短潜伏期体感诱发电位在慢性炎性脱髓鞘性多发性神经根神经病中的诊断作用

Role of short-latency somatosensory evoked potential in the diagnosis of chronic inflammatory demyelinating polyneuropathy

摘要:

目的 探讨短潜伏期体感诱发电位（SSEP）对慢性炎性脱髓鞘性多发性神经根神经病（CIDP）的诊断作用。方法 48例确诊或可能CIDP患儿及40例健康对照儿童进行肌电图神经传导和/或SSEP检查（健康对照仅行SSEP检查）。肌电图神经传导检查采用4道肌电图仪进行，包括至少4条运动神经和2条感觉神经；SSEP主要观察正中神经的N6（肘部电位），N13（颈髓电位），N20（皮质电位）；胫神经的N8（腘窝电位），N22（腰髓电位），P39（皮质电位）。结果 肌电图神经传导检测提示，48例患儿中35例运动、感觉神经均脱髓鞘，符合CIDP确诊标准；8例为感觉神经脱髓鞘，5例为轴突变性为主。40例患儿SSEP异常（未符合CIDP确诊标准的8例感觉受累患儿和5例继发轴突变性患儿的SSEP均异常），其中7例可见臂丛神经干和/或后根水平传导异常，33例同时有腰骶丛和/或后根损害。与健康对照相比，CIDP患儿N13、N22波幅潜伏期明显延长（P < 0.05）。结论 SSEP可用于CIDP辅助诊断，特别是对于感觉神经受累为主或继发轴突变性的CIDP患儿。

Abstract:

Objective To investigate the role of short-latency somatosensory evoked potential (SSEP) in the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Methods A total of 48 children with a confirmed or suspected CIDP and 40 healthy children were enrolled. Nerve electrophysiological examination and/or SSEP examination was performed (the children in the healthy control group only underwent SSEP examination). Four-lead electromyography was used for nerve electrophysiological examination, including at least 4 motor nerves and 2 sensory nerves. N6 (elbow potential), N13 (cervical cord potential), and N20 (cortex potential) of the median nerve and N8 (popliteal fossa potential), N22 (lumbar cord potential), and P39 (cortex potential) of the tibial nerve were observed by SSEP examination. Results Among the 48 children with CIDP, 35 had demyelination in both motor and sensory nerves, 8 had demyelination in sensory nerves, and 5 had axonal degeneration. SSEP examination showed that 7 had conduction abnormality in the trunk of the brachial plexus and/or the posterior root and 33 had damage in the lumbosacral plexus and/or the posterior root. The 40 children with abnormal findings of SSEP examination included 8 children with affected sensory nerves and 5 children with secondary axonal degeneration who did not meet the electrophysiological diagnostic criteria for CIDP. Compared with the healthy control group, the CIDP group had significantly prolonged latency periods of N13 and N22 (P < 0.05). Conclusions SSEP can be used for the auxiliary diagnosis of CIDP, especially in CIDP children with affected sensory nerves or secondary axonal degeneration.