秋水仙碱致可逆性轴索型感觉运动神经病  

Colchicine induced reversible axonal sensorimotor neuropathy

作　　者：陈海[1] 胡天芹 卢岩[1] 邸丽[1] 笪宇威[1] Chen Hai;Hu Tianqin;Lu Yan;Di Li;Da Yuwei(Department of Neurology,the Xuanwu Hospital of CapitalMedical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]和田地区人民神经内科

出　　处：《脑与神经疾病杂志》2021年第6期351-356,共6页Journal of Brain and Nervous Diseases

基　　金：北京市属医院科研培育项目(PX2017023)。

摘　　要：目的探讨秋水仙碱致周围神经病的临床特征、治疗和预后,提高临床医生对该药物导致周围神经损害的认识和重视。方法通过对秋水仙碱导致轴索性周围神经病患者的病程、发病早期、恢复期肌电图、肌肉磁共振结合相关辅助检查,对比分析秋水仙碱致周围神经损害的严重性和可逆性。结果患者男性,31岁,主因“双手、双足麻木无力2月余”于2020年5月13日收住首都医科大学宣武医院神经内科。患者主要表现为服用秋水仙碱后四肢远端无力、感觉障碍,停药后症状逐渐好转。患者有减肥、高尿酸血症病史。入院时阳性查体:四肢近端肌力4级,上肢远端3级,下肢远端1级,双上肢腱反射(+),下肢膝腱反射(++),跟腱反射(+),双踝以下音叉振动觉减弱。肌电图神经传导证实四肢严重的轴索型感觉运动神经病变。入院后停用秋水仙碱,给予甲钴胺针0.5mg·d-1x7d、维生素B1注射液100mg·d-1x7d治疗,患者无力症状改善,1个月后复查肌电图波幅较前好转,体征也较前好转。结论秋水仙碱对周围神经损害以轴索为主,及时停用可逆性恢复。Objective To investigate the clinical features,treatment and prognosis of colchicine induced peripheral neuropathy,and to improve clinicians'understanding and attention to the peripheral nerve damage caused by colchicine.Methods The severity and reversibility of colchicine induced peripheral nerve damage in a patient with colchicine induced axonal peripheral neuropathy were analyzed by comparing the course of disease,early onset and convalescent EMG,and muscular MRI combined with related auxiliary examinations.Results The patient was a 31 years old male with the hands feet numb to 2 months before admission.He was admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University on May 13,2020.The main symptoms of the patient were weakness in the extremities and sensory disturbance after taking colchicine,and the symptoms gradually improved after withdrawal of colchicine.The patient had a history of weight loss and hyperuricemia.He was proximal limb muscle strength grade 4,distal upper limb grade 3,distal lower limb grade 1,tendon reflex of both upper limbs(+),knee tendon reflex of lower limbs(++),Achilles tendon reflex(+),and vibration sense of tuning fork below both ankles was weakened.The nerve conduction confirmed severe axonal sensorimotor neuropathy in the extremities.After admission,colchicine was stopped,and he was treated with VitB1100mg·d-1×7d and VitB120.5mg·d-1×7d.His weakness symptoms were improved,and the amplitude of NCS and physical signs were improved after reexamination 1 month later.Conclusion Colchicine damage to the peripheral nerve mainly axons,timely stop reversible recovery.

关 键 词：秋水仙碱 轴索型 感觉运动神经病 可逆 

分 类 号：R745[医药卫生—神经病学与精神病学]