Athanasopoulou Ioanna M, Rasenack Maria, Grimm Christine, Axer Hubertus, Sinnreich Michael, Décard Bernhard F, Grimm Alexander
Department of Neurology, Basel University Hospital, Basel, Switzerland.
Department of Internal Medicine, County Hospital Reutlingen, Germany.
J Neurol Sci. 2016 Mar 15;362:188-95. doi: 10.1016/j.jns.2016.01.055. Epub 2016 Jan 26.
To investigate the use of peripheral nerve ultrasound (PNUS) in addition to nerve conduction studies (NCS) in the diagnosis of paraproteinemic neuropathies (PN).
PNUS/NCS of predefined peripheral nerves and the 5th/6th cervical roots were performed in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) (+/-paraprotein), patients with anti-MAG neuropathy, and patients with neuropathy and multiple myeloma or monoclonal gammopathy of uncertain significance (MGUS) - summarized as M-protein associated neuropathies (MPAN) and compared to controls (+/-paraprotein).
39 patients and 27 age-matched controls were included. Nerve enlargement was most marked in patients with CIDP, while in anti-MAG neuropathies enlargement was significant in the legs. In MPAN, no nerve enlargement is found regularly. However, in two cases, the diagnostic steps were influenced by the finding of multiple enlarged nerves and finally immunotherapy response was successfully initiated. By the use of the ultrasound pattern sum score (UPSS), differentiation of PN can be simplified.
Due to the heterogeneous findings in NCS, correct diagnosis of PN, and straightforward therapeutic decisions often may be controversial. Particularly in cases of M-protein related neuropathy, the finding of multiple nerve enlargements facilitates the decision for therapeutic approaches or nerve biopsy. The UPSS enables the distinction of different PN from each other.
The use of an ultrasound quantification tool in addition to NCS facilitates a differentiation of PN.
研究除神经传导研究（NCS）外，外周神经超声（PNUS）在诊断副蛋白血症性神经病（PN）中的应用。
对慢性炎症性脱髓鞘性多发性神经病（CIDP）（伴或不伴副蛋白）患者、抗MAG神经病患者以及患有神经病且伴有多发性骨髓瘤或意义未明的单克隆丙种球蛋白病（MGUS）的患者（总结为M蛋白相关神经病（MPAN））进行预定外周神经和第5/6颈神经根的PNUS/NCS检查，并与对照组（伴或不伴副蛋白）进行比较。
纳入39例患者和27例年龄匹配的对照组。神经增粗在CIDP患者中最为明显，而在抗MAG神经病中，腿部增粗显著。在MPAN中，未经常发现神经增粗。然而，在两例中，多条神经增粗的发现影响了诊断步骤，最终成功启动了免疫治疗反应。通过使用超声模式总分（UPSS），可以简化PN的鉴别。
由于NCS结果的异质性，PN的正确诊断和直接的治疗决策往往可能存在争议。特别是在M蛋白相关神经病的病例中，多条神经增粗的发现有助于治疗方法的决策或神经活检。UPSS能够区分不同的PN。
除NCS外，使用超声量化工具有助于区分PN。
