高同型半胱氨酸血症患者的周围神经损害及治疗观察

目的 探讨高同型半胱氨酸（Hcy）血症对周围神经的损害及干预治疗的效果和意义,了解伴随周围神经损害出现的临床和电生理表现.方法 通过入组标准在已确诊的146例高Hcy血症患者中,筛选出周围神经病（PND）组和非PND组,同时排除其他病因所致的PND.电生理检查选择交感神经皮肤反应和感觉、运动神经传导速度比较PND组和非PND组的电生理数据的差异.对入组患者给予叶酸及维生素B12治疗并随访6个月,观察治疗前后效果的差异性.结果 146例高Hcy血症患者中有39例（26.7％）存在周围神经损害 PND组血清Hcy浓度为26 ～ 81 μmol/L,平均（51±13） μmol/L;非PND组21 ～ 44 μmol/L,平均（30±5）μmol/L,2组间血清Hcy浓度差异有统计学意义（P＜0.05） 治疗及随访显示,PND组3个月时总有效率为48.7％（19例）,6个月时为82.0％（32例）.治疗前双上肢潜伏期为（1 596±143）ms,波幅为（1.01±0.32）mV;双下肢潜伏期为（2 796±381）ms,波幅为（0.28 ±0.14）mY;治疗后3个月双上肢潜伏期为（1 438±126）ms,波幅为（2 610 ±273） mV;双下肢潜伏期为（1.58 ±0.31）ms,波幅为（0.37±0.13）mY;治疗后6个月双上肢潜伏期为（1 326 ± 102）ms,波幅为（2 090±122） mV;双下肢潜伏期为（1.78 ±0.37）ms,波幅为（0.70±0.11）mV.治疗后3个月和6个月双上肢和双下肢潜伏期和波幅与治疗前比较,差异均有统计学意义（均P＜0.05）.电生理检查提示周围神经损害以轴索为主,且电生理指标的改善滞后于临床.结论 高Hcy血症可并发周围神经损害,并符合代谢性PND,病变程度可能与血清Hcy浓度相关,及时、有效的治疗可以缓解患者病情.

Effects of hyperhomocysteinemia on peripheral neuropathy

Objective To investigate the relationship between plasma homocysteine（Hcy） and peripheral neuropathy.Methods The 146 patients diagnosed as hyperhomocysteinemia were divided into two groups：hyperhomocysteinemia with peripheral neuropathy （case group）and hyperhomocysteinemia without peripheral neuropathy （control group）.Patients with peripheral neuropathy caused by other etiologies were excluded.Sympathetic skin response,sensory and motor nerve conduction velocity were selected as electrophysiological examination methods.The differences in physiological data electric of non PND and PND group were compared.The patients in case group were treated with folic acid and vitamin B12 and followed for 6 months and than the differences of before and after treatment were observed.Results Totally 146 patients with hyperhomocysteinemia were included in this study.The case group （n =39,26.7%） with peripheral neuropathy mainly had axonal lesion.Hcy concentration in the study group was 26-81 μmol/L with an average of （51 ± 13）μmol/L.Hey concentration of control group was 21-44 μmol/L with an average of （30± 5）μmol/L.The difference between the two groups was significant （P 〈0.05）.The total effective rate of three months was 48.7% （19 cases） and the total effective rate of three months was 82.0% （32 cases）.The incubation period of double upper limb before treatment was （1 596 ± 143）ms and amplitude was （1.01 ±0.32）mV.The incubation period of lower limbs was （2 796 ±381）ms and amplitude was （0.28 ± 0.14）mV.3 months after treatment,incubation period of double upper limb was （1 438 ± 126）ms and amplitude was （2 610 ± 273） mV.The incubation period of lower limbs ws （1.58 ± 0.31） ms and amplitude was （0.37 ± 0.13）mY.6 months after treatment,incubation period of double upper limb was （1 326 ± 102）ms and amplitude was （2 090 ± 122） mV.The incubation period of lower limbs was（1.78 ± 0.37） ms and amplitude was （0.70 ± 0.11） mV.3 months and 6 months after treatment,the incubation period of double upper limb and double lower limbs and amplitude had statistical significant differences compared with those before treatment （all P 〈 0.05）.Conclusions Hyperhomocysteinemia may be implicated by peripheral nerve damage and meet the criteria of metabolic peripheral neuropathy.Lesions may be dose-dependent of serum Hcy concentrations.