接触性热痛诱发电位在慢性炎性脱髓鞘性多发性周围神经病中的应用

目的:应用接触性热痛诱发电位(CHEPs)技术研究慢性炎性脱髓鞘性多发性周围神经病(CIDP)患者的痛觉传导通路病变特点,探讨CHEPs在CIDP诊断中的应用价值。方法:选取确诊为CIDP的患者21例及对照组32例,应用CHEP刺激器进行刺激,记录Cz/N的潜伏期,分析比较外周神经Aδ纤维及N波峰潜伏期,同时进行神经传导速度的测定并比较其阳性率。结果:(1)对照组CHEPs波形引出率高于患者组。(2)患者组中VAS评分明显低于对照组(P<0.05)。(3)患者组Aδ纤维传导速度明显低于对照组(P<0.05)。(4)患者组上肢Aδ纤维传导速度减慢率较下肢低(P<0.05)。(5)患者组上下肢近端N波峰潜伏期较对照组延长(P>0.05);但患者组上下肢远端N波峰潜伏期较对照组延长(P<0.05)。(6)患者组Aδ纤维CV异常率高于MCV及SCV(P<0.05)。结论:CHEPs能反应CIDP患者的痛觉传导通路的异常部位及损伤程度,且较传统的神经传导速度更敏感,可作为临床诊断CIDP的一项电生理参考指标。

Application of Contact Heat Evoked Potentials in chronic inflammatory demyelinating polyradiculoneuritis

Objective To study the characteristics of nociceptive conduction system in chronic inflammatory demyelinating polyradiculoneuritis(CIDP)by Contact Heat Evoked Potentials(CHEPs),to evaluate its application value in the diagnosis of CIDP.Methods Twenty-one patients diagnosed as CIDP and thirty-two heathy controls were included in this study,stimulated by CHEP stimulator.The latency of Cz/N was recorded.The Aδfibers of peripheral nerves and N-wave latencies were analyzed and compared,while nervous conduction velocities were tested and the positive rates were compared.Results(1)CHEPs wave eduction rates in control were significantly higher than CIDP group.(2)The VAS scores in CIDP were significantly lower than control group(P < 0.05).(3)The Aδfibers conduction velocities in CIDP were significantly lower than control group(P < 0.05).(4)The reduced rates of Aδfiber conduction velocity in upper limbs were lower than lower limbs(P < 0.05).(5)N-wave latencies of upper proximal and lower proximal limbs in CIDP group were not significantly different from control group(P > 0.05),while N-wave latencies of upper distal and lower distal limbs in CIDP group were significantly longer than control group(P < 0.05).(6)The abnormality rates of Aδfibers in CHEPs were higher than MCV and SCV(P < 0.05).Conclusions CHEPs can present the abnormal regions and damaged degree of nociceptive conduction system in CIDP patients and is more sensitive than traditional nervous conduction velocities.CHEPs may be used as an electrophysiology reference index for the clinical diagnosis of CIDP.