副肿瘤性周围神经病的神经电生理特点
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摘要
目的研究副肿瘤性周围神经病(paraneoplastic peripheral neuropathy,PPN)的神经电生理特点.方法回顾性分析2000年1月至2017年6月昆明医科大学第一附属医院神经内科住院的29例副肿瘤性周围神经病患者上下肢运动、感觉神经电生理特点.测定指标包括:(1)正中神经、尺神经、胫神经、腓总神经运动神经传导速度、末端运动潜伏期、复合肌肉动作电位波幅;(2)正中神经、尺神经、胫神经、腓浅神经感觉神经传导速度、感觉神经动作电位波幅;(3)正中神经、胫神经F波.结果 (1)副肿瘤性周围神经病患者上下肢感觉运动神经均受损,波幅总异常率高于神经传导速度总异常率(P<0.05),感觉神经动作电位波幅异常率高于运动神经复合肌肉动作电位波幅异常率(P<0.05),运动神经传导速度与感觉神经传导速度异常率比较,无统计学差异(P>0.05);(2)神经传导检测下肢异常率高于上肢(P<0.05);(3)F波异常率低于神经传导检测异常率(P<0.05).结论副肿瘤性周围神经病神经电生理表现为感觉运动神经病多见,远端损害重,下肢比上肢损害明显,以感觉神经轴突损害为主,运动和感觉神经脱髓鞘程度相似.分析周围神经病的神经电生理特点能为早期诊断提供客观依据.
Objective To study the neuro electrophysiological characteristics of paraneoplastic peripheral neuropathy(PPN). Me thods A retrospective study was conducted for 29 PPN patients consecutively referred to Neurology Department of the First Affiliated Hospital of Kunming Medical University between January 2000 and June2017. The electrophysiological characteristics of motor nerves, sensory nerves of upper and lower limbs were analyzed. Measurement indicators include:(1) The motor conduction velocity and compound muscle action potential amplitude of median, ulnar, tibial, and common peroneal nerves;(2) The sensory conduction velocity and sensory nerve action potential amplitude of median, ulnar, tibial, and superficial peroneal nerves;(3) F waves of median and tibial nerves.Results(1) For patients with PPN, their motor and sensory nerves in upper and lower limbs were damaged. The total anomaly rate of the amplitude was higher than that of the nerve conduction velocity(P<0.05), while the abnormal rate of amplitude of sensory nerve action potential was greater than that of motor nerve compound muscle action potential(P<0.05). Abnormal motor nerve conduction velocityhad a similar incidence to abnormal sensory nerve conduction velocity(P>0.05).(2) Nerve conduction study showed that abnormality rate of lower extremity is higher than that of upper extremity.(3) Abnormal F waves were observed less frequently than abnormal nerve conduction rates(P<0.05). Conclusions The electrophysiological properties of PPN were frequently seen in sensorimotor neuropathy. The damage of distal extremities is more serious.The damage in lower extremity is more severe than that in the upper extremity. The axonal damage mainly occurred in sensory nerves. There is no obvious difference in the degree of demyelination between motor and sensory nerves.Evidence can be provided by analyzing the neuro ectrophysiological characteristics for diagnosis of paraneoplastic peripheral neuropathy in early stage.
Objective To study the neuro electrophysiological characteristics of paraneoplastic peripheral neuropathy(PPN). Me thods A retrospective study was conducted for 29 PPN patients consecutively referred to Neurology Department of the First Affiliated Hospital of Kunming Medical University between January 2000 and June2017. The electrophysiological characteristics of motor nerves, sensory nerves of upper and lower limbs were analyzed. Measurement indicators include:(1) The motor conduction velocity and compound muscle action potential amplitude of median, ulnar, tibial, and common peroneal nerves;(2) The sensory conduction velocity and sensory nerve action potential amplitude of median, ulnar, tibial, and superficial peroneal nerves;(3) F waves of median and tibial nerves.Results(1) For patients with PPN, their motor and sensory nerves in upper and lower limbs were damaged. The total anomaly rate of the amplitude was higher than that of the nerve conduction velocity(P<0.05), while the abnormal rate of amplitude of sensory nerve action potential was greater than that of motor nerve compound muscle action potential(P<0.05). Abnormal motor nerve conduction velocityhad a similar incidence to abnormal sensory nerve conduction velocity(P>0.05).(2) Nerve conduction study showed that abnormality rate of lower extremity is higher than that of upper extremity.(3) Abnormal F waves were observed less frequently than abnormal nerve conduction rates(P<0.05). Conclusions The electrophysiological properties of PPN were frequently seen in sensorimotor neuropathy. The damage of distal extremities is more serious.The damage in lower extremity is more severe than that in the upper extremity. The axonal damage mainly occurred in sensory nerves. There is no obvious difference in the degree of demyelination between motor and sensory nerves.Evidence can be provided by analyzing the neuro ectrophysiological characteristics for diagnosis of paraneoplastic peripheral neuropathy in early stage.
引文
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[13]王宪玲,贾建平.以运动障碍起病的癌性周围神经病[J].脑与神经疾病杂志,2006,14(6):404-406.
[14]OH S J,GRTEKIN Y,DROPCHO E J,et al.Anti-Hu antibody neuropathy:a clinical,electrophysiological,and pathological study[J].Clin Neurophysiol,2005,116(1):28-34.
[15]钱传忠,陈卓友.副肿瘤性周围神经病15例临床分析[J].临床神经病学杂志,2007,20(1):79.
[16]郭玉璞,Pollard J,Mcleod J G.癌性周围神经病(附7例临床和神经活检观察)[J].中华神经精神科杂志,1989,22(4):216-219.
[17]GAZIC B,PISEMJ,DOLENC-GROSEL J L,et al.Paraneoplastic encephalomyelitis/sensory motor peripheral neuropathy-an autopsy case study[J].Folia Neuropathol,2005,43(2):113-117.
[2]GRAUS F,DELATTRE J Y,ANTOINE J C,et al.Recommended diagnostic criteria for paraneoplastic neurological syndromes[J].Neurol Neurosurg Psychiatry,2004,75(8):1135-1140.
[3]DAVID C,PRESTON M D.Electromyography and neuromuscular disorders[M].London:Elsevier Inc,2013:625-629.
[4]王锁彬,贾建平.副肿瘤性周围神经病的诊断分析[J].中国现代神经疾病杂志,2010,10(3):392-394.
[5]郑当,曾兆光.硫锌酸联合甲钴胺治疗2型糖尿病并周围神经病变的疗效及安全性[J].昆明医科大学学报,2016,37(2):130-132.
[6]徐玉善,王曦,李红.2型糖尿病周围神经病变与颈动脉内膜中层厚度的关系探讨[J].昆明医学院学报,2009,30(1):46-49.
[7]王丹,李仲铭,赵明洁.原发性干燥综合征患者周围神经电生理特点分析:前瞻性病例系列研究方案及预试验结果[J].中国组织工程研究,2018,22(12):1939-1943.
[8]CAMDESSANCH J P,ANTOINE J C,HONNORAT J,et al.Paraneoplastic peripheral neuropathy associated with anti-Hu antibodies:A clinical and electrophysiological study of 20 patients[J].Brain,2002,125(Pt1):166-175.
[9]RUDNICKI S A,DALMAU J.Paraneoplastic syndromes of the peripheral nerves[J].Curr Opin Neurol,2005,18(5):598-603.
[10]ANTOINE J C,CAMDESSANCHE J P.Peripheral nervous system involvement in patients[J].Lancet Neurulogy,2007,6(1):75-86.
[11]魏中华,谢炳.副肿瘤性周围神经病的临床及神经电生理特点分析[J].广东医学,2013,34(2):288-291.
[12]党静霞.肌电图诊断与临床应用[M].第2版.北京:人民卫生出版社,2013:295-296.
[13]王宪玲,贾建平.以运动障碍起病的癌性周围神经病[J].脑与神经疾病杂志,2006,14(6):404-406.
[14]OH S J,GRTEKIN Y,DROPCHO E J,et al.Anti-Hu antibody neuropathy:a clinical,electrophysiological,and pathological study[J].Clin Neurophysiol,2005,116(1):28-34.
[15]钱传忠,陈卓友.副肿瘤性周围神经病15例临床分析[J].临床神经病学杂志,2007,20(1):79.
[16]郭玉璞,Pollard J,Mcleod J G.癌性周围神经病(附7例临床和神经活检观察)[J].中华神经精神科杂志,1989,22(4):216-219.
[17]GAZIC B,PISEMJ,DOLENC-GROSEL J L,et al.Paraneoplastic encephalomyelitis/sensory motor peripheral neuropathy-an autopsy case study[J].Folia Neuropathol,2005,43(2):113-117.