Sharma K R, Saadia D, Facca A G, Resnick S, Ayyar D R
Department of Neurology, University of Miami School of Medicine, FL 33136, USA.
Acta Neurol Scand. 2009 Apr;119(4):224-32. doi: 10.1111/j.1600-0404.2008.01078.x. Epub 2008 Jul 29.
Evidence is accumulating that patients with polyneuropathy may present with normal clinical deep tendon reflexes (C-DTR). There are few studies that assessed the diagnostic utility of electromyographically recorded DTR (Er-DTR) in patients with polyneuropathy.
The objectives of this study were twofold: (i) to evaluate the prevalence of preserved C-DTR in polyneuropathy; (ii) diagnostic value of Er-DTR latency measurement in patients with polyneuropathy.
We prospectively studied 38 controls and 185 patients with polyneuropathy. All subjects had evaluation of C-DTR, Er-DTR obtained from right biceps brachii (BR), right patellar (PR) and bilateral ankle reflexes (AR).
Of these 185 patients, 118 (63.8%) had chronic axonal neuropathy (CAN), 49 (26.5%) demyelinating polyradiculoneuropathy (DPN) and 18 (9.7%) small fiber neuropathy (SFN). The C-DTR were normal in 65 patients whereas 39 of these 65 (60%) patients had abnormalities of Er-DTR at one or more sites. Er-DTR latencies in patients with polyneuropathies were prolonged at all sites compared with controls (P < 0.01). Among patients with various types of polyneuropathies the Er-DTR, mean latencies at all the sites and latency indicative of demyelination (>150% of the normal mean) were higher in patients with DPN than that of CAN or SFN (P < 0.01).
We conclude that C-DTR are preserved in 35.1% of the patients with polyneuropathies and Er-DTR should be performed in such patients in order to provide electrophysiological evidence of a polyneuropathy. Er-DTR are useful in distinguishing axonal from demyelinating disorders of peripheral nerve, and detection of subclinical involvement of large fibers in SFN.
越来越多的证据表明，患有多发性神经病的患者临床深腱反射（C-DTR）可能正常。很少有研究评估肌电图记录的DTR（Er-DTR）在多发性神经病患者中的诊断效用。
本研究的目的有两个：（i）评估多发性神经病中保留C-DTR的患病率；（ii）评估Er-DTR潜伏期测量在多发性神经病患者中的诊断价值。
我们前瞻性地研究了38名对照者和185名多发性神经病患者。所有受试者均接受了C-DTR评估，以及从右肱二头肌（BR）、右髌骨（PR）和双侧跟腱反射（AR）获得的Er-DTR评估。
在这185名患者中，118名（63.8%）患有慢性轴索性神经病（CAN），49名（26.5%）患有脱髓鞘性多发性神经根神经病（DPN），18名（9.7%）患有小纤维神经病（SFN）。65名患者的C-DTR正常，而这65名患者中有39名（60%）在一个或多个部位存在Er-DTR异常。与对照组相比，多发性神经病患者所有部位的Er-DTR潜伏期均延长（P<0.01）。在各种类型的多发性神经病患者中，DPN患者所有部位的Er-DTR平均潜伏期以及提示脱髓鞘的潜伏期（>正常平均值的150%）均高于CAN或SFN患者（P<0.01）。
我们得出结论，35.1%的多发性神经病患者C-DTR正常，对于此类患者应进行Er-DTR检查，以提供多发性神经病的电生理证据。Er-DTR有助于区分周围神经的轴索性疾病和脱髓鞘性疾病，以及检测SFN中大纤维的亚临床受累情况。
