视神经脊髓炎谱系疾病周围神经病变的相关神经电生理研究
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摘要
目的探讨视神经脊髓炎谱系疾病(NMOSD)周围神经病变的神经电生理改变。方法对15例NMOSD患者(NMOSD组)及20名健康对照者(正常对照组)进行EMG检查。结果 NMOSD组中,10例(66.7%)患者的EMG检查有异常改变,主要表现为运动或感觉神经传导速度减慢,波幅减低,F波出现率下降和H反射的潜伏期延长。与正常对照组比较,NMOSD组胫神经及腓总神经运动神经传导速度显著降低(均P<0.01),正中神经远/近段潜伏期、胫神经远端潜伏期显著升高(均P<0.05),胫神经、腓总神经运动神经远/近端波幅显著降低(均P<0.01)。与正常对照组比较,NMOSD组尺神经、正中神经、腓肠神经感觉神经传导速度显著减慢(均P<0.01),腓肠神经感觉神经潜伏期显著升高(P<0.01),正中神经、腓肠神经感觉神经波幅显著降低(均P<0.01)。NMOSD组H反射潜伏期(26.22±10.10)与正常对照组(24.36±0.63)差异无统计学意义(P>0.05)。结论 NMOSD患者可以合并周围神经系统受损。EMG检查主要表现为运动或感觉神经传导速度减慢,波幅减低,F波出现率下降和H反射的潜伏期延长。
Objective To investigate the neuroelectrophysiological changes of peripheral neuropathy in neuromyelitis optic spectrum disease( NMOSD). Methods Fifteen patients with NMOSD( NMOSD group) and 20 healthy controls( normal control group) underwent EMG examination. Results In the NMOSD group,10 patients( 66. 7%) had abnormal EMG findings,which mainly features were motor or sensory nerve conduction velocity slowed down,amplitude decreases,F wave rate decreases and H reflex latency prolongs. Compared with the normal control group,the motor nerve conduction velocity in the tibial nerve and the common peroneal nerve of the NMOSD group were significantly decreased( all P < 0. 01); the latency of the distal and proximal segments of the median nerve and the distal latency of the tibial nerve were significantly increased( all P < 0. 05); the tibial nerve and peroneal nerve motor distal/proximal amplitude were significantly reduced( all P < 0. 01). Compared with the normal control group,sensory nerve conduction velocity of the ulnar nerve,median nerve and sural nerve of the NMOSD group were significantly slowed down( all P < 0. 01),and sensory nerve latency of the sural nerve increased significantly( P <0. 01),the median nerve,sural nerve sensory nerve amplitude was significantly reduced( all P < 0. 01). There was no significant difference in H reflex latency( 26. 22 ± 10. 10) between NMOSD group and normal control group( 24. 36 ± 0. 63)( P > 0. 05). Conclusions Patients with NMOSD may be associated with peripheral nervous system lesions. The results of EMG examination are mainly slowed down by motor or sensory nerve conduction velocity,decreased amplitude,decreased F wave rate and prolonged latency of H reflex.
Objective To investigate the neuroelectrophysiological changes of peripheral neuropathy in neuromyelitis optic spectrum disease( NMOSD). Methods Fifteen patients with NMOSD( NMOSD group) and 20 healthy controls( normal control group) underwent EMG examination. Results In the NMOSD group,10 patients( 66. 7%) had abnormal EMG findings,which mainly features were motor or sensory nerve conduction velocity slowed down,amplitude decreases,F wave rate decreases and H reflex latency prolongs. Compared with the normal control group,the motor nerve conduction velocity in the tibial nerve and the common peroneal nerve of the NMOSD group were significantly decreased( all P < 0. 01); the latency of the distal and proximal segments of the median nerve and the distal latency of the tibial nerve were significantly increased( all P < 0. 05); the tibial nerve and peroneal nerve motor distal/proximal amplitude were significantly reduced( all P < 0. 01). Compared with the normal control group,sensory nerve conduction velocity of the ulnar nerve,median nerve and sural nerve of the NMOSD group were significantly slowed down( all P < 0. 01),and sensory nerve latency of the sural nerve increased significantly( P <0. 01),the median nerve,sural nerve sensory nerve amplitude was significantly reduced( all P < 0. 01). There was no significant difference in H reflex latency( 26. 22 ± 10. 10) between NMOSD group and normal control group( 24. 36 ± 0. 63)( P > 0. 05). Conclusions Patients with NMOSD may be associated with peripheral nervous system lesions. The results of EMG examination are mainly slowed down by motor or sensory nerve conduction velocity,decreased amplitude,decreased F wave rate and prolonged latency of H reflex.
引文
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[13]Warabi Y,Yamazaki M,Shimizu T,et al.Abnormal nerve conduction study findings indicating the of peripheral neuropathy in multiple sclerosis and neuromyelitis optica[J].Biomed Res Int,2013,10:1155.
[14]Gold R,Hartung HP,Toyka KV.Animal models for autoimmune demyelinafing disorders of the ncrvou-system[J].Mol Med Today,2000,6:88.
[15]李美山.中枢-周围炎症性脱髓鞘综合征的临床及基础研究进展[J].临床神经电生理杂志,2002,11:252.
[16]詹淑琴,谢淑萍,王玉平,等.多发性硬化周围神经损害[J].中华神经科杂志,2003,36:8.
[2]王楚涵,邸卫英,李晓芳,等.极后区综合征起病的视神经脊髓炎谱系病1例报告[J].临床神经病学杂志,2017,30:400.
[3]邵冰,楚兰,徐竹,等.极后区综合征在视神经脊髓炎谱系疾病中的研究进展[J].临床神经病学杂志,2017,30:385.
[4]Lennon VA,Wingerchuk DM,Kryzer TJ,et al.A serum autoantibody marker of neuromyelitis optica:distinction from multiple sclerosis[J].Lancet,2004,364:2106.
[5]Sarova-Pinhas I,Achiron A,Gilad R,et al.Peripheral neuropathy in multiple sclerosis:a clinical and electrophysiologic study[J].Acta Neurol Scand,1995,91:234.
[6]Misawa S,Kuwabara S,Mori M,et al.Peripheral nerve demyelination in multiple sclerosis[J].Clinical Neurophysiology,2008,119:1829.
[7]Kamm C,Zettl UK.Autoimmune disorders affecting both the central and peripheral nervous system[J].Autoimmun Rev,2012,11:196.
[8]Wingerchuk DM,Banwell B,Bennett JL,et al.Internatinal panel for NMO diagnosis.International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J].Neurology,2015,85:177.
[9]Aimoto Y,Ito K,Moriwaka F,et al.Demyelinating peripheral neuropathy in Devic disease[J].Jpn J Psychiatry Neurol,1991,45:861.
[10]Kitada M,Suzuki H,Ichihashi J,et al.Acute combined central and peripheral demyelination showing anti-aquaporin 4 antibody positivity[J].Intern Med,2012,51:2443.
[11]Grewal AK,Lopes MB,Berg CL,et al.Recurrent demyelinating myelitis associated with hepatitis C viral infection[J].Neurol Sci,2004,224:101.
[12]王亚丽,连亚军,吴川杰.伴周围神经损害的视神经脊髓炎谱系疾病一例[J].中华神经科杂志,2016,49:972.
[13]Warabi Y,Yamazaki M,Shimizu T,et al.Abnormal nerve conduction study findings indicating the of peripheral neuropathy in multiple sclerosis and neuromyelitis optica[J].Biomed Res Int,2013,10:1155.
[14]Gold R,Hartung HP,Toyka KV.Animal models for autoimmune demyelinafing disorders of the ncrvou-system[J].Mol Med Today,2000,6:88.
[15]李美山.中枢-周围炎症性脱髓鞘综合征的临床及基础研究进展[J].临床神经电生理杂志,2002,11:252.
[16]詹淑琴,谢淑萍,王玉平,等.多发性硬化周围神经损害[J].中华神经科杂志,2003,36:8.