g/L in the group of typical CIDP and（0.92±0.53）g/L in atypical one（t=2.39,P=0.01）.In typical and atypical CIDP groups,the distal CMAP amplitude of median,ulnar and tibial nerves were（5.30±3.34）mV vs（7.18±2.60）mV（t=2.14;P=0.04）,（4.74±3.00）mV vs（7.99±3.62）mV（t=3.17,P=0.003）and（2.89±2.58）mV vs（7.18±4.71）（t=3.20,P=0.004）;the sensory conduction velocity of median nerve,（49.82±11.68）m/s vs（56.81±7.27）m/s（t=2.11,P=0.04）;the SNAP amplitude of sural nerve,（6.08±2.62）μV vs（10.40±5.62）μV（t=2.63,P=0.01）,respectively.Conclusion Typical CIDP is still the predominant type clinically.Compared with the atypical CIDP,the typical CIDP patients have higher protein content of cerebrospinal fluid,slower motor and sensory conduction velocities with lower amplitudes,in which these biomarkers may be of certain distinguishing s

关 键 词：慢性炎性脱髓鞘性多发性神经病 临床特征 神经电生理 

分 类 号：R745.44[医药卫生—神经病学与精神病学]