多发性硬化周围神经损害的肌电图及病理研究

目的：探讨多发性硬化（MS）产生周围神经损害的肌电图，病理特点和影响MS累及周围神经的相关因素。方法：33例MS患者，均满足Poser的确定诊断标准，排除其他神经系统疾病，30名正常自愿受试者作为对照，排除周围神经损害的相关因素，两组分别进行运动，感觉神经传导检测，F波潜伏期及出现率，H反射潜伏期检测，腓肠神经活检，光镜及电镜观察周围神经病理变化。结果：（1）33例MS患者中，9例有根性疼痛，3例有手袜套样感觉障碍，6例不对称性肌萎缩，2例有明显的自主神经症状；（2）肌电图显示复合肌肉动作电位波幅降低，正中神经，尺神经感觉运作电位波幅增高，F波及H反射的潜伏期延长，F波出现率降低。MS周围神经损害的程度与神经功能缺损、病程及病变部位有关，神经功能缺损越重，病程越长，胫神经和腓总神经运动传导波幅降低越明显，正中神经、尺神经感觉动作电位波幅增高越明显；脊髓型MS周围神经受损明显高于脑型；（3）6例患者腓肠神经活检，光镜下可见有髓纤维呈不同程度的髓鞘脱失。电镜下以轴索变性为主，髓鞘板层解离及髓球形成。结论：MS是一种以CNS受损为主的脱髓鞘疾病，在部分患者可对同时累及周围神经系统，脱髓鞘改变主要发生在脊神经根，远端轴突可继发轴索损害，肌电图是比较理想的可全面评价MS周围神经损害的临床检测手段，对判断预后有一定的实用价值。

Peripheral neuropathy in multiple sclerosis:an electromyographic and pathological study

Objective To investgate the electromyographic and pathological features of peripheral nerve involvement in MS,and clarify factors that affect the involvement of PNS Methods Thirty three multiple sclerosis(MS) patients were selected according to Poser's definite diagnosis of MS,without other nervous system disorders and thirty volunteers served as controls All subjects received nerve conduction study:MCV,SCV,F wave and H reflex Sural nerve biopsy and pathological change were observed in light and electronic microscope Results Electromyograph findings:decreased CMAP of the median,tibial and peroneal nerves,and high amplitude of SAP of median and ulnar nerves were observed in MS Our study also showed the prolonged F wave response and H reflex in median and tibial nerves,low F wave rates Electrophysiologic abnormalities in MS showed close relationship to the EDSS,duration and lesion position in spinal cord Sural nerve biopsy revealed myelinated nerve fibers with segmental demyelination by light microscope Inflammatory cellular infiltration and onion bulb formation were not found? Axonal degeneration and laminae dissociation in myelin sheath were demonstrated by electromicroscope Conclusion MS is a demyelinating disease attacking to CNS In some MS patients,both CNS and PNS might be involved at the same time The peripheral demyelinating lesions seem to be common in spinal nerve root But the secondary axonal degeneration in distal segment should be another pathologic feature of MS EMG is a useful test method to evaluate the peripheral nerve damage and prognosis of MS