交感神經皮膚反應在慢性炎癥性脫髓鞘性多發(fā)性神經根神經病中的臨床應用
發(fā)布時間：2019-03-29 12:47
【摘要】：目的： 探討交感神經皮膚反應(sympathetic skin response, SSR)對慢性炎癥性脫髓鞘性多發(fā)性神經根神經病(chronic inflammatory demyelinating polyradiculoneuropathy, CIDP)自主神經功能損害的診斷價值。 方法： 收集2011年11月至2013年3月在浙江大學醫(yī)學院附屬第二醫(yī)院住院診治的CIDP患者29例,排除中樞或其他外周神經系統(tǒng)損害以及任何影響自主神經系統(tǒng)的疾病。選擇同期健康體檢者30例作為正常對照組,分別進行SSR測定及自主神經癥狀量表(autonomic symptom profile, ASP)評定。 結果： 1.病例組SSR異常率(75.86%)顯著高于正常對照組SSR異常率(0),差異有顯著統(tǒng)計學意義(p0.01)。 2.與正常對照組比較,病例組SSR波幅顯著降低,差異有顯著統(tǒng)計學意義(p0.01),而潛伏期無顯著延長(p0.05)。 3.病例組上、下肢SSR異常率比較,差異無統(tǒng)計學意義(p0.05)。 4.病例組ASP評分(25.35分)及評分異常率(65.52%)均顯著高于正常對照組的評分(12.58分)及評分異常率(0),差異有顯著統(tǒng)計學意義(p0.01)。 5.病例組SSR異常率(75.86%)及ASP評分異常率(65.52%)與臨床自主神經癥狀出現率(31.03%)分別比較,差異均有顯著統(tǒng)計學意義(p0.01),而SSR異常率與ASP評分異常率相比較,差異無統(tǒng)計學意義(p0.05)。 6.29例CIDP患者中臨床表現有自主神經癥狀亞組SSR異常率(100.00%)與無自主神經癥狀亞組SSR異常率(65.00%)比較,差異有統(tǒng)計學意義,兩者具有相關性(p0.05)。有自主神經癥狀亞組ASP評分異常率(77.78%)與無自主神經癥狀亞組ASP評分異常率(60.00%)比較,差異無統(tǒng)計學意義,兩者無相關性(p0.05)。 7.CIDP患者的SSR結果與運動末端潛伏期、運動傳導波幅及F波潛伏期均無相關性。 8.CIDP患者的腦脊液蛋白含量與SSR結果無相關性。 9.病程不少于12個月的CIDP患者與少于12個月的患者比較,兩者上下肢的SSR潛伏期及波幅差異均無統(tǒng)計學意義(p0.05)。 結論： 1.SSR能靈敏地檢測出CIDP患者自主神經功能受損的情況。 2.SSR的異常率與CIDP患者臨床自主神經癥狀的出現率高度相關,且可以客觀量化,SSR可以成為一個臨床上早期檢測CIDP患者自主神經功能損害的可靠電生理指標。
[Abstract]:Aim: to investigate the diagnostic value of sympathetic skin reaction (sympathetic skin response, SSR) in the diagnosis of autonomic nerve dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy (chronic inflammatory demyelinating polyradiculoneuropathy, CIDP). Methods: 29 CIDP patients admitted to the second affiliated Hospital of Zhejiang University Medical College from November 2011 to March 2013 were collected to exclude central or other peripheral nervous system damage and any diseases affecting the autonomic nervous system. 30 healthy subjects were selected as normal control group. SSR was measured and (autonomic symptom profile, ASP) was assessed by autonomic neurosis scale (autonomic neurosis scale). Results: 1. The abnormal rate of SSR in the case group (75.86%) was significantly higher than that in the normal control group (0), the difference was statistically significant (p0.01). 2. Compared with the normal control group, the amplitude of SSR in the case group was significantly lower than that in the control group (p0.01), but the latency was not significantly prolonged (p0.05). 3. In the case group, there was no significant difference in the abnormal rate of lower limb SSR (p0.05). 4. The ASP score (25.35) and abnormal rate (65.52%) in the case group were significantly higher than those in the normal control group (12.58 points) and abnormal score rate (0). There was significant difference between the two groups (p0.01). 5. The abnormal rate of SSR (75.86%) and ASP score (65.52%) in the case group were significantly higher than those in the clinical autonomic symptoms (31.03%) (p0.01). There was no significant difference between the abnormal rate of SSR and the abnormal rate of ASP score (p0.05). In 6.29 patients with CIDP, the abnormal rate of SSR in the subgroup with autonomic symptoms (100.00%) was significantly higher than that in the subgroup without autonomic symptoms (65.00%). There was a significant correlation between the abnormal rate of SSR in the subgroup with autonomic symptoms and that in the subgroup without autonomic symptoms (p0.05). There was no significant difference between the abnormal rate of ASP score between the subgroup with autonomic symptoms (77.78%) and the subgroup without autonomic symptoms (60.00%), and there was no correlation between them (p0.05). There was no correlation between the results of SSR and motor terminal latency, motor conduction amplitude and F wave latency in 7.CIDP patients. There was no correlation between CSF protein content and SSR results in 8.CIDP patients. 9. There was no significant difference in the latency and amplitude of SSR between the patients with CIDP at least 12 months and those with less than 12 months (p0.05). Conclusion: 1.SSR can sensitively detect autonomic nerve dysfunction in CIDP patients. The abnormal rate of 2.SSR is highly correlated with the occurrence rate of clinical autonomic nerve symptoms in CIDP patients, and can be quantified objectively. SSR can be used as a reliable electrophysiological index for early detection of autonomic nerve dysfunction in patients with CIDP.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R744.5
[Abstract]:Aim: to investigate the diagnostic value of sympathetic skin reaction (sympathetic skin response, SSR) in the diagnosis of autonomic nerve dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy (chronic inflammatory demyelinating polyradiculoneuropathy, CIDP). Methods: 29 CIDP patients admitted to the second affiliated Hospital of Zhejiang University Medical College from November 2011 to March 2013 were collected to exclude central or other peripheral nervous system damage and any diseases affecting the autonomic nervous system. 30 healthy subjects were selected as normal control group. SSR was measured and (autonomic symptom profile, ASP) was assessed by autonomic neurosis scale (autonomic neurosis scale). Results: 1. The abnormal rate of SSR in the case group (75.86%) was significantly higher than that in the normal control group (0), the difference was statistically significant (p0.01). 2. Compared with the normal control group, the amplitude of SSR in the case group was significantly lower than that in the control group (p0.01), but the latency was not significantly prolonged (p0.05). 3. In the case group, there was no significant difference in the abnormal rate of lower limb SSR (p0.05). 4. The ASP score (25.35) and abnormal rate (65.52%) in the case group were significantly higher than those in the normal control group (12.58 points) and abnormal score rate (0). There was significant difference between the two groups (p0.01). 5. The abnormal rate of SSR (75.86%) and ASP score (65.52%) in the case group were significantly higher than those in the clinical autonomic symptoms (31.03%) (p0.01). There was no significant difference between the abnormal rate of SSR and the abnormal rate of ASP score (p0.05). In 6.29 patients with CIDP, the abnormal rate of SSR in the subgroup with autonomic symptoms (100.00%) was significantly higher than that in the subgroup without autonomic symptoms (65.00%). There was a significant correlation between the abnormal rate of SSR in the subgroup with autonomic symptoms and that in the subgroup without autonomic symptoms (p0.05). There was no significant difference between the abnormal rate of ASP score between the subgroup with autonomic symptoms (77.78%) and the subgroup without autonomic symptoms (60.00%), and there was no correlation between them (p0.05). There was no correlation between the results of SSR and motor terminal latency, motor conduction amplitude and F wave latency in 7.CIDP patients. There was no correlation between CSF protein content and SSR results in 8.CIDP patients. 9. There was no significant difference in the latency and amplitude of SSR between the patients with CIDP at least 12 months and those with less than 12 months (p0.05). Conclusion: 1.SSR can sensitively detect autonomic nerve dysfunction in CIDP patients. The abnormal rate of 2.SSR is highly correlated with the occurrence rate of clinical autonomic nerve symptoms in CIDP patients, and can be quantified objectively. SSR can be used as a reliable electrophysiological index for early detection of autonomic nerve dysfunction in patients with CIDP.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R744.5
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