[丙型肝炎病毒感染中的冷球蛋白血症性周围神经病：22例临床与解剖学相关性研究]

Taieb G, Maisonobe T, Musset L, Cacoub P, Léger J-M, Bouche P

Service de neurologie, groupe hospitalo-universitaire Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France.

Rev Neurol (Paris). 2010 May;166(5):509-14. doi: 10.1016/j.neurol.2009.10.019. Epub 2010 Mar 24.

INTRODUCTION

Cryoglobulinemic neuropathies caused by hepatitis C virus are frequent and may have severe clinical outcomes. The aim of this study was to clarify the clinical and anatomical correlations of these neuropathies.

METHODS

Between 1992 and 2007, 22 consecutive patients with cryoglobulinemic neuropathies caused by hepatitis C virus were retrospectively included. Patients were evaluated clinically, electrophysiologically and underwent a neuromuscular biopsy. The group of patients with vasculitis on nerve biopsy was compared with the group without vasculitis.

RESULTS

All the neuropathies were axonal with 11 polyneuropathies and 11 mononeuropathies multiplex. The seven patients with medium-sized vasculitis on the nerve biopsy presented an acute sensorimotor mononeuropathy multiplex in six cases (85%), with ischemic conduction block in three cases (42%) and wallerian degeneration in four cases (57%). Among the four patients with small-sized vasculitis, two had a mononeuropathy multiplex (50%) without conduction block (0%) and with wallerian degeneration in one case (25%). The 11 patients without vasculitis (nine lymphocytic perivascular infiltrates and two non inflammatory biopsies) had a polyneuropathy in eight cases (72%) without conduction block and wallerian degeneration (0%). The type of neuropathy was different in the group of patients with vasculitis compared with the group without vasculitis. The neuropathies with vasculitis were significantly different with more frequent mononeuropathies multiplex (p<0.05), acute early stage (p<0.01), disability (p<0.05) and wallerian degeneration (p=0.01).

CONCLUSION

Among hepatitis C patients with cryoglobulinemia, neuropathies with small-sized vasculitis show a pattern between severe mononeuropathies multiplex with medium-sized vasculitis and moderate polyneuropathies with lymphocytic perivascular infiltrates. In cryoglobulinemic vasculitis with hepatitis C, the severity of the neuropathy depends on the nature of the cellular inflammation and the size of the vessel involvement.

引言

丙型肝炎病毒引起的冷球蛋白血症性神经病很常见，且可能产生严重的临床后果。本研究的目的是阐明这些神经病的临床和解剖学相关性。

方法

回顾性纳入1992年至2007年间连续的22例由丙型肝炎病毒引起的冷球蛋白血症性神经病患者。对患者进行临床、电生理评估，并进行神经肌肉活检。将神经活检有血管炎的患者组与无血管炎的患者组进行比较。

结果

所有神经病均为轴索性，其中11例为多发性神经病，11例为多灶性单神经病。神经活检有中等大小血管炎的7例患者中，6例（85%）表现为急性感觉运动性多灶性单神经病，3例（42%）有缺血性传导阻滞，4例（57%）有华勒氏变性。在4例有小血管炎的患者中，2例有多灶性单神经病（50%），无传导阻滞（0%），1例（25%）有华勒氏变性。11例无血管炎的患者（9例淋巴细胞血管周围浸润和2例非炎症性活检）中，8例（72%）有多发性神经病，无传导阻滞和华勒氏变性（0%）。与无血管炎的患者组相比，有血管炎的患者组神经病类型不同。有血管炎的神经病有显著差异，多灶性单神经病更常见（p<0.05）、急性早期（p<0.01）、残疾（p<0.05）和华勒氏变性（p=0.01）。