眨眼R1潜伏期在多神经根神经病-器官肿大-内分泌病-单克隆蛋白-皮肤改变综合征及慢性炎症性脱髓鞘性多神经根神经病诊断和治疗评估中的应用
Blink R1 latency utility in diagnosis and treatment assessment of polyradiculoneuropathy-organomegaly-endocrinopathy-monoclonal protein-skin changes and chronic inflammatory demyelinating polyradiculoneuropathy.
作者信息
Wang Wei, Litchy William J, Mauermann Michelle L, Dyck P James B, Dispenzieri Angela, Mandrekar Jay, Dyck Peter J, Klein Christopher J
机构信息
Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota, 55905, USA.
Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
出版信息
Muscle Nerve. 2018 Jan;57(1):E8-E13. doi: 10.1002/mus.25731. Epub 2017 Jul 7.
INTRODUCTION
In polyradiculoneuropathy-organomegaly-endocrinopathy-monoclonal protein-skin changes (POEMS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), limb nerve conduction studies (NCSs) are limited in identifying demyelination and in detecting treatment effects in severely affected patients. Blink R1 latency may improve these assessments.
METHODS
POEMS and CIDP patients who had undergone NCS and blink reflex were identified. Correlations among R1 latency, limb NCS, and neuropathy impairment scores (NIS) were compared.
RESULTS
Among 182 patients (124 POEMS, 58 CIDP) who were identified, R1 prolongation (>13 ms) occurred in 64.3% (65.3% POEMS, 62.1% CIDP). R1 prolongation correlated with more severely affected NCS in both POEMS (ulnar CMAP 2.6 mV vs. 4.5 mV, P = 0.001) and CIDP (2.0 mV vs. 6.1 mV, P < 0.001). In severely affected patients (ulnar CMAP ≤0.5 mV [10%:18/182]), R1 (>13 ms) helped establish demyelination. In 31 patients (16 POEMS, 15 CIDP), the R1 latency changes were concordant with NIS changes in 94% of patients with POEMS and 60% of patients with CIDP.
DISCUSSION
Blink R1 latencies are valuable in defining demyelination and detecting improvement in severely affected POEMS and CIDP patients. Muscle Nerve 57: E8-E13, 2018.
引言
在多神经根神经病-脏器肿大-内分泌病-单克隆蛋白-皮肤改变（POEMS）综合征和慢性炎症性脱髓鞘性多神经根神经病（CIDP）中，肢体神经传导研究（NCS）在识别脱髓鞘以及检测严重受累患者的治疗效果方面存在局限性。眨眼R1潜伏期可能会改善这些评估。
方法
确定已接受NCS和眨眼反射检查的POEMS综合征和CIDP患者。比较R1潜伏期、肢体NCS和神经病变损害评分（NIS）之间的相关性。
结果
在确定的182例患者（124例POEMS综合征，58例CIDP）中，64.3%（POEMS综合征为65.3%，CIDP为62.1%）出现R1延长（>13毫秒）。在POEMS综合征（尺神经复合肌肉动作电位[CMAP]为2.6毫伏对4.5毫伏，P = 0.001）和CIDP（2.0毫伏对6.1毫伏，P < 0.001）中，R1延长均与更严重受累的NCS相关。在严重受累患者（尺神经CMAP≤0.5毫伏[10%：18/182]）中，R1（>13毫秒）有助于确定脱髓鞘。在31例患者（16例POEMS综合征，15例CIDP）中，94%的POEMS综合征患者和60%的CIDP患者的R1潜伏期变化与NIS变化一致。
讨论
眨眼R1潜伏期在定义脱髓鞘以及检测严重受累的POEMS综合征和CIDP患者的病情改善方面具有重要价值。《肌肉与神经》57：E8-E13，2018年。
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