正己烷中毒性周围神经病的临床与预后分析

正己烷是工业上广泛应用的有机溶剂，其代谢产物2，5-己二酮已被证实为周围神经毒物。现将我院收治的46例中毒性周围神经病患者的临床特点与预后分析如下。     

75例正己烷中毒性周围神经病临床分析

目的 探讨正己烷中毒性周围神经病的临床特征、诊断及防治。方法 对密切接触正己烷的96名皮鞋厂工人中75人存在周围神经损害症状患者的临床资料进行分析。结果 75例均表现肢端麻木、无力，末梢型感觉障碍，17例四肢肌萎缩，2例出现球麻痹症状。神经电生理检查示神经传导速度减慢，波幅下降，部分有失神经改变。常规治疗组有效率18．78％，皮质激素治疗组25％，神经生长因子组60％，75例患者均明显好转，70例恢复正常工作。结论 正己烷中毒可引起周围神经轴索变性、脱髓鞘，出现周围神经受损症状。皮质激素治疗无效，神经生长因子优于普通神经营养药物。患者大多预后良好，症状、体症先天神经电生理恢复。     

神经生长因子治疗正己烷中毒性周围神经病疗效观察

目的 观察神经生长因子治疗正己烷中毒性周围神经病疗效。方法 采用随机双盲、安慰剂平行对照方法。治疗组35例，肌注神经生长因子9000U，1次／日，疗程30天；对照组35例，使用外观完全一样的无活性制剂。结果 治疗组有效率60％，对照组有效率17．14％，差异非常显(X^2＝13．57 P≤0．01)。结论 神经生长因子治疗正己烷统中毒性周围神经病疗效确切，无严重的毒副作用。     

亚急性正己烷中毒临床跟踪分析

目的研究亚急性正己烷中毒所致周围神经病的转归。方法记录17例亚急性正己烷中毒所导致的周围神经病患者的临床资料、神经肌电图、治疗经过,并追踪观察1年预后。神经肌电检查包括四肢感觉和运动神经传导功能,肌电图记录上下肢远端肌肉各1块。结果治疗1年后临床表现和体征均已恢复正常,神经肌电图的感觉和运动传导速度15例患者完全正常,2例重症患者仍存在损害。结论亚急性正己烷中毒及早脱离环境、及早治疗,预后较好。     

肌电图在中毒性周围神经病中的应用

我院从2001年起自用肌电图确诊中毒性周围神经病18例，现报告如下。     

中毒性周围神经病的肌电图及神经电图分析

引起周围神经病的病因很多,随着工农业的发展,中毒性周围神经病的发病逐渐增高。分析了25例中毒引发的周围神经病的肌电图(EMG)及神经电图结果,现报告如下。资料和方法25例中毒性周围神经病病人中,男16例,女9例,年龄14~65岁,平均34.7岁。中毒后检查时间,最短20d,最长20年。中毒原     

呋喃类药物中毒性周围神经病临床与肌电图分析

临床资料总结分析96例呋喃类药物中毒性周围神经病临床资料简介如下:一般情况:男61例,女35例;年龄:20￣73岁;服药时间:3￣21d10例,11￣20d24例,21￣30d25例,31￣40d3例,41￣50d3例,51￣60d10例,61￣90d6例,长期间断口服药15例。服药剂量:13例按0.3g·d-1,11例0.4g·d-1,3例0.5g     

血管炎性周围神经病

血管炎是一组累及不同血管的炎症，它们造成多脏器系统和周围神经的损害。本文叙述血管炎性周围神经病的分类和临床表现。     

正已烷中毒周围神经病的临床与电生理

正已烷是一种溶剂 ,主要用于电子元件、彩色印刷板清洗及箱包粘合等。其属于低毒类化学物 ,但其挥发性和脂溶性高 ,在人体内可积蓄 ,特别对神经系统有毒性。近年来由于用途日益广泛 ,对人体损害时有发生。现报道 4例正已烷中毒所致周围神经损害的临床及电生理表现。一、临床资料一般资料 :4例患者均为女性 ,年龄 17岁 1例 ,2 0岁 3例 ,均在某厂任粘合工 ,主要接触有正已烷的 10 3、 10 8、 80 4粘合剂。工作时不带手套、口罩 ,直接用手接触合剂 ,每天工作 13小时 ,大约用粘合剂 6 0 KG,工作间 15× 2 0 m2 ,无排风设施。工作 4～ 6个月后出…     

一氧化二氮滥用致周围神经病患者的神经电生理特点

目的探讨一氧化二氮(N_2O)滥用致中毒性周围神经病患者的神经电生理特点。方法回顾性分析10例N_2O滥用导致的周围神经病患者的神经电生理(神经传导速度测定、针极肌电图检查、F波、H波)特点。结果与正常参考值相比,上、下肢近端所检运动纤维及上、下肢远端所检运动纤维异常率分别为0、40%、37.5%、90%,异常运动纤维远端潜伏期(MLAT)分别延长0、36.1%、17.8%、37.2%,复合肌肉动作电位(CMAP)分别下降0、88.6%、31.4%、64.5%;上、下肢远端运动纤维运动传导速度测定(MCV)分别延长10.4%、16.4%;上、下肢远端感觉纤维异常率分别为7.5%、80%;上、下肢异常感觉纤维波幅分别下降7.5%、79.4%,感觉传导速度测定分别延长0、8.6%;上、下肢F波异常率分别为0、50%;双下肢H波异常率100%;双上肢针极肌电图异常率30%,双下肢针极肌电图异常率90%(P<0.05)。结论N2O滥用致周围神经损害可同时累及运动纤维与感觉纤维,以轴索损害为主,下肢受累为著,远端受累较近端受累为重,具有长度依赖性及对称性。针极肌电图可早期出现中-多量失神经电位,大力收缩募集减少,伴或不伴运动单位时限增宽。神经电图提示F波出现率减少或H波波幅降低,伴或不伴潜伏期延长。     

Vincristine-induced peripheral neuropathy: A mini-review

Vincristine (VCR), an alkaloid extracted from vinca, is often used in combination with other chemotherapeutic drugs to treat a variety of cancers, such as acute lymphoblastic leukaemia (ALL), malignant lymphoma, and neuroblastoma. However, VCR possesses dose-dependent neurotoxicity, which is the main factor restricting its application. Vincristine-induced peripheral neuropathy (VIPN) not only limits the dose of VCR and leads to the discontinuation of treatment but also triggers serious damage to the physical and mental health of patients. In addition, VIPN brings huge healthcare costs to patients and society. Individuals with VIPN often exhibit mechanical allodynia, sensory/tactile disorders, and numbness in the hands and feet. Unfortunately, VIPN is easily ignored due to its variable symptoms, which gives rise to insufficient research on the aetiology and pathogenesis of this disease, thereby resulting in a lack of appropriate preventive and therapeutic management. We performed a comprehensive review of the latest findings on VIPN in terms of symptoms, risk factors, potential mechanisms, and prevention and treatment measures. The purpose was to help clinicians better understand and accurately diagnose VIPN, select appropriate intervention measures and reduce the damage to cancer patients.     

Polyarteritis nodosa and peripheral neuropathy

Summary Peripheral nerves from 13 patients suffering from polyarteritis nodosa with multiple mononeuropathy were studied by light and electron microscopy. In the majority of cases, the vascular lesions were associated with Wallerian-like degeneration. Myelinated fibers presenting a normal axon with a disproportionately thin myelin sheath were less numerous. Unusual abnormalities consisted of swollen axons with an accumulation of organelles. Unmyelinated fibers were also damaged. A quantitative estimation of myelinated fibers loss did not show any selective vulnerability of either the large or the small diameter group.     

2型糖尿病周围神经病变与C肽水平的相关性研究

目的探讨C肽的生物学活性与2型糖尿病周围神经病变的相关关系,为临床C肽与胰岛素联合应用治疗2型糖尿病并发症提供更多的理论支持。方法回顾性分析98例2型糖尿病患者的神经传导速度与空腹C肽水平的关联性(因不同的神经传导速度不同,特以右侧腓肠神经感觉支为例)。结果相关分析显示:神经传导速度与体重指数,C肽呈正相关,与病程、糖化血红蛋白呈负相关。随着C肽水平的下降,2型糖尿病周围神经病变的分期逐渐加重。结论 C肽对神经具有保护性作用,推测其具有剂量依赖性,外源性C肽应用可能成为2型糖尿病周围神经病变的一种新的治疗手段。     

Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy

OBJECTIVE: The reliability and accuracy of the Michigan neuropathy screening instrument (MNSI) have been discussed recently. As a result of the difficulties of performing and analyzing nerve biopsy as a standard diagnostic test, electromyography and neuronography is used as the best alternative diagnostic procedure. The objective of this study was to determine the diagnostic performance of the test characteristics and cut-off point of MNSI scoring for the diagnosis of diabetic peripheral neuropathy. METHOD: Over a 2-year period, a cross-sectional study was conducted on 176 type 2 diabetic patients. An internist carried out the MNSI and the sum of scores varying from 0 to 1 for each abnormality as revealed in foot appearance, ulceration, ankle reflexes and vibratory perception has been recorded. A neurologist, who was blind to the MNSI scores, performed all neurophysiological studies. The test performance characteristics of the MNSI procedure were measured for different cut-off values. RESULTS: MNSI scores of 1.5, 2.0, 2.5 and 3.0 were assessed as cut-off values. Sensitivities were 79%, 65%, 50% and 35% and specificities were 65%, 83%, 91% and 94%, respectively. Positive predictive values increased and negative predictive values decreased for each score. Accuracies, likelihood ratios and post-test probabilities were measured. CONCLUSION: The accuracy of MNSI scoring makes it a useful screening test for diabetic neuropathy in taking a decision regarding which patients should be referred to a neurologist for electrophysiological studies. High specificity, likelihood ratios over 5 and a moderate to good post-test probability give a high diagnostic impact for MNSI scoring. We suggest a cut-off point of 2 for the MNSI procedure. However, electrophysiological studies should be considered when the patient has signs and symptoms other than those rated by the MNSI, suggesting peripheral nerve involvement, and also because the MNSI is still just a screening test.     

大鼠慢性酒精中毒性周围神经病的自由饮模型

目的为探讨酒精中毒性周围神经病的肌电图及病理改变,建立慢性酒精中毒性周围神经病的自由饮模型。方法30只Wistar大鼠随机分为2组,即对照组和实验组,对照组饮水,实验组酒浓度从6、9、12%各5d递增至20%后以该浓度维持饲养,于第2、3、4个月末行肌电图及病理检查,每周记录大鼠体重,每2d记录饮食量。结果(1)实验组体重及食量均较对照组差;(2)电生理检查4个月时实验组大鼠运动神经传导速度减慢,复合肌肉动作电位(CMAP)波幅降低;(3)实验组饮酒4个月时大鼠坐骨神经HE染色、银染色光镜下显示轴索变性伴继发性节段性脱髓鞘,但神经节结构无明显异常,甲苯氨兰染色后做形态计量学分析,结果示实验组有髓纤维横切面积与对照组比较差异具有显著性(P<0.05)。结论大鼠自由饮模型可用于模拟人类慢性酒精中毒性周围神经病。     

Electrodiagnosis of peripheral neuropathy

Electrodiagnostic studies are an important component of the evaluation of patients with suspected peripheral nerve disorders. The pattern of findings and the features that are seen on the motor and sensory nerve conduction studies and needle electromyography can help to identify the type of neuropathy, define the underlying pathophysiology (axonal or demyelinating), and ultimately help to narrow the list of possible causes. This article reviews the electrodiagnostic approach to and interpretation of findings in patients with peripheral neuropathies.     

Congenital Leigh's disease: Panencephalomyelopathy and peripheral neuropathy

Summary A dystrophic newborn girl (38th week of gestation) presented as a floppy infant with relapsing episodes of lactic acidosis and progressive cerebral deterioration. She died after serious apnoea at the age of 8 weeks. Neuropathological examination demonstrated widespread changes of Leigh's subacute polioencephalomyelopathy affecting the cerebral cortex, basal ganglia, mesencephalon and spinal cord. In addition, there was severe leukoencephalopathy of the cerebral hemispheres with sudanophilic tissue degregation, advanced axonal loss and reactive astrocytic gliosis. There was marked demyelination of the sciatic nerves. Electron-microscopical examination of the hypertrophic heart revealed pathological mitochondria with tubular inclusions suggestive of primary mitochondrial cardiomyopathy. Similar mitochondrial changes were not detected in the CNS and PNS. The complex of neuropathological alterations in this case is nevertheless consistent with a congenital variant of Leigh's disease.     

周围神经显微减压术治疗上肢透析相关周围神经病的疗效分析

目的探讨周围神经显微减压术治疗上肢透析相关周围神经病(DRPN)的疗效。方法回顾性分析2017年1月至12月中日友好医院神经外科收治的15例上肢DRPN患者的临床资料。15例患者共22侧患肢,其中对2侧患肢行单纯正中神经减压术,对20侧患肢行正中神经联合尺神经减压术。出院后对所有患者行门诊随访,随访内容包括复查肌电图,询问患者患肢麻木、疼痛症状及运动功能障碍的改善情况,以评估手术疗效。结果15例患者的手术均成功。术后6处(6/42)切口出现愈合不良,经保守治疗后好转。15例患者的随访时间为(12.0±4.5)个月(6.0~20.0个月)。肌电图复查结果显示,正中神经感觉神经的传导速度[(46.3±3.1)m/s]和动作电位波幅[(9.2±1.6)mV]均较术前增加[分别为(37.5±1.8)m/s、(7.7±1.1)mV,均P<0.05],运动神经的传导速度[(47.7±2.8)m/s]和动作电位波幅[(10.1±1.9)mV]也均较术前增加[分别为(37.8±2.4)m/s、(7.7±1.6)mV,均P<0.05]。尺神经感觉神经的传导速度[(45.0±3.6)m/s]和动作电位波幅[(9.2±2.1)mV]均较术前增加[分别为(36.4±2.9)m/s、(6.9±1.2)mV,均P<0.05],运动神经的传导速度[(45.8±3.2)m/s]和动作电位波幅[(8.6±2.5)mV]也均较术前增加[分别为(40.1±1.6)m/s、(6.2±1.3)mV,均P<0.05]。至末次随访,15例患者22侧(22/22)患肢的疼痛症状均得到缓解,16侧(16/22)患肢的麻木症状得到缓解,18侧(18/18)患肢的运动功能障碍得到缓解。结论初步推测周围神经显微减压术是治疗上肢DRPN的有效方法;同时术前明确诊断和术中神经彻底减压是保证疗效的关键。     

胰激肽原酶联合甲钴胺治疗糖尿病周围神经病变80例临床分析

目的评价胰激肽原酶联合甲钴胺治疗糖尿病周围神经病变的疗效。方法 80例糖尿病周围神经病变患者随机分为胰激肽原酶加甲钴胺治疗组(治疗组)40例和甲钴胺治疗组(对照组)40例。结果对照组显效率22.5%,总有效率65%;观察组显效率40%,总有效率87.5%。2组间有显著性差异(P<0.05)。结论胰激肽原酶联合甲钴胺治疗糖尿病周围神经病变疗效满意。