高频超声检测吉兰巴雷综合征尺桡神经变化对周围神经损害的预测价值  

Predictive Value of High-frequency Ultrasound in Detecting the Changes of the Radial Ulnar Nerve in Guillain-Barre Syndrome to Peripheral Nerve Damage

作　　者：徐竹 楚兰 胡小丽 张艺凡 黄娴 XU Zhu;CHU Lan;HU Xiao-li;ZHANG Yi-fan;HUANG Xian(Department of Neurology,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou Province,550004 China;Department of Imaging,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou Province,550004 China)

机构地区：[1]贵州医科大学附属医院神经内科,贵州贵阳550004 [2]贵州医科大学附属医院影像科,贵州贵阳550004

出　　处：《世界复合医学》2021年第1期35-39,共5页World Journal of Complex Medicine

基　　金：贵州省科技厅联合基金项目[黔科合J字(2009)2162号]。

摘　　要：目的探讨高频超声分析吉兰-巴雷综合征(guillain-barre syndrome,GBS)患者周围神经的影像改变对周围神经损害的预测价值。方法随机选取2009年1月—2013年11月就诊于贵阳医学院附属医院的GBS患者及贵阳医学院体检中心健康对照者,各100例,收集上肢尺神经及桡神经的直径、横经和横截面积(CSA);收集尺、桡神经的高频超声声像变化;比较GBS脱髓鞘者、轴索损害者和健康对照周围神经参数和声像变化,以预测GBS患者周围神经损害及对患者预后的判断。结果①健康对照组(HCs)桡神经长径四分位数4.50(0.55)m、横径四分位数2.12(0.30)m、横截面积(CSA)四分位数7.42(1.98)mm^(2);HCs尺神经长径四分位数3.18(0.81)m、横径四分位数1.85(0.25)m、横截面积(CSA)四分位数4.65(1.84)mm^(2);GBS脱髓鞘组(GBS-d)桡神经长径四分位数5.40(0.76)m、横径四分位数2.41(0.63)m、横截面积(CSA)四分位数10.05(4.15)mm^(2);GBS-d尺神经长径四分位数3.83(0.46)m、横径四分位数1.85(0.20)m、横截面积(CSA)四分位数5.51(1.34)mm^(2);GBS轴索变性组(GBS-a)桡神经长径四分位数4.95(0.46)m、横径四分位数2.00(0.25)m、横截面积(CSA)四分位数7.87(1.66)mm^(2);GBS-a尺神经长径四分位数3.30(0.50)m、横径四分位数1.90(0.16)m、横截面积(CSA)四分位数5.00(1.11)mm^(2)。经统计分析HCs桡神经及尺神经的直径和横截面(CSA)均小于GBS患者,差异有统计学意义(P<0.001);GBS-d和GBS-a之间超声改变差异有统计学意义(χ^(2)=27.440,P<0.001);②GBS患者双上肢肌无力、肌萎缩和麻木均与轴索变性相关,差异有统计学意义(χ^(2)=15.880,P<0.001;χ^(2)=19.290,P<0.001;χ^(2)=7.656,P=0.006);③GBS患者早期,甚至在电生理改变不明显时,已发生了神经肿大。结论超声检测周围神经的直径和横截面(CSA)可以作为周围神经病定位和定性诊断的可靠依据,脱髓鞘改变为主的GBS患者的周围神经横截面(CSA)通常比轴索变性为主者增大�Objective To investigate the predictive value of high-frequency ultrasound analysis of peripheral nerve imaging changes in patients with Guillain-Barre syndrome(GBS)on peripheral nerve damage.Methods Randomly selected 100 GBS patients in the Affiliated Hospital of Guiyang Medical College from January 2009 to November 2013 and 100 healthy controls from the Physical Examination Center of Guiyang Medical College.The diameter and cross-sectional area of the upper limb ulnar nerve,transverse diamenter and radial nerve were collected(CSA);Collect the changes of high-frequency ultrasound images of the ulnar and radial nerves;compare the changes in peripheral nerve parameters and acoustic images of GBS demyelinated,axonal damage and healthy controls to predict peripheral nerve damage and the prognosis of patients with GBS judgment.Results 1.Healthy control group(HCs)radial nerve quartile of length 4.50(0.55)m,transverse diameter quartile of 2.12(0.30)m,cross-sectional area(CSA)quartile of 7.42(1.98)mm^(2);HCs ulnar nerve long diameter quartile 3.18(0.81)m,transverse diameter quartile 1.85(0.25)m,cross-sectional area(CSA)quartile 4.65(1.84)mm^(2);GBS demyelination group(GBS-d)radial nerve long diameter quartile 5.40(0.76)m,transverse diameter quartile 2.41(0.63)m,cross-sectional area(CSA)quartile 10.05(4.15)mm^(2);GBS-d Ulnar nerve long diameter quartile 3.83(0.46)m,transverse diameter quartile 1.85(0.20)m,cross-sectional area(CSA)quartile 5.51(1.34)mm^(2);GBS axonal degeneration group(GBS-a)radial nerve long diameter quartile 4.95(0.46)m,transverse diameter quartile 2.00(0.25)m,cross-sectional area(CSA)quartile 7.87(1.66)mm^(2);GBS-a ulnar nerve length diameter quartile was 3.30(0.50)m,the transverse diameter quartile was 1.90(0.16)m,and the cross-sectional area(CSA)quartile was 5.00(1.11)mm^(2).According to statistical analysis,the diameter and cross-section(CSA)of HCs radial nerve and ulnar nerve are smaller than those of GBS patients,the difference was statistically significant(P<0.001);the ultrasound changes between

关 键 词：超声检查 周围神经 吉兰-巴雷综合征 尺神经 桡神经 

分 类 号：R741[医药卫生—神经病学与精神病学]