Anish Lawrence, Nagappa Madhu, Mahadevan Anita, Taly Arun B
Department of Neurology, NIMHANS, Bangalore, Karnataka 560029, India.
Department of Neuropathology, NIMHANS, Bangalore, Karnataka, India.
Age Ageing. 2015 Mar;44(2):312-7. doi: 10.1093/ageing/afu171. Epub 2014 Nov 1.
To study the utility of nerve biopsy in providing diagnostic, therapeutic or prognostic information that aid in clinical management in elderly subjects with peripheral neuropathy.
Clinico-pathological data of 100 elderly subjects aged 65 and above with peripheral neuropathy who underwent nerve biopsy in the last decade (2002-2011) was reviewed.
The study included 100 subjects (M:F 78:22). Mean age at biopsy and symptom duration was 69.62±4.8 years and 24.17±40.4 months, respectively. The most common pattern of was distal symmetric sensorimotor polyneuropathy (35%), followed by multiple mononeuropathy (29%) and asymmetric sensorimotor neuropathy (15%). The nerve biopsy was 'diagnostic' in 24%, (definite vasculitis in 12, leprosy in 10 and acute inflammatory demyelinating polyradiculoneuropathy in 2) and proved 'essential' or 'helpful' in therapeutic management in 81% subjects. In 60 (60%) patients, where a pre-biopsy aetiological diagnosis could be arrived at based on the available data, nerve biopsy confirmed the diagnosis in 29 of 60 (48.3%), and offered a new diagnosis in 25 (41.7%). A higher yield of biopsy was noted in subjects with asymmetric/multiple mononeuropathy compared with symmetric neuropathies (32.7% versus 17.7%). In 40 (40%) patients without a pre-biopsy aetiological diagnosis, nerve biopsy was 'essential' in 7 of 40 (17.5%) as it provided a definitive diagnosis (definite vasculitis: 5, leprosy: 2), and 'helpful' in 21 of 40 (52.5%) (ischaemic neuropathy: 10, possible vasculitis: 9, probable vasculitis: 2).
Nerve biopsy aided in the detection of potentially treatable disorders and influenced patient management in a significant proportion of elderly subjects with peripheral neuropathy (81%), particularly in subset with undiagnosed neuropathies confirming that it's a useful tool in diagnosis of neuropathy in the elderly. With minor differences, the aetiological profile in our biopsied neuropathic elderly subjects may reflect the findings in other similar cohorts.
研究神经活检在为老年周围神经病患者提供有助于临床管理的诊断、治疗或预后信息方面的作用。
回顾了过去十年（2002 - 2011年）接受神经活检的100例65岁及以上老年周围神经病患者的临床病理资料。
该研究纳入100例患者（男∶女为78∶22）。活检时的平均年龄和症状持续时间分别为69.62±4.8岁和24.17±40.4个月。最常见的类型是远端对称性感觉运动性多发性神经病（35%），其次是多灶性单神经病（29%）和不对称性感觉运动性神经病（15%）。神经活检在24%的患者中具有“诊断性”（12例确诊为血管炎，10例为麻风，2例为急性炎症性脱髓鞘性多发性神经根神经病），并在81%的患者的治疗管理中被证明“至关重要”或“有帮助”。在60例（60%）患者中，根据现有数据在活检前可得出病因诊断，神经活检在60例中的29例（48.3%）中证实了诊断，并在25例（41.7%）中提供了新的诊断。与对称性神经病相比，不对称性/多灶性单神经病患者的活检阳性率更高（32.7%对17.7%）。在40例（40%）活检前无病因诊断的患者中，神经活检在40例中的7例（17.5%）中具有“决定性”作用（确诊为血管炎：5例，麻风：2例），并在40例中的21例（52.5%）中“有帮助”（缺血性神经病：10例，可能的血管炎：9例，可能的血管炎：2例）。
神经活检有助于检测潜在可治疗的疾病，并在相当比例（81%）的老年周围神经病患者中影响患者管理，特别是在未确诊神经病的亚组中，证实其是老年神经病诊断的有用工具。我们活检的神经病老年患者的病因学特征虽有细微差异，但可能反映其他类似队列的研究结果。
