严重正己烷中毒性周围神经病16例患者的电生理学改变

目的观察经积极治疗后的严重正己烷中毒性周围神经病患者的电生理变化规律,探讨预后。方法随访经积极治疗的16例严重正己烷中毒性周围神经病患者,依次在治疗前和治疗后第1、3、9、24个月对其右侧大鱼际肌、胫前肌及股内肌进行肌电图检查,测定其右侧正中神经、腓总神经和腓肠神经进行神经传导速度,分析肌电图和神经传导速度各参数的变化规律。结果严重正己烷中毒性周围神经病患者电生理表现为肌肉放松时自发电位增多(25.0%),轻收缩时运动单位电位时限延长(20.8%)、波幅增高(12.5%)、多相波增多(16.5%),重收缩时募集减少(25.0%);神经传导速度(MCV、SCV)减慢、感觉神经动作电位(SNAP)和复合肌肉动作电位(CMAP)波幅下降、远端潜伏期(DML)延长,其中正中神经:MCV(46.00±4.32)m/s、SCV(40.66±2.65)m/s、SNAP(7.98±1.05)μV、DML(4.28±0.63)ms、CMAP(6.32±1.54)mV,腓总神经:MCV(34.96±2.55)m/s、CMAP(3.21±1.99)mV、DML(7.32±1.65)ms,腓肠神经:SCV(36.48±5.20)m/s、SNAP(2.15±1.22)μV;而正常对照组的正中神经:MCV(54.63±5.33)m/s、SCV(59.25±6.45)m/s、SNAP(26.53±6.32)μV、DML(3.96±0.65)ms、CMAP(9.89±2.30)mV,腓总神经:MCV(48.49±3.25)m/s、CMAP(5.47±1.77)mV、DML(5.20±3.27)ms,腓肠神经:SCV(63.21±9.30)m/s、SNAP(4.63±1.29)μV;两组各指标的差异均有统计学意义(均P<0.01);经积极治疗后,正己烷中毒患者以上各项参数均逐渐好转,24个月后基本恢复正常。结论严重正己烷中毒性周围神经病患者电生理表现明显异常,经积极治疗后,电生理指标可望恢复正常,临床预后良好。

Electrophysiological study of 16 patients with severe N-hexane neuropathy

OBJECTIVE: To observe electrophysiological changes of severe N-hexane neuropathy getting active therapies and discuss its prognosis. METHODS: A follow-up study involved 16 adult severe N-hexane neuropathy patients who got active therapies was performed. EMG in right muscle of thenar, tibial muscle, and vastus medialis, NCV in right median nerve, common peroneal nerve, and sural nerve were determined and analyzed before treatment and in the first, the third, the ninth, and the twenty-fourth month after treatment. RESULTS: The electrophysiology in severe N-hexane neuropathy patients showed that the voluntary potential during muscle relaxation increased by 25.0%; the motor unit potential time limit prolonged by 20.8%, and the amplitude increased by 12.5%, and multiphasic wave increased by 16.5% during mild contraction; the raise decreased by 25.0% during strong contraction. In control group, the MCV, SCV, SNAP, DML, and CMAP of median nerve were (54.63 +/- 5.33) m/s, (59.25 +/- 6.45) m/s, (26.53 +/- 6.32) microV, (3.96 +/- 0.65)ms, and (9.89 +/- 2.30) mV respectively, the MCV, CMAP, DML of common peroneal nerve were (48.49 +/- 3.25) m/s, (5.47 +/- 1.77) mV, (5.20 +/- 1.27) ms respectively, and the SCV, SNAP of sural nerve were (63.21 +/- 9.30) m/s, (4.63 +/- 1.29) microV respectively. Severe N-hexane neuropathy patients presented significantly different abnormalities in the NCV and EMG (P < 0.01). The MCV, SCV, SNAP, DML, CMAP of median nerve were (46.00 +/- 4.32) m/s, (40.66 +/- 2.65) m/s, (7.98 +/- 1.05) microV, (4.28 +/- 0.63) ms, and (6.32 +/- 1.54) mV respectively. The MCV, CMAP, DML of common peroneal nerve were (48.49 +/- 3.25) m/s, (3.21 +/- 1.99) mV, (7.32 +/- 1.65) ms respectively. The SCV, SNAP of sural nerve were (36.48 +/- 5.20) m/s, (2.15 +/- 1.22) microV respectively. These parameters gradually recovered to normal levels in 24 months after treatment. CONCLUSION: The electrophysiological abnormalities in severe N-hexane neuropathy patients can restore after treatment, and clinical prognosis is good.