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  本文選題：糖尿病-慢性炎性脫髓鞘性多發(fā)性神經(jīng)根神經(jīng)病 + 糖尿病周圍神經(jīng)病��； 參考：《第二軍醫(yī)大學(xué)》2016年碩士論文

【摘要】：目的糖尿病-慢性炎性脫髓鞘性多發(fā)性神經(jīng)根神經(jīng)病(diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy,DM-CIDP)、糖尿病周圍神經(jīng)病(diabetic peripheral neuropathy,DPN)及慢性炎性脫髓鞘性多發(fā)性神經(jīng)根神經(jīng)病(CIDP)三組疾病的臨床、電生理及神經(jīng)病理改變特點研究。資料和方法收集2009年1月-2015年12月期間就診于海軍總醫(yī)院及北京大學(xué)第一醫(yī)院神經(jīng)內(nèi)科的DM-CIDP、DPN和CIDP三組疾病共32例患者的臨床資料,其中DM-CIDP組9例、DPN組13例和CIDP組10例;所有32患者均進行了神經(jīng)電生理和腓腸神經(jīng)病理檢查;對三組患者的臨床資料(發(fā)病年齡、病程、起病方式、癥狀和體征、腦脊液檢查)、神經(jīng)電生理檢查(運動神經(jīng)傳導(dǎo)、感覺神經(jīng)傳導(dǎo)及F波)、腓腸神經(jīng)病理結(jié)果(洋蔥球、薄髓鞘、神經(jīng)纖維密度、軸索變性、軸索再生簇、血管基底膜增厚、炎細胞浸潤)分別進行對比分析,探討三組患者在臨床癥候、神經(jīng)電生理及神經(jīng)病理的異同點。結(jié)果1、臨床特點:(1)三組患者在年齡、性別、病程方面差異無統(tǒng)計學(xué)意義(P0.05);(2)起病方式:緩解-復(fù)發(fā)型CIDP組有4例,DPN組和DM-CIDP兩組未見此類型。提示CIDP組較DPN組及DM-CIDP組在起病過程中出現(xiàn)更多的緩解-復(fù)發(fā)型病例,差異有統(tǒng)計學(xué)意義(P0.05)。(3)臨床癥候:下肢受累起病DPN組(9例,69.2%)最多見,其次是DM-CIDP組(6例,55.6%),而CIDP組(4例,40.0%)最少。DM-CIDP組患者肢體感覺障礙7例(77.8%)、肌力減弱8例(88.9%)、肌萎縮6例(66.7%)、腱反射減弱或消失9例(100%);DPN組患者肢體感覺障礙12例(92.3%)、肌力減弱11例(84.6%)、肌肉萎縮1例(7.7%)、腱反射減弱或消失8例(61.5%);CIDP組患者肢體感覺障礙8例(80.0%)、肌力減弱10例(100%)、肌萎縮4例(40.0%)、腱反射減弱或消失8例(80.0%)。(4)腦脊液結(jié)果:DM-CIDP組腦脊液檢查5例(蛋白-細胞分離3例);DPN組腦脊液檢查4例(蛋白輕微升高和正常各2例);CIDP組腦脊液檢查6例,均可見蛋白-細胞分離。2、神經(jīng)電生理特點:(1)DM-CIDP組:運動神經(jīng)傳導(dǎo)速度(motor nerve conduction velocity,MNCV)異常7例(77.8%),感覺神經(jīng)傳導(dǎo)速度(sensory nerve conduction velocity,SNCV)異常9例(100%),F波異常9例(100%)。(2)DPN組:MNCV異常9例(90%),SNCV異常7例(70%),F波異常8例(80%)。(3)CIDP組:MNCV異常9例(100%),SNCV異常8例(88.9%),F波異常9例(100%)。經(jīng)統(tǒng)計學(xué)分析,DM-CIDP、DPN、CIDP組在運動神經(jīng)傳導(dǎo)、感覺神經(jīng)傳導(dǎo)及F波檢測的神經(jīng)電生理數(shù)據(jù),差異均未見統(tǒng)計學(xué)意義(P0.05)。3、腓腸神經(jīng)病理特點:DM-CIDP組(9例)、DPN組(13例)和CIDP組(10例)三組患者的神經(jīng)病理特點分別為髓鞘“洋蔥球”樣改變(2/9、0/13、4/10)、薄髓鞘(6/9、6/13、10/10)、無髓神經(jīng)減少(4/9、9/13、4/10)、軸索變性(8/9、5/13、1/10)、有髓神經(jīng)纖維再生簇(6/9、13/13、7/10)、血管基底膜增厚(7/9、13/13、3/10)、炎細胞(8/9、1/13、8/10)。對比分析DPN、DM-CIDP和CIDP三組神經(jīng)病理在洋蔥球、薄髓鞘、無髓神經(jīng)減少、軸索變性、有髓神經(jīng)纖維再生簇、血管基底膜增厚、炎細胞的構(gòu)成比方面差異有統(tǒng)計學(xué)意義(P0.05)。DM-CIDP和其余兩組多重比較發(fā)現(xiàn):(1)CIDP組出現(xiàn)薄髓鞘較DM-CIDP組更為常見,差異有統(tǒng)計學(xué)意義(P0.05);(2)DM-CIDP組出現(xiàn)軸索變性顯著高于DPN組(P0.05)和CIDP組(P0.01),差異有統(tǒng)計學(xué)意義;(3)DPN組出現(xiàn)有髓神經(jīng)纖維再生簇較DM-CIDP組更為常見,差異有統(tǒng)計學(xué)意義(P0.05);(4)DM-CIDP組血管基底膜增厚較CIDP組更為常見,差異有統(tǒng)計學(xué)意義(P0.05);(5)DM-CIDP組炎性細胞浸潤較DPN組多見,差異有統(tǒng)計學(xué)意義(P0.01)。結(jié)論(1)CIDP組緩解-復(fù)發(fā)型病例最為多見,DM-CIDP組和CIDP組的腦脊液蛋白分離較DPN組多見;(2)在神經(jīng)病理方面:(1)CIDP組薄髓鞘神經(jīng)纖維較DM-CIDP組常見;(2)DM-CIDP組軸索變性較DPN組和CIDP組多見;(3)DPN組有髓神經(jīng)纖維軸索再生簇較DM-CIDP組多見;(4)DM-CIDP組血管基底膜增厚較CIDP組多見;(5)DM-CIDP炎性細胞浸潤較DPN組多見。
[Abstract]:Objective diabetes - chronic inflammatory demyelinating multiple neuropathy (diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy, DM-CIDP), diabetic peripheral neuropathy (diabetic peripheral neuropathy, DPN) and chronic inflammatory demyelinating multiple neuropathy (CIDP), three groups of diseases Study on the characteristics of physiological and neuropathological changes. Data and methods were collected in the clinical data of 32 patients with three groups of diseases, DM-CIDP, DPN and CIDP, which were diagnosed in Navy General Hospital and the neurology department of Navy General Hospital during January 2009 -2015, including 9 cases in group DM-CIDP, 13 cases in group DPN and 10 cases in group CIDP; all 32 patients underwent nerve. Electrophysiological and sural nerve pathological examination; clinical data of three groups (age of onset, course of disease, onset of disease, symptoms and signs, cerebrospinal fluid examination), electrophysiological examination (motor nerve conduction, sensory nerve conduction and F wave), pathological results of the gastrocnemius (onion, thin myelin sheath, nerve fiber density, axonal degeneration, axonal regeneration, regenerative cluster of axons, blood) The basilar membrane thickening and inflammatory cell infiltration were compared and analyzed to investigate the clinical symptoms, neurophysiology and neuropathic differences between the three groups. Results 1, clinical characteristics: (1) there was no significant difference in age, sex, and course of disease (P0.05) in the three groups (2) the onset mode: remission CIDP group, group DPN and DM-CIDP Two groups were not found in the two group, suggesting that more remission cases were found in the CIDP group than in the DPN group and the DM-CIDP group. The difference was statistically significant (P0.05). (3) the clinical symptoms: the DPN group (9 cases, 69.2%) of the lower extremities (9 cases, 69.2%), followed by the DM-CIDP group (6 cases, 55.6%), and the CIDP group (4, 40%) with the least.DM-CIDP patients' limb sensory impairment. In 7 cases (77.8%), muscle strength decreased in 8 cases (88.9%), muscle atrophy was 6 (66.7%), tendon reflex was weakened or disappeared in 9 cases (100%); in group DPN, 12 cases (92.3%), muscle atrophy 11 (84.6%), muscle atrophy 1 (84.6%), tendon reflex weakened or disappeared, and CIDP group, muscle atrophy, muscle atrophy, muscle atrophy, muscle atrophy, muscle atrophy, and muscle atrophy Cases (40%), tendon reflex weakened or disappeared in 8 cases (80%). (4) cerebrospinal fluid results in group DM-CIDP, 5 cases of cerebrospinal fluid examination (3 cases of protein cell separation), 4 cases of cerebrospinal fluid examination in group DPN (mild protein increase and 2 cases of normal); and 6 cases of cerebrospinal fluid examination in group CIDP, all showed protein cell separation.2, neurophysiological characteristics: (1) DM-CIDP group: DM-CIDP group: motor nerve conduction velocity Degree (motor nerve conduction velocity, MNCV) abnormal 7 cases (77.8%), sensory nerve conduction velocity (sensory nerve conduction velocity, SNCV) abnormal 9 cases (100%), F wave abnormality in 9 cases (100%). (2) DPN group: 9 cases (90%), 7 exceptions (80%). (100%). After statistical analysis, DM-CIDP, DPN, and CIDP groups were in the neuroelectrophysiological data of motor nerve conduction, sensory nerve conduction and F wave detection, the difference was not statistically significant (P0.05).3, the pathological characteristics of the gastrocnemius: DM-CIDP group (9 cases), DPN group (13 cases) and CIDP group (10 cases), the neuropathological characteristics were the myelin "onion bulb", respectively. Sample change (2/9,0/13,4/10), Bo Suiqiao (6/9,6/13,10/10), myeloamedullary neuropathy (4/9,9/13,4/10), axonal degeneration (8/9,5/13,1/10), myelinated nerve fiber regeneration cluster (6/9,13/13,7/10), vascular basement membrane thickening (7/9,13/13,3/10), inflammatory cells (8/9,1/13,8/ 10). Comparative analysis of DPN, DM-CIDP and CIDP three in onion bulb, thin myelin sheath, and unmyelinated group Neurodegeneration, axonal degeneration, regenerative clusters of myelinated nerve fibers, thickening of vascular basilar membrane, and significant difference in the composition of the inflammatory cells (P0.05).DM-CIDP and the other two groups of multiple comparisons found: (1) the thin myelin sheath in the CIDP group was more common than the DM-CIDP group (P0.05); (2) there was a significant higher axonal degeneration in the DM-CIDP group. The difference was statistically significant between group DPN (P0.05) and group CIDP (P0.01). (3) there were more common myelinated nerve fibers in DPN group than that in DM-CIDP group (P0.05); (4) the thickening of the basilar membrane in the group DM-CIDP was more common than the CIDP group, and the difference was statistically significant (P0.05); (5) the infiltration of inflammatory cells in DM-CIDP group was more common than the DPN group, and the difference was less than that of the DPN group. There was statistical significance (P0.01). Conclusion (1) the most common remission cases in group CIDP were seen, and the separation of cerebrospinal fluid protein from group DM-CIDP and CIDP was more common than that in group DPN; (2) neuropathic aspects: (1) group CIDP thin myelin nerve fibers were more common than those in the DM-CIDP group; (2) DM-CIDP group was more common than the DPN group and CIDP group; (3) DPN group had the myelinated nerve fiber axis. The regenerated clusters were more common than those in group DM-CIDP; (4) thickening of basement membrane in group DM-CIDP was more common than that in group CIDP; (5) inflammatory cell infiltration in DM-CIDP was more common than that in DPN group.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R744.5;R587.2

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