神经型布氏杆菌病周围神经损害的临床与电生理研究
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摘要
目的研究神经型布氏杆菌病周围神经损害的临床特征,探讨电生理对其的诊断价值。方法对32例神经型布氏杆菌病周围神经损害患者(病例组)和32名性别及年龄与病例组匹配的正常对照组进行神经电生理检查,并对所得检查结果进行统计学分析。结果病例组与对照组在运动末梢潜伏期(distal motor latency,DML)、复合肌肉动作电位(compound motor active potentials,CMAP)波幅、运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经动作电位潜伏期(sensory nerve action potential latency,SL)、感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉神经传导速度(sensory nerve conduction velocity,SCV)方面的比较,差异均有统计学意义(P<0.05)。电生理检查提示上下肢周围神经损害,感觉神经及运动神经均受累,其中感觉神经占55.47%,运动神经占16.80%,上肢以正中神经(64条)最多见,下肢以腓肠神经(16条)最多见。四肢运动神经256条中43条传导速度减慢,占16.80%,四肢感觉神经256条中142条传导速度减慢,占55.47%,SCV较MCV改变明显,上肢病变重于下肢。结论神经电生理检查为神经型布氏杆菌病周围神经损害的临床诊断提供了客观依据。
Objective To characterize the clinical manifestations and to evaluate the value of the electrophysio-logical examination in patients with peripheral nerves injuries caused by neurobrucellosis. Methods Electrophysiology examination was conducted in 32 patients with peripheral nerve injuries caused by neurobrucellosis and 32 normal controls who had equivalent age and gender. The results were further statistically analyzed. Results There were significant difference between patients and healthy control group in distal motor latency(DML), compound motor active potentials(CMAP) amplitude, motor nerve conduction velocity(MCV), sensory nerve action potential latency(SL),senso-ry nerve action potential(SNAP) amplitude and sensory nerve conduction velocity(SCV)( P ﹤ 0.05). Electrophysiology examination revealed peripheral nerve damage of limbs involving, both sensory nerve and motor nerves, of which sen-sory and motor nerve injuries accounted for 55.47% and 16.80%, respectively. Median and sural nerve injuries were most frequently affected in upper(64) and lower limbs(16). Motor and sensory nerve conduction velocity was delayed in 43 nerves(16.80%) of 256 examined motor nerves and in 142 nerves(55.47%) of 256 examined sensory nerves.The damage of the sensory nerves was more severe than those of the motor nerves and damage of nerves in the upper limbs was more severe than those in the lower limbs. Conclusion Electrophysiologoical examination provides objective basis for the diagnosis of peripheral nerve injuries in neurobrucellosis.
Objective To characterize the clinical manifestations and to evaluate the value of the electrophysio-logical examination in patients with peripheral nerves injuries caused by neurobrucellosis. Methods Electrophysiology examination was conducted in 32 patients with peripheral nerve injuries caused by neurobrucellosis and 32 normal controls who had equivalent age and gender. The results were further statistically analyzed. Results There were significant difference between patients and healthy control group in distal motor latency(DML), compound motor active potentials(CMAP) amplitude, motor nerve conduction velocity(MCV), sensory nerve action potential latency(SL),senso-ry nerve action potential(SNAP) amplitude and sensory nerve conduction velocity(SCV)( P ﹤ 0.05). Electrophysiology examination revealed peripheral nerve damage of limbs involving, both sensory nerve and motor nerves, of which sen-sory and motor nerve injuries accounted for 55.47% and 16.80%, respectively. Median and sural nerve injuries were most frequently affected in upper(64) and lower limbs(16). Motor and sensory nerve conduction velocity was delayed in 43 nerves(16.80%) of 256 examined motor nerves and in 142 nerves(55.47%) of 256 examined sensory nerves.The damage of the sensory nerves was more severe than those of the motor nerves and damage of nerves in the upper limbs was more severe than those in the lower limbs. Conclusion Electrophysiologoical examination provides objective basis for the diagnosis of peripheral nerve injuries in neurobrucellosis.
引文
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[2]SKALSKY K,YAHAV D,BISHARA J,et al.Treatment of human brucellosis:systematic review and meta-analysis of randomized controlled trials[J].BMJ,2008,336(7646):701-704.
[3]许莉,牛松涛.神经系统布氏杆菌病研究现状[J].中华神经科杂志,2009,42(10):706-707.
[4]AKDENIZ H,IRMAK H,ANLAR O,et al.Central nervous system brucellosis:presentation,diagnosis and treatment[J].J Infect,1998,36(3):297-301.
[5]SCHOONMAN L.Epidemiology of leptospirosis and other zoonotic diseases in cattle in Tanzania and their relative risk to public health[M].UK:University of Reading,2007:98-102.
[6]SWAI E,SCHOONMAN L.Human Brucellosis:Seroprevalence and risk factors related to high risk occupational groups in tanga municipality,Tanzania[J].Zoonoses Public Health,2009,56(4):183-187.
[7]王昭旖,邓文静,张瑞峰,等.布氏杆菌病合并吉兰-巴雷综合征临床研究[J].中国实用神经疾病杂志,2014,17(23):30-32.
[8]KOJAN S,ALOTHMAN A,ALTHANI Z,et al.Granulomatous myositis associated with brucellosis:A case report and literature review[J].Muscle&nerve,2012,45(2):290-293.
[9]DESHAYES P,BARTHES C,WEBER J,et al.Cauda equina syndrome caused by epiduritis,disclosing brucellar spondylodiscitis and hepatitis[J].Revue du rhumatisme et des maladies osteo-articulaires,1979,47(7-9):527-527.
[10]傅强,周莹雪,赵美萍,等.以周围神经损伤为主要表现的布氏杆菌病1例报告[J].中风与神经疾病杂志,2014,31(2):172.
[11]矫黎东,王宪玲,袁泉,等.神经型布氏杆菌病6例临床分析[J].北京医学,2015,37(5):412-414.
[12]GUL H C,ERDEM H,BEK S.Overview of neurobrucellosis:a pooled analysis of 187 cases[J].Int J Infect Dis,2009,13(6):339-343.
[13]宋秀娟,许艳秋,王慧词,等.神经型布氏杆菌病四例[J].脑与神经疾病杂志,2016,24(4):210-213.
[14]GUL H C,ERDEM H,BEK S.Overview of neurobrucellosis:a pooled analysis of 187 cases[J].International Journal of Infectious Diseases,2009,13(6):e339-e343.
[15]马军,王林,王建龙.64例布氏杆菌病的治疗体会[J].中国医药指南,2015,30:41.
[16]KUTLU G,ERTEM G T,COSKUN O,et al.Brucella:a cause of peripheral neuropathy[J].European neurology,2008,61(1):33-38.
[17]逯英,刘之荣,赵钢.以双下肢截瘫为主要表现的布氏杆菌病1例[J].中国神经精神疾病杂志,2011,37(1):58-59.
[18]AL-SOUS M W,BOHLEGA S,AL-KAWI M Z,et al.Neurobrucellosis:clinical and neuroimaging correlation[J].American journal of neuroradiology,2004,25(3):395-401.