慢性炎性脱髓鞘性多发神经根神经病和多灶性运动神经病临床对比分析  

Clinical comparative analysis of chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy

作　　者：陈雪婷 郑惠文 张琪 刘洁 张作慧 刘永海 CHEN Xueting;ZHENG Huiwen;ZHANG Qi;LIU Jie;ZHANG Zuohui;LIU Yonghai(The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院,江苏徐州221004

出　　处：《中国实用神经疾病杂志》2020年第16期1386-1392,共7页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:81501095);江苏省自然科学基金青年基金(编号:BK20150219);江苏省卫生计生委青年科研课题(编号:Q201505)。

摘　　要：目的对比分析慢性炎性脱髓鞘性多发神经根神经病(CIDP)和多灶性运动神经病(MMN)的临床特征和肌电图特点,以期指导临床诊疗。方法收集2015-01—2020-01徐州医科大学附属医院收治的MMN患者8例,并与17例同期住院治疗的与之性别、年龄相匹配的CIDP患者临床表现、肌电图特点和脑脊液结果进行比较。结果CIDP组患者症状多表现为对称性双下肢远端麻木或无力,多从远端向近端进展,而MMN组患者以不对称上肢肌无力为主,两者相比差异有统计学意义(P<0.05)。CIDP组感觉障碍和腱反射减弱比例高于MMN组,而肌肉萎缩比例低于MMN组,差异有统计学意义(P<0.05)。CIDP组脑神经麻痹比例较MMN组稍高,但两者相比差异无统计学意义(P>0.05)。与正常对照组相比,CIDP组和MMN组均有复合肌肉动作电位(CMAP)波幅减低、运动神经传导速度(MNCV)减慢和F波潜伏期延长;CIDP组还表现为明显的远端潜伏期(DL)延长;MMN组虽无DL延长,但有明显的运动神经传导阻滞;CIDP组在MNCV减慢、DL延长、F波潜伏期延长、CMAP波幅减低方面的程度比MMN组重。与正常对照组相比,CIDP组感觉神经动作电位波幅(SNAP)明显减低、感觉神经传导速度(SNCV)明显减慢(P<0.001),而MMN组与正常对照组相比差异则无统计学意义(P>0.05)。结论CIDP组为弥漫性对称性的运动神经感觉神经脱髓鞘,MMN组为仅累及运动神经的局灶性脱髓鞘改变,2组患者均有继发性轴索损害,而CIDP组较重。Objective To analyze the clinical characteristics and electrophysiological features of chronic inflammatory demyelinating polyneuropathy(CIDP)and multifocal motor neuropathy(MMN)in order to guide clinical diagnosis.Methods A retrospective study was conducted on 8 patients with MMN who treated in the Affiliated Hospital of Xuzhou Medical University between January 2015 to January 2020.Then,these patients were compared with 17 cases of age and sex-matched CIDP patients in aspect of clinical manifestations,electrophysiological features and lumbar puncture laboratory results.Results Clinical features of CIDP group were symmetrical weakness or numbness in distal lower limb and always developed from distal to proximal,the features of MMN group were asymmetric weakness in distal upper extremity,and there was statistically significant difference between the two groups.Compared with MMN group,the proportion of combining sensory symptoms and tendon reflexes weakened in the CIDP group were statistically significantly higher,but the proportion of combining muscle atrophy in CIDP group were significantly lower than that of MMN group.The rate of combining cranial nerve involvement in CIDP groups were slightly higher,but there was no statistically significant difference between the two groups.Compared with health control group,CIDP and MMN group has the characters of decreasing of compound muscle action potentials(CMAP),slowing down of motor nerve conductive velocities(MNCV)and prolonging of F wave latency.CIDP group also has the characters of prolonging of distal latencies(DL).Besides,obvious and continuous motor nerve conduction block occurred in MMN group.The decreasing of CMAP,slowing down of MNCV,prolonging of DL and F wave latency in CIDP were more serious than that of MMN group.Compared with health control group,the mean sensory nerve action potentials(SNAP)and sensory nerve conductive velocities(SNCV)in CIDP were significantly reduced(P<0.001),but there was no statistically significant difference between MMN group and h

关 键 词：慢性炎性脱髓鞘性多发神经根神经病 多灶性运动神经病 临床特点 神经电生理 脱髓鞘 轴索损害 传导阻滞 

分 类 号：R745[医药卫生—神经病学与精神病学]