结节性多动脉炎并发周围神经病的临床表现和电生理特点分析  

Analysis of clinical manifestations and electrophysiological characteristics of polyarteritis nodosa complicated with peripheral neuropathy

作　　者：李一凡[1] 李懋[2] 徐菲[2] 杨飞[2] 王红芬[2] 柏秀娟[1] 陈朝晖[2] 凌丽[2] 黄旭升[2] Li Yifan;Li Mao;Xu Fei;Yang Fei;Wang Hongfen;Bai Xiujuan;Chen Zhaohui;Ling Li;Huang Xusheng(Department of Neurology,National Clinical Research Center for Geriatric Diseases,The Second Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心神经内科国家老年疾病临床医学研究中心,北京100853 [2]解放军总医院第一医学中心神经内科

出　　处：《北京医学》2022年第9期777-781,共5页Beijing Medical Journal

摘　　要：目的探讨结节性多动脉炎(polyarteritis nodosa,PAN)并发周围神经病的临床表现及神经电生理特点。方法选取2006年1月至2022年1月在解放军总医院第一医学中心住院治疗的PAN患者35例,对其临床资料、实验室及神经电生理检查结果进行回顾性分析,计算双侧同一神经的侧间波幅比(interside amplitude ratios,IAR)。结果35例PAN患者中有16例存在周围神经受损表现(45.7%),经神经电生理确诊为PAN并发周围神经病患者共10例(28.6%),其中男8例,女2例,发病年龄为(42.7±12.1)岁。4例以周围神经病症状首发,就诊时多为慢性病程(8/10),多发性单神经病(5/10),感觉运动均受累(9/10)和轴索损伤为主(8/10),1例为小纤维神经病。IAR可以发现神经电生理非对称性特点(6/10)。通过激素及免疫抑制剂治疗,超过半数患者周围神经症状得到缓解(6/10),全部接受了甲泼尼龙冲击治疗。结论PAN临床虽少见,但周围神经系统常受累,多为慢性病程和多发性单神经病。详细的神经电生理检查,包括针对小纤维神经的检查有助于疾病的诊断。甲泼尼龙冲击治疗可能有助于改善周围神经症状。Objective To investigate the clinical manifestations and electrophysiological characteristics of polyarteritis nodosa(PAN)complicated with peripheral neuropathy.Methods A total of 35 patients with PAN who were hospitalized in the First Medical Center of PLA General Hospital from January 2006 to January 2022 were selected.The clinical data,laboratory and neuro-electrophysiological examination results were retrospectively analyzed,and the interside amplitude ratios(IAR)of the same nerve on both sides were calculated.Results There were 16(45.7%)patients with peripheral nerve damage among the 35 PAN patients.Ten patients(28.6%)with peripheral neuropathy were diagnosed by neuroelectrophysiology,including eight males and two females,and the age of onset was(42.7±12.1)years old.Four patients presented with peripheral neuropathy at first,mostly with chronic disease course(8/10),mononeuritis multiplex(5/10),sensorimotor involvement(9/10)and axonal injury(8/10),and one patient with small fiber neuropathy.Neuroelectrophysiological asymmetry could be detected by IAR(6/10).By glucocorticoids and immunosuppressant treatments,neurological symptoms were relieved in more than half of the patients(6/10),who all received methylprednisolone pulse therapy.Conclusions Although PAN is rare in clinic,the peripheral nervous system is often involved,most of which are chronic course and mononeuritis multiplex.Detailed neuro-electrophysiological examination including small fiber function evaluation,is helpful in diagnosis.Methylprednisolone pulse therapy may help to improve peripheral nerve symptoms.

关 键 词：结节性多动脉炎 周围神经病 小纤维神经病 神经电生理检查 

分 类 号：R543.5[医药卫生—心血管疾病] R745[医药卫生—内科学]