急性运动轴索神经病的临床和电生理特点及其与预后的相关性研究
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摘要
目的研究急性运动轴索神经病(acute motor axonal neuropathy,AMAN)的临床和电生理特点及其与预后的相关性。方法分析我院神经科自2015年1月—2018年1月收治的54例AMAN患者的临床资料和神经电生理检查结果,探讨40例获随访者的临床和电生理特点与预后的相关性。结果预后较好组患者腹泻、上呼吸道感染、肝功能障碍、延髓功能障碍的发生率,住院时间、发病至入院时间及Hughes评分均显著低于预后较差组,差异具有统计学意义(P <0. 05)。预后较好组dCMAP异常、F波异常发生率显著低于预后较差组,正中神经MCV、尺神经MCV、胫神经MCV及腓总神经MCV显著高于预后较差组,差异具有统计学意义(P <0. 05)。AMAN患者预后与腹泻、上呼吸道感染、肝功能障碍、延髓功能障碍、dCMAP异常及F波异常呈负相关(P <0. 05)。结论 AMAN患者电生理改变主要为dCMAP及F波异常,而腹泻、上呼吸道感染、肝功能障碍、延髓功能障碍、dCMAP异常及F波异常可作为判断AMAN患者预后的观察项目。
Objective: To study the clinical and electrophysiological characteristics of acute motor axonal neuropathy and its correlation with prognosis. Methods: The clinical data and electrophysiological examination of 64 patients with AMAN from January 2016 to January 2018 in Neurological Department of our hospital were analyzed. The correlation between clinical and electrophysiological characteristics and prognosis of 40 patients were investigated. Results: The incidence of diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction,hospitalization time,time from onset to admission and Hughes score in patients with better prognosis were significantly lower than those in patients with poor prognosis( P < 0. 05). The incidence of abnormal dCMAP and F wave in the better prognosis group was significantly lower than that in the worse prognosis group. The Median nerve MCV,ulnar nerve MCV,tibial nerve MCV and common peroneal nerve MCV were significantly higher than those in the worse prognosis group( P < 0. 05). The prognosis of AMAN patients was negatively correlated with diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction and abnormal F wave( P < 0. 05). Conclusion: The main electrophysiological changes in AMAN patients are abnormal dCMAP and F wave,while diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction,abnormal dCMAP and F wave can be used as prognostic observation items.
Objective: To study the clinical and electrophysiological characteristics of acute motor axonal neuropathy and its correlation with prognosis. Methods: The clinical data and electrophysiological examination of 64 patients with AMAN from January 2016 to January 2018 in Neurological Department of our hospital were analyzed. The correlation between clinical and electrophysiological characteristics and prognosis of 40 patients were investigated. Results: The incidence of diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction,hospitalization time,time from onset to admission and Hughes score in patients with better prognosis were significantly lower than those in patients with poor prognosis( P < 0. 05). The incidence of abnormal dCMAP and F wave in the better prognosis group was significantly lower than that in the worse prognosis group. The Median nerve MCV,ulnar nerve MCV,tibial nerve MCV and common peroneal nerve MCV were significantly higher than those in the worse prognosis group( P < 0. 05). The prognosis of AMAN patients was negatively correlated with diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction and abnormal F wave( P < 0. 05). Conclusion: The main electrophysiological changes in AMAN patients are abnormal dCMAP and F wave,while diarrhea,upper respiratory tract infection,liver dysfunction,medulla oblongata dysfunction,abnormal dCMAP and F wave can be used as prognostic observation items.
引文
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[11]王银霞,吴荷花,张国华,等.急性运动轴索性神经病与急性炎性脱髓鞘性多神经病的比较研究[J].北京医学,2017,39(11):1142-1145.
[12] Versace V,Campostrini S,Tezzon F,et al. Atypical Electrophysiological Findings in a Patient with Acute Motor and Sensory Axonal Neuropathy.[J]. Frontiers in Neurology,2017,8(12):632-634.
[13]彭静,邢燕蒙,吴川杰.空肠弯曲杆菌感染相关的吉兰-巴雷综合征易感基因的研究进展[J].中风与神经疾病,2017,34(7):660-663.
[2]张静,宋秀娟,候慧清,等.急性炎性脱髓鞘性多发神经根神经病和急性运动轴索性神经病的长期随访观察[J].中华医学杂志,2016,96(25):1987-1990.
[3] Khadilkar S V,Yadav R S,Patel B A. Acute Motor Axonal Neuropathy[J]. 2018,16(32):187-190.
[4]中华医学会神经病学分会神经肌肉病学组.中国吉兰-巴雷综合征诊治指南[J].中华神经科杂志,2010,43(8):583-586.
[5]王一楠,李君,于滋润,等.吉兰—巴雷综合征的发病机制及研究进展[J].中国实验诊断学,2016,20(6):1036-1038.
[6]曹娜,申东方,CAONa,等.吉兰-巴雷综合征发病机制及诊疗的相关进展[J].医学综述,2016,22(10):1963-1966.
[7] Sawada D,Fujii K,Misawa S,et al. Bilateral spinal anterior horn lesions in acute motor axonal neuropathy[J]. Brain&Development,2018,21(18):345-347.
[8]王玉明.吉兰-巴雷综合征的临床分型及预后研究[J].实用临床医药杂志,2017,21(15):21-24.
[9]王伟芳,王玉忠,郝延磊.吉兰—巴雷综合征的免疫治疗进展[J].中国神经免疫学和神经病学杂志,2017,24(3):210-213.
[10]乔凌燕,孙裕平,于洪波,等.神经电生理检查对吉兰-巴雷综合征患儿临床严重度和预后的判断价值[J].中国临床研究,2016,29(10):1333-1335.
[11]王银霞,吴荷花,张国华,等.急性运动轴索性神经病与急性炎性脱髓鞘性多神经病的比较研究[J].北京医学,2017,39(11):1142-1145.
[12] Versace V,Campostrini S,Tezzon F,et al. Atypical Electrophysiological Findings in a Patient with Acute Motor and Sensory Axonal Neuropathy.[J]. Frontiers in Neurology,2017,8(12):632-634.
[13]彭静,邢燕蒙,吴川杰.空肠弯曲杆菌感染相关的吉兰-巴雷综合征易感基因的研究进展[J].中风与神经疾病,2017,34(7):660-663.