Al-Shekhlee Amer, Hachwi Rami N, Preston David C, Katirji Bashar
Department of Neurology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106-5040, USA.
Muscle Nerve. 2005 Jul;32(1):66-72. doi: 10.1002/mus.20342.
A variety of electrodiagnostic methods are used to confirm the diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP), but difficulties are frequent during the first few weeks of weakness. We compared the nerve conduction studies (NCS) of patients with AIDP to those with critical illness polyneuropathy (CIP), a subacute axonal polyneuropathy. New electrodiagnostic criteria with graded certainty (normal, nondiagnostic, suggestive, highly suggestive, and definite) were designed and applied in a blinded manner to both groups. Among the AIDP patients, 64% met the highly suggestive and definite criteria (specificity 95-100%, P < 0.01), whereas 80% of the CIP group fell in the nondiagnostic criteria (P < 0.001). The relative preservation of the sural sensory response in spite of at least two abnormal sensory NCS in the upper limb suggested acute demyelination (sensitivity 48%, specificity 96%, P < 0.001) and was even more conclusive when associated with absent or prolonged F waves. Motor and sensory response amplitudes were lower in the CIP group, with comparable mean motor and sensory distal latencies and motor conduction velocities. Motor conduction blocks were present in 10% of nerves in AIDP and were not encountered in CIP. The frequency of absent or delayed F waves and absent H reflex was similar in both groups. The correlation coefficient of the cerebrospinal fluid protein concentration with the designed criteria was higher in the AIDP group (r = 0.9). We conclude that a new criterion with graded certainty is of higher specificity in the majority of patients with early AIDP.
多种电诊断方法用于确诊急性炎性脱髓鞘性多发性神经病（AIDP），但在肌无力的最初几周常遇到困难。我们将AIDP患者的神经传导研究（NCS）与危重病性多发性神经病（CIP，一种亚急性轴索性多发性神经病）患者的进行了比较。设计了具有分级确定性（正常、非诊断性、提示性、高度提示性和确定性）的新电诊断标准，并以盲法应用于两组。在AIDP患者中，64%符合高度提示性和确定性标准（特异性95 - 100%，P < 0.01），而CIP组80%属于非诊断性标准（P < 0.001）。尽管上肢至少有两项感觉NCS异常，但腓肠感觉反应相对保留提示急性脱髓鞘（敏感性48%，特异性96%，P < 0.001），当与F波缺失或延长相关时更具决定性。CIP组的运动和感觉反应波幅较低，平均运动和感觉远端潜伏期及运动传导速度相当。AIDP患者10%的神经存在运动传导阻滞，CIP患者未出现。两组中F波缺失或延迟及H反射缺失的频率相似。AIDP组脑脊液蛋白浓度与设计标准的相关系数更高（r = 0.9）。我们得出结论，具有分级确定性的新标准在大多数早期AIDP患者中具有更高的特异性。
