Tilki Hacer Erdem, Akpolat Tekin, Coşkun Melek, Stålberg Erik
Department of Neurology, Ondokuz Mayis University, Samsun, Turkey.
J Electromyogr Kinesiol. 2009 Jun;19(3):500-8. doi: 10.1016/j.jelekin.2007.10.011. Epub 2007 Dec 26.
The aim of this study was to quantitatively determine the electrophysiologic changes occurring in the peripheral nerves and muscles in patients with chronic renal failure (CRF) treated with haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), and to determine which electrophysiologic parameters are most commonly abnormal in uraemic patients. We investigated the relationship between the parameters of neurography and quantitative electromyography (QEMG) and clinical findings. The study included 42 patients with CRF (30 on HD and 12 on CAPD). Nerve conduction studies (NCSs) of the median, ulnar, tibial, peroneal, and sural nerves, and QEMG of the tibialis anterior and biceps brachii muscles were performed. We found axonal and/or demyelinating polyneuropathies in 97.6% of the patients (100% of HD and 91.7% of CAPD patients), but were not able to verify any significant differences between the HD and CAPD patients using NCS or QEMG. Median, ulnar, sural sensory nerve action potential (SNAP) amplitudes, peroneal CV and F-latency were the most common abnormal parameters in sensory and motor NCSs, respectively. The clinical findings only correlated with the parameters of neurography, and not with the parameters of QEMG. Sural SNAP amplitudes, peroneal and tibial CVs, F-latencies also correlated with the severity of the clinical findings in these patients, suggesting that these parameters can be used in follow up studies in these patients. In this study, most of the uraemic patients were found to have already mild or moderate neuropathies in which the objective clinical signs might be absent, even if they have some clinical symptoms. NCS showed abnormality indicating polyneuropathy in 24 out of 25 patients with clinical neuropathy signs and in 17 out of 17 patients with no clinical signs. Thus, in subclinical conditions NCS is useful to detect the abnormalities in peripheral nerves of the ureamic patients under chronic dialysis.
本研究的目的是定量测定接受血液透析（HD）或持续性非卧床腹膜透析（CAPD）治疗的慢性肾衰竭（CRF）患者外周神经和肌肉发生的电生理变化，并确定尿毒症患者中哪些电生理参数最常出现异常。我们研究了神经传导检查和定量肌电图（QEMG）参数与临床发现之间的关系。该研究纳入了42例CRF患者（30例接受HD治疗，12例接受CAPD治疗）。对正中神经、尺神经、胫神经、腓总神经和腓肠神经进行了神经传导研究（NCS），并对胫前肌和肱二头肌进行了QEMG检查。我们发现97.6%的患者存在轴索性和/或脱髓鞘性多发性神经病（HD患者为100%，CAPD患者为91.7%），但使用NCS或QEMG未能证实HD和CAPD患者之间存在任何显著差异。正中神经、尺神经、腓肠感觉神经动作电位（SNAP）波幅以及腓总神经传导速度（CV）和F波潜伏期分别是感觉和运动NCS中最常见的异常参数。临床发现仅与神经传导检查参数相关，而与QEMG参数无关。腓肠神经SNAP波幅、腓总神经和胫神经CV以及F波潜伏期也与这些患者的临床发现严重程度相关，提示这些参数可用于这些患者的随访研究。在本研究中，发现大多数尿毒症患者已存在轻度或中度神经病，即使他们有一些临床症状，可能也没有客观的临床体征。在25例有临床神经病体征的患者中，24例NCS显示异常，提示多发性神经病；在17例无临床体征的患者中，17例NCS也显示异常。因此，在亚临床情况下，NCS有助于检测慢性透析的尿毒症患者外周神经的异常情况。
