中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (1): 112-118.doi: 10.4103/1673-5374.150716

• 原著:颅神经损伤修复保护与再生 • 上一篇    下一篇

神经活检病理诊断多发性单神经病:78%支持临床诊断

  

  • 收稿日期:2014-09-02 出版日期:2015-01-15 发布日期:2015-01-15

Nerve biopsy findings contribute to diagnosis of multiple mononeuropathy: 78% of findings support clinical diagnosis

Ying-shuang Zhang 1, A-ping Sun 1, Lu Chen 1, Rong-fang Dong 2, Yan-feng Zhong 2, Jun Zhang 1, *   

  1. 1 Department of Neurology, Peking University Third Hospital, Beijing, China
    2 Department of Pathology, Peking University Health Science Center, Beijing, China
  • Received:2014-09-02 Online:2015-01-15 Published:2015-01-15
  • Contact: Jun Zhang, Ph.D., who626@163.com.

摘要:

多发性单神经病是累及两条及以上神经干的少见周围神经病变,是多种不同病因引起的临床综合征。以往的关于多发性单神经病的文献主要是临床电生理特点的总结,诊断信息尚不全面,文章回顾性分析有完整详尽病史的14例多发性单神经病患者的临床、电生理和神经活检病理特点。发现6例诊断为血管炎性周围神经病,2例诊断为神经束膜炎,2例诊断为慢性炎症性脱髓鞘性多发性神经根神经炎,1例诊断为Lewis-Sumner综合征,另外有2例临床诊断为血管炎性周围神经病,1例临床诊断为慢性炎症性脱髓鞘性多发性神经根神经炎,未出现相应的典型病理改变。神经活检对多发性单神经病的病理确诊率为78.57%(11/14)。结果表明,神经活检病理诊断对多发性单神经病的病因诊断至关重要。

关键词: 神经再生, 周围神经再生, 多发性单神经病, 不对称的感觉运动多发性神经病变, 系统性血管炎病变, 假性血管炎病变, 视神经, 炎性脱髓鞘, 刘易斯-萨姆纳综合征, 腓肠神经活检, 皮肤活检, 周围神经系统

Abstract:

Multiple mononeuropathy is an unusual form of peripheral neuropathy involving two or more nerve trunks. It is a syndrome with many different causes. We reviewed the clinical, electrophysiological and nerve biopsy findings of 14 patients who suffered from multiple mononeuropathy in our clinic between January 2009 and June 2013. Patients were diagnosed with vasculitic neuropathy (n = 6), perineuritis (n = 2), chronic inflammatory demyelinating polyradiculoneuropathy(n = 2) or Lewis-Sumner syndrome (n = 1) on the basis of clinical features, laboratory data, electrophysiological investigations and nerve biopsies. Two patients who were clinically diagnosed with vasculitic neuropathy and one patient who was clinically diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy were not confirmed by nerve biopsy. Nerve biopsies confirmed clinical diagnosis in 78.6% of the patients (11/14). Nerve biopsy pathological diagnosis is crucial to the etiological diagnosis of multiple mononeuropathy.

Key words: nerve regeneration, peripheral nerve regeneration, multiple mononeuropathy, asymmetrical sensory-motor polyneuropathy, systemic vasculitic neuropathy, nonsystemic vasculitic neuropathy, perineuritis, inflammatory demyelinating polyradiculoneuropathy, Lewis-Sumner syndrome, sural nerve biopsy, skin biopsy, peripheral nervous system