神经传导检查在奥沙利铂诱导性周围神经病中的应用研究
发布时间：2018-09-13 16:38
【摘要】：目的:本研究通过临床量表评估和神经传导检查初步探讨奥沙利铂诱导性周围神经病(Oxaliplatin induced peripheral neuropathy,OXLIPN)的临床特点和早期神经传导特点,从而早期发现并准确评价奥沙利铂的周围神经毒性,以指导预防神经毒性用药。方法:本研究收集了2015年12月至2017年03月蚌埠医学院第一附属医院肿瘤内科住院的病人,经病理检查确诊为结肠癌,计划实施XELOX方案(第1天静滴奥沙利铂130mg/m2,第1-14天口服卡培他滨,后停药1周,21天为1周期),每周期化疗后对患者进行问卷调查,了解急性OXLIPN发病情况;化疗前和化疗4周期后(患者入院计划行第5周期化疗前1-2天)行神经传导检查,观察患者的感觉神经及运动神经的传导速度和波幅的变化;另外,在4周期化疗结束后对患者进行慢性OXLIPN临床量表评估,并与神经传导检查结果进行对比分析。结果:1、本实验共完成30例,其中男性患者16例,女性患者14例,平均年龄(58.83±8.63)岁,所有患者均接受了预期的4周期化疗,所有患者在治疗过程中没有致命的毒性事件发生。2、临床观察发现急性OXLIPN总发生率为90%,其中冷诱发肢体感觉异常的患者有26例(86.66%),冷诱发口周感觉异常10例(33.33%),冷诱发咽喉部感觉异常8例(26.66%),下颌僵硬5例(16.66%),肌痉挛3例(10%),喉痉挛2例(6.67%),声音改变3例(10%),有些症状如憋气、吞咽困难、肌束颤动、眼睑下垂、视力改变在本研究中未出现。3、与化疗前相比,化疗4周期后右侧正中神经及左侧腓总神经运动神经复合肌肉动作电位波幅较化疗前下降,差异有统计学意义(P0.05),化疗前后各运动神经传导速度以及各神经同期左右两侧波幅及传导速度对比差异均无统计学意义(P0.05)。化疗4周期后两侧正中神经和两侧腓肠神经感觉神经动作电位波幅均较化疗前明显下降,差异有统计学意义(P0.01),右侧正中神经和左侧腓肠神经感觉神经传导速度较化疗前下降,差异有统计学意义(P0.05),而各感觉神经同期左右两侧波幅及传导速度对比差异无统计学意义(P0.05)。4、化疗后上、下肢神经传导检查异常率比较:运动神经上下肢差异无统计学意义(P0.05),感觉神经上下肢差异有统计学意义(P0.05)。5、化疗结束后临床量表评估慢性OXLIPN检出率为43.33%,神经传导检查慢性OXLIPN检出率为66.67%,两组间比较,差异有统计学意义(P0.05)。结论:1.临床观察急性OXLIPN发生率较高;与临床量表评估相比,神经传导检查对慢性OXLIPN检出率更高。2.慢性OXLIPN早期神经传导特点是双侧、对称性、感觉神经轴索性损害为主,以上肢损伤为重,同时伴有轻度的运动神经损伤。神经传导检查能够早期发现无明显自觉症状的周围神经损害,从而早期诊断,以指导周围神经毒性预防用药。
[Abstract]:Objective: to investigate the clinical and early nerve conduction characteristics of oxaliplatin induced peripheral neuropathy (Oxaliplatin induced peripheral neuropathy,OXLIPN) by clinical evaluation and nerve conduction examination. So early detection and accurate evaluation of oxaliplatin peripheral neurotoxicity, in order to guide the prevention of neurotoxicity drug. Methods: patients admitted to Department of Oncology, first affiliated Hospital of Bengbu Medical College, from December 2015 to March 2017, were diagnosed as colon cancer by pathological examination. XELOX regimen was planned to be implemented (oral administration of oxaliplatin 130 mg / m2 on day 1, oral capecitabine on day 1-14, and withdrawal for 21 days after one week). Questionnaires were conducted to investigate the incidence of acute OXLIPN after each cycle of chemotherapy. Nerve conduction tests were performed before and after 4 cycles of chemotherapy (1-2 days before admission plan for the fifth cycle) to observe the changes of conduction velocity and amplitude of sensory and motor nerves. The patients were evaluated with chronic OXLIPN scale after 4 cycles of chemotherapy and compared with the results of nerve conduction examination. Results in this study, 30 patients (16 male and 14 female, mean age (58.83 卤8.63) years) received the expected 4-cycle chemotherapy. No fatal toxic events occurred in all patients. Clinical observation showed that the total incidence of acute OXLIPN was 90. Among them, 26 cases (86.66%) were cold induced limb sensory abnormalities, 10 cases (33.33%) were cold induced peroral sensory abnormalities, and 10 cases (33.33%) were cold induced. There were 8 cases (26.66%) with abnormal pharynx and larynx, 5 cases (16.66%) with mandibular stiffness, 3 cases (10%) with myospasm, 2 cases (6.67%) with laryngeal spasm, 3 cases (10%) with voice change. Dysphagia, fibrillation of muscle bundle, blepharoptosis, visual acuity did not appear in this study. Compared with before chemotherapy, the amplitude of motor complex muscle action potential of right median nerve and left common peroneal nerve decreased after 4 cycles of chemotherapy. The difference was statistically significant (P0.05). There was no significant difference in the conduction velocity of motor nerve before and after chemotherapy and the amplitude and conduction velocity of left and right side of nerve in the same period (P0.05). After 4 cycles of chemotherapy, the amplitude of action potential of bilateral median nerve and bilateral sural nerve decreased significantly (P0.01), and the conduction velocity of right median nerve and left sural nerve decreased compared with that before chemotherapy. The difference was statistically significant (P0.05), but there was no significant difference in amplitude and conduction velocity between the left and right sides of the sensory nerve in the same period (P0.05). Comparison of abnormal rate of nerve conduction in lower extremities: there was no significant difference in motor nerve upper and lower extremity (P0.05), but sensory nerve lower extremity difference was statistically significant (P0.05). The detection rate of chronic OXLIPN was 43.33 after chemotherapy. The detection rate of chronic OXLIPN was 66.67. The difference was statistically significant (P0.05). Conclusion 1. The incidence of acute OXLIPN was higher in clinical observation, and the detection rate of chronic OXLIPN by nerve conduction test was higher than that of clinical scale. 2. 2. In the early stage of chronic OXLIPN, bilateral, symmetrical and sensory nerve axonal damage was the main feature, with severe upper limb injury and mild motor nerve injury. Nerve conduction examination can detect the injury of peripheral nerve without obvious symptoms in the early stage, so as to diagnose early, and guide the preventive medication of peripheral nerve toxicity.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35;R745
本文编号：2241735
[Abstract]:Objective: to investigate the clinical and early nerve conduction characteristics of oxaliplatin induced peripheral neuropathy (Oxaliplatin induced peripheral neuropathy,OXLIPN) by clinical evaluation and nerve conduction examination. So early detection and accurate evaluation of oxaliplatin peripheral neurotoxicity, in order to guide the prevention of neurotoxicity drug. Methods: patients admitted to Department of Oncology, first affiliated Hospital of Bengbu Medical College, from December 2015 to March 2017, were diagnosed as colon cancer by pathological examination. XELOX regimen was planned to be implemented (oral administration of oxaliplatin 130 mg / m2 on day 1, oral capecitabine on day 1-14, and withdrawal for 21 days after one week). Questionnaires were conducted to investigate the incidence of acute OXLIPN after each cycle of chemotherapy. Nerve conduction tests were performed before and after 4 cycles of chemotherapy (1-2 days before admission plan for the fifth cycle) to observe the changes of conduction velocity and amplitude of sensory and motor nerves. The patients were evaluated with chronic OXLIPN scale after 4 cycles of chemotherapy and compared with the results of nerve conduction examination. Results in this study, 30 patients (16 male and 14 female, mean age (58.83 卤8.63) years) received the expected 4-cycle chemotherapy. No fatal toxic events occurred in all patients. Clinical observation showed that the total incidence of acute OXLIPN was 90. Among them, 26 cases (86.66%) were cold induced limb sensory abnormalities, 10 cases (33.33%) were cold induced peroral sensory abnormalities, and 10 cases (33.33%) were cold induced. There were 8 cases (26.66%) with abnormal pharynx and larynx, 5 cases (16.66%) with mandibular stiffness, 3 cases (10%) with myospasm, 2 cases (6.67%) with laryngeal spasm, 3 cases (10%) with voice change. Dysphagia, fibrillation of muscle bundle, blepharoptosis, visual acuity did not appear in this study. Compared with before chemotherapy, the amplitude of motor complex muscle action potential of right median nerve and left common peroneal nerve decreased after 4 cycles of chemotherapy. The difference was statistically significant (P0.05). There was no significant difference in the conduction velocity of motor nerve before and after chemotherapy and the amplitude and conduction velocity of left and right side of nerve in the same period (P0.05). After 4 cycles of chemotherapy, the amplitude of action potential of bilateral median nerve and bilateral sural nerve decreased significantly (P0.01), and the conduction velocity of right median nerve and left sural nerve decreased compared with that before chemotherapy. The difference was statistically significant (P0.05), but there was no significant difference in amplitude and conduction velocity between the left and right sides of the sensory nerve in the same period (P0.05). Comparison of abnormal rate of nerve conduction in lower extremities: there was no significant difference in motor nerve upper and lower extremity (P0.05), but sensory nerve lower extremity difference was statistically significant (P0.05). The detection rate of chronic OXLIPN was 43.33 after chemotherapy. The detection rate of chronic OXLIPN was 66.67. The difference was statistically significant (P0.05). Conclusion 1. The incidence of acute OXLIPN was higher in clinical observation, and the detection rate of chronic OXLIPN by nerve conduction test was higher than that of clinical scale. 2. 2. In the early stage of chronic OXLIPN, bilateral, symmetrical and sensory nerve axonal damage was the main feature, with severe upper limb injury and mild motor nerve injury. Nerve conduction examination can detect the injury of peripheral nerve without obvious symptoms in the early stage, so as to diagnose early, and guide the preventive medication of peripheral nerve toxicity.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35;R745
【参考文献】
相关期刊论文 前9条
1 刘立芝;伍建宇;吴志勇;陈朝晖;凌丽;孙博;李一凡;黄旭升;;奥沙利铂诱导性周围神经病的临床及电生理观察[J];中华医学杂志;2016年13期
2 邵景芳;杜方民;施巧完;黄帅;;铂类化疗药物诱导周围神经损害的电生理与临床[J];大家健康(学术版);2016年05期
3 廖丽红;刘甲兴;张江灵;何文钦;;神经传导速度在评价奥沙利铂相关性外周神经损伤中的应用[J];中华胃肠外科杂志;2015年10期
4 刘素;张侠;;奥沙利铂神经毒性机制及基因多态性研究进展[J];中华临床医师杂志(电子版);2015年09期
5 史晓芳;董继宏;韩荣;朱一皓;周宇红;汪昕;;肿瘤化疗药物诱导性周围神经病的临床横断面研究[J];中国临床神经科学;2012年05期
6 张思维;雷正龙;李光琳;邹小农;赵平;陈万青;;中国肿瘤登记地区2006年肿瘤发病和死亡资料分析[J];中国肿瘤;2010年06期
7 蒋晓宇;许晓薇;刘建华;;神经传导速度对糖尿病周围神经病变的诊断价值[J];医学理论与实践;2009年04期
8 曲卓慧;孟春;王耀辉;;奥沙利铂神经毒性的机制及防治方法[J];中国全科医学;2008年02期
9 刘荫华;徐玲;;第七版《AJCC肿瘤分期手册》结直肠癌内容的更新与解读[J];中华胃肠外科杂志;2010年08期
，本文编号：2241735
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2241735.html
最近更新
教材专著
