经典型慢性炎性脱髓鞘性多发性神经根神经病患者肌电图与磁共振神经成像相关性研究  

Association between electromyography and magnetic resonance neurography in patients with typical chronic inflammatory demyelinating polyradiculoneuropathy

作　　者：冯园 粟小芸 初红[1] 刘书平[1] 付秀娟[1] 孔祥泉[2] 卢祖能[1] Feng Yuan;Su Xiaoyun;Chu Hong;Liu Shuping;Fu Xiujuan;Kong Xiangquan;Lu Zuneng(Department of Neurology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Radiology,Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]武汉大学人民医院神经内科,430060 [2]华中科技大学同济医学院附属协和医院放射科,430030

出　　处：《中华神经科杂志》2019年第11期912-918,共7页Chinese Journal of Neurology

摘　　要：目的探讨慢性炎性脱髓鞘性多发性神经根神经病(CIDP)患者临床、肌电图与磁共振神经成像(MRN)所示神经根横截面积(nr-CSA)的相关性。方法收集2017年5月至2019年5月就诊于武汉大学人民医院神经内科的经典型CIDP患者进行横断面研究。采用Hughes残疾评分评估病情严重程度;分析正中、尺、胫、腓、腓肠神经的运动传导速度(MCV)、复合肌肉动作电位(CMAP)波幅、F波潜伏期和感觉传导速度(SCV)、感觉神经动作电位(SNAP)波幅,所测神经均可引出波形为A组,一条及以上神经测不出波形为B组;采用MRN定量测定臂丛和腰骶丛nr-CSA;用线性回归分析临床、电生理与MRN的相关性。结果符合标准的经典型CIDP患者共32例,其中男性占75%(24例);A组16例,B组16例,F波潜伏期的异常率最高。两组脑脊液蛋白和残疾评分与臂丛和腰骶丛nr-CSA均呈显著正相关(A组:脑脊液蛋白和臂丛nr-CSA:r=0.498,P=0.004;脑脊液蛋白和腰骶丛nr-CSA:r=0.479,P=0.007;残疾评分和臂丛nr-CSA:r=0.650,P=0.000;残疾评分和腰骶丛nr-CSA:r=0.625,P=0.000。B组:脑脊液蛋白和臂丛nr-CSA:r=0.497,P=0.049;脑脊液蛋白和腰骶丛nr-CSA:r=0.503,P=0.047;残疾评分和臂丛nr-CSA:r=0.605,P=0.001;残疾评分和腰骶丛nr-CSA:r=0.648,P=0.000)。两组正中和尺神经MCV与臂丛nr-CSA呈负相关(A组:正中神经MCV和臂丛nr-CSA:r=-0.309,P=0.019;尺神经MCV和臂丛nr-CSA:r=-0.286,P=0.027。B组:正中神经MCV和臂丛nr-CSA:r=-0.660,P=0.000;尺神经MCV和臂丛nr-CSA:r=-0.581,P=0.001),B组正中和尺神经F波潜伏期与臂丛nr-CSA呈正相关,胫神经CMAP波幅和腓肠神经SNAP波幅与腰骶丛nr-CSA呈正相关。结论CIDP患者以男性为主;臂丛和腰骶丛nr-CSA越大,脑脊液蛋白和残疾评分越高;臂丛nr-CSA越大,正中和尺神经MCV越慢。对于神经损伤更严重的B组患者,臂丛nr-CSA越大,正中和尺神经F波潜伏期越长,腰骶丛nr-CSA越大,胫神经CMAP波幅和腓肠神经SNAP波幅越低�Objective To explore the association among clinical features,electromyography(EMG)and magnetic resonance neurography(MRN)in patients with chronic inflammatory demyelinating polyradiculoneuropathy(CIDP).Methods A cross-sectional survey was conducted to enroll consecutively typical CIDP patients in Renmin Hospital of Wuhan University from May 2017 to May 2019.The Hughes Disability Scale(HDS)was used to evaluate the illness severity of the patients.The electrodiagnostic parameters including motor conduction velocity(MCV),compound muscle action potential(CMAP),F-wave latency,sensory nerve conduction velocity(SCV)and sensory nerve action potential(SNAP)of upper and lower limbs were analyzed.The patients whose response waveform can be elicited in all nerves were defined as group A,and those without response in one or more nerves as group B.MRN quantitative technique was used to calculate the cross-sectional area of nerves roots(nr-CSA)of brachial plexus and lumbosacral plexus.The linear regression method was used to analyze the correlation among clinical features,EMG and nr-CSA.Results A total of 32 patients with typical CIDP met the criteria,75%(24/32)of whom were males.There were 16 patients in the mild group(group A)and 16 in the severe one(group B).The abnormal rate of F-wave latency was the highest.Cerebrospinal fluid(CSF)protein,HDS score were correlated significantly with the nr-CSA of brachial plexus and lumbosacral plexus in the two groups(group A:CSF protein and brachial plexus nr-CSA:r=0.498,P=0.004;CSF protein and lumbosacral plexus nr-CSA:r=0.479,P=0.007;HDS score and brachial plexus nr-CSA:r=0.650,P=0.000;HDS score and lumbosacral plexus nr-CSA:r=0.625,P=0.000.group B:CSF protein and brachial plexus nr-CSA:r=0.497,P=0.049;CSF protein and lumbosacral plexus nr-CSA:r=0.503,P=0.047;HDS score and brachial plexus nr-CSA:r=0.605,P=0.001;HDS score and lumbosacral plexus nr-CSA:r=0.648,P=0.000).MCV of median nerve and ulnar nerve was negatively correlated with nr-CSA of brachial plexus in the two groups(group A:M

关 键 词：多发性神经根性神经病 慢性感染性脱髓鞘性 肌电描记术 磁共振成像 

分 类 号：R74[医药卫生—神经病学与精神病学]