Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
Medizinisches Proteom-Center, Ruhr-University Bochum, Bochum, Germany.
Neurocrit Care. 2021 Aug;35(1):139-152. doi: 10.1007/s12028-020-01148-2. Epub 2020 Nov 24.
Diagnosis of intensive care unit acquired weakness (ICUAW) is challenging. Pathogenesis of underlying critical illness polyneuromyopathy (CIPNM) remains incompletely understood. This exploratory study investigated whether longitudinal neuromuscular ultrasound examinations and cytokine analyses in correlation to classical clinical and electrophysiological assessment contribute to the understanding of CIPNM.
Intensive care unit patients were examined every 7 days until discharge from hospital. Clinical status, nerve conduction studies, electromyography as well as ultrasound of peripheral nerves and tibial anterior muscle were performed. Cytokine levels were analyzed by a bead-based multiplex assay system.
Of 248 screened patients, 35 patients were included at median of 6 days (IQR: 8) after admission to intensive care unit. Axonal damage was the main feature of CIPNM. At the peak of CIPNM (7 days after inclusion), nerve ultrasound showed cross-sectional area increase of tibial nerve as a sign of inflammatory edema as well as hypoechoic nerves as a possible sign of inflammation. Cytokine analyses showed signs of monocyte and macrophage activation at this stage. Fourteen days after inclusion, cytokines indicated systemic immune response as well as profiles associated to neovascularization and regeneration.
Exploratory neuromuscular ultrasound and cytokine analyses showed signs of inflammation like macrophage and monocyte activation at the peak of CIPNM followed by a systemic immune response parallel to axonal damage. This underlines the role of both axonal damage and inflammation in pathogenesis of CIPNM.
重症监护病房获得性肌无力（ICUAW）的诊断具有挑战性。潜在的危重病多发性神经病（CIPNM）的发病机制仍不完全清楚。这项探索性研究调查了纵向神经肌肉超声检查和细胞因子分析与经典临床和电生理评估的相关性是否有助于理解 CIPNM。
对重症监护病房的患者进行每 7 天一次的检查，直到出院。进行临床状态、神经传导研究、肌电图以及周围神经和胫骨前肌的超声检查。通过基于珠的多重分析系统分析细胞因子水平。
在 248 名筛选出的患者中，35 名患者在入住重症监护病房后的中位数 6 天（IQR：8）时被纳入。轴索损伤是 CIPNM 的主要特征。在 CIPNM 的高峰期（纳入后 7 天），神经超声显示胫骨神经的横截面积增加，这是炎症性水肿的标志，而低回声神经可能是炎症的标志。细胞因子分析显示在此阶段有单核细胞和巨噬细胞激活的迹象。纳入后 14 天，细胞因子表明存在全身免疫反应以及与新生血管和再生相关的特征。
探索性神经肌肉超声和细胞因子分析显示，在 CIPNM 的高峰期出现炎症迹象，如巨噬细胞和单核细胞激活，随后是与轴索损伤平行的全身免疫反应。这强调了轴索损伤和炎症在 CIPNM 发病机制中的作用。
