Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan.
Brain Behav. 2017 Sep 15;7(10):e00812. doi: 10.1002/brb3.812. eCollection 2017 Oct.
In chronic inflammatory demyelinating polyneuropathy (CIDP), exclusion of secondary axonal degeneration is challenging with conventional methods such as nerve conduction study (NCS), needle electromyography, and nerve biopsy. Increased echo intensity (EI) and decreased muscle thickness (MT) identified on muscle ultrasound (MUS) examination represent muscle denervation due to axonal degeneration in neurogenic disorders, suggesting MUS as a new tool to detect secondary axonal degeneration in patients with CIDP.
EI and MT of abductor pollicis brevis, abductor digiti minimi, and first dorsal interosseous muscles were measured in 16 CIDP patients. Raw values were converted into -scores using data from 60 normal controls (NCs).
Six of 45 muscles showed abnormally high EI and low MT, suggesting denervation following secondary axonal degeneration. These six muscles belonged to two patients with long disease history, unresponsiveness to treatment, and long interval from onset to initial therapy. There were no significant differences in EI and MT ( = .23 and .67, respectively) between the CIDP and NC groups, although NCS results revealed obvious demyelinating abnormalities in all CIDP patients, suggesting the fact that muscle structures will be preserved, and EI and MT will not change unless secondary axonal degeneration occurs in CIDP.
MUS is a promising tool for evaluating secondary axonal degeneration in patients with CIDP.
在慢性炎症性脱髓鞘性多发性神经病（CIDP）中，通过常规方法（如神经传导研究、针极肌电图和神经活检）排除继发性轴突变性具有挑战性。肌肉超声（MUS）检查中发现的回声强度增加（EI）和肌肉厚度降低（MT）代表神经源性疾病中轴突变性引起的肌肉失神经支配，这表明 MUS 是一种新的工具，可以检测 CIDP 患者的继发性轴突变性。
对 16 例 CIDP 患者的拇短展肌、小指展肌和第一骨间背侧肌的 EI 和 MT 进行测量。使用 60 名正常对照（NC）的数据将原始值转换为 -分数。
45 块肌肉中有 6 块表现出异常高的 EI 和低的 MT，提示继发性轴突变性后的失神经支配。这 6 块肌肉属于两名病史较长、对治疗无反应且从发病到初始治疗的间隔时间较长的患者。尽管所有 CIDP 患者的神经传导研究结果均显示明显的脱髓鞘异常，但 CIDP 组和 NC 组之间的 EI 和 MT 无显著差异（=分别为.23 和.67），这表明在 CIDP 中，肌肉结构将得到保留，并且 EI 和 MT 不会改变，除非发生继发性轴突变性。
MUS 是评估 CIDP 患者继发性轴突变性的一种有前途的工具。
