摘要：
目的 探讨急性炎症性脱髓鞘性多发性神经病(AIDP)患者神经电生理指标的动态变化及其与临床症状及脑脊液蛋白含量变化的差异,为神经电生理诊断及病情评估提供依据.方法 36例AIDP患者于发病1周内、发病后1个月及3个月进行吉兰-巴雷综合征功能分级(Hughes scale)评定,同时行多节段神经传导、F波和针电极肌电图检测,分析其神经电生理指标的动态变化与Hughes scale及脑脊液蛋白含量的差异.结果 36例入院时Hughes scale分级2～5级,平均3.75级,即临床症状重;发病后1个月1～3级,平均2.13级,即临床症状有改善;发病后3个月1～2级,平均1.25级.发病1周内,运动神经传导异常率为73.3％,感觉神经传导异常率为50.5％,传导阻滞发生率为26.1％,F波异常率为86.1％,有神经源性损害的肌肉占32.6％;发病后1个月,运动神经传导异常率为90.2％,感觉神经传导异常率为80.1％,传导阻滞发生率为15.4％,F波异常率达100％;发病后3个月,运动神经传导异常率为53.4％,感觉神经传导异常率为45.1％,传导阻滞发生率为8.6％,F波异常率为50.0％.各项神经电生理指标中仅传导阻滞发生率与Hughes scale变化相似.36例发病后1周、3周、3个月脑脊液蛋白含量的变化与运动传导速度、复合肌肉动作电位及Hughes scale变化大致相同.结论 AIDP患者最严重的神经电生理损害出现于发病后1个月,其特征与临床症状存在不一致性,神经传导的恢复滞后于临床症状的改善,但是传导阻滞的发生率与临床症状的变化相似,脑脊液蛋白含量变化与Hughes scale及运动传导速度、复合肌肉动作电位变化大致相同.%Objective To investigate the dynamic variations of neuro-electrophysiological parameters and the diferences of variations between them and clinical symptoms or protein concentration in the cerebrospinal fluid in patients diagnosed with acute inflammatory demyelinating polyneuropathy (AIDP),aiming to provide basis for the neuro-electrophysiological diagnosis and evaluation of the severity of AIDP.Methods Hughes scale was performed to classify the function of Guillain-Barré syndrome in 36 AIDP patients within 1 week,1 month and 3 months after onset.Multi-segment nerve conduction,F wave and needle electrode electromyography were conducted to analyze the dynamic changes of neuroelectrophysiological parameters and their diferences with Hughes scale and protein concentration in the cerebrospinal fluid.Results Upon admission,36 cases were classified as grade 2-5 by Hughes scale,grade 3.75 on average,suggesting the severe clinical symptoms.At 1 month after onset,the Hughes scale score was ranged from 1-3,grade 2.13 on average,suggesting the clinical symptoms were alleviated,and grade 1-2 with a mean grade of 1.25 at 3 months after onset.Within 1 week after onset,the abnormal rate of motor nerve conduction was 73.3％,50.5％ for sensory nerve conduction,26.1％ for conduction block and 86.1％ for F wave.The proportion of muscle with neurogenic muscular injury was 32.6％.At 1 month after onset,the abnormal rate of motor nerve conduction was 90.2％,80.1％ for sensory nerve conduction,15.4％ for conduction block and 100％ for F wave.At 3 months after onset,the abnormal rate of motor nerve conduction was 53.4％,45.1％ for sensory nerve conduction,8.6％ for conduction block and 50.0％ for F wave.Among all neuro-electrophysiological parameters,the incidence of conduction block alone shared similar changes with those of Hughes scale.At 1 week,1 month and 3 months after onset,the protein concentration in the cerebrospinal fluid of 36 cases shared almost identical variations with those of motor conduction velocity,compound muscle action potential and Hughes scale.Conclusions The most severe electrophysiological injury occurs at 1 month after onset of AIDP.Inconsistency is observed between neuro-electrophysiological characteristics and clinical symptoms.The recovery of nerve conduction occurs after the improvement of clinical symptoms.However,the incidence of conduction block shares similar variations with clinical symptoms.The variation patterns among the protein concentration in the cerebrospinal fluid,Hughes scale,motor conduction velocity and compound muscle action potential are almost identical.
