交感神经皮肤反应在慢性炎症性脱髓鞘性多发性神经根神经病中的临床应用
发布时间：2019-03-29 12:47
【摘要】：目的： 探讨交感神经皮肤反应(sympathetic skin response, SSR)对慢性炎症性脱髓鞘性多发性神经根神经病(chronic inflammatory demyelinating polyradiculoneuropathy, CIDP)自主神经功能损害的诊断价值。 方法： 收集2011年11月至2013年3月在浙江大学医学院附属第二医院住院诊治的CIDP患者29例,排除中枢或其他外周神经系统损害以及任何影响自主神经系统的疾病。选择同期健康体检者30例作为正常对照组,分别进行SSR测定及自主神经症状量表(autonomic symptom profile, ASP)评定。 结果： 1.病例组SSR异常率(75.86%)显著高于正常对照组SSR异常率(0),差异有显著统计学意义(p0.01)。 2.与正常对照组比较,病例组SSR波幅显著降低,差异有显著统计学意义(p0.01),而潜伏期无显著延长(p0.05)。 3.病例组上、下肢SSR异常率比较,差异无统计学意义(p0.05)。 4.病例组ASP评分(25.35分)及评分异常率(65.52%)均显著高于正常对照组的评分(12.58分)及评分异常率(0),差异有显著统计学意义(p0.01)。 5.病例组SSR异常率(75.86%)及ASP评分异常率(65.52%)与临床自主神经症状出现率(31.03%)分别比较,差异均有显著统计学意义(p0.01),而SSR异常率与ASP评分异常率相比较,差异无统计学意义(p0.05)。 6.29例CIDP患者中临床表现有自主神经症状亚组SSR异常率(100.00%)与无自主神经症状亚组SSR异常率(65.00%)比较,差异有统计学意义,两者具有相关性(p0.05)。有自主神经症状亚组ASP评分异常率(77.78%)与无自主神经症状亚组ASP评分异常率(60.00%)比较,差异无统计学意义,两者无相关性(p0.05)。 7.CIDP患者的SSR结果与运动末端潜伏期、运动传导波幅及F波潜伏期均无相关性。 8.CIDP患者的脑脊液蛋白含量与SSR结果无相关性。 9.病程不少于12个月的CIDP患者与少于12个月的患者比较,两者上下肢的SSR潜伏期及波幅差异均无统计学意义(p0.05)。 结论： 1.SSR能灵敏地检测出CIDP患者自主神经功能受损的情况。 2.SSR的异常率与CIDP患者临床自主神经症状的出现率高度相关,且可以客观量化,SSR可以成为一个临床上早期检测CIDP患者自主神经功能损害的可靠电生理指标。
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.5
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