Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.
Neuropathophysiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy.
Neurophysiol Clin. 2021 Mar;51(2):183-191. doi: 10.1016/j.neucli.2021.02.001. Epub 2021 Feb 18.
To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features.
Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 control AIDP (C-AIDP) without SARS-CoV-2 infection were compared.
S-AIDP patients more frequently developed respiratory failure (83.3% vs. 25%, P=0.000) and required intensive care unit (ICU) hospitalization (58.3% vs. 31.3%, P=0.000). In C-AIDP, distal motor latencies (DMLs) were more frequently prolonged (70.9% vs. 26.2%, P=0.000) whereas in S-AIDP distal compound muscle action potential (dCMAP) durations were more frequently increased (49.5% vs. 32.4%, P=0.002) and F waves were more often absent (45.6% vs. 31.8%, P=0.011). Presence of nerves with increased dCMAP duration and normal or slightly prolonged DML was elevenfold higher in S-AIDP (31.1% vs. 2.8%, P=0.000);11 S-AIDP patients showed this pattern in 2 nerves.
Increased dCMAP duration, thought to be a marker of acquired demyelination, can also be oserved in critical illness myopathy. In S-AIDP patients, an increased dCMAP duration dissociated from prolonged DML, suggests additional muscle fiber conduction slowing, possibly due to a COVID-19-related hyperinflammatory state. Absent F waves, at least in some S-AIDP patients, may reflect α-motor neuron hypoexcitability because of immobilization during the ICU stay. These features should be considered in the electrodiagnosis of SARS-CoV-2 patients with weakness, to avoid misdiagnosis.
评估是否患有 SARS-CoV-2 相关急性炎症性脱髓鞘性多发性神经病（AIDP）的患者具有特征性的电生理特征。
比较 24 例 SARS-CoV-2 感染合并 AIDP（S-AIDP）患者和 48 例无 SARS-CoV-2 感染的对照 AIDP（C-AIDP）患者的临床和电生理检查结果。
S-AIDP 患者更常发生呼吸衰竭（83.3% vs. 25%，P=0.000）和需要入住重症监护病房（ICU）（58.3% vs. 31.3%，P=0.000）。在 C-AIDP 中，远端运动潜伏期（DML）更常延长（70.9% vs. 26.2%，P=0.000），而在 S-AIDP 中，远端复合肌肉动作电位（dCMAP）持续时间更常增加（49.5% vs. 32.4%，P=0.002），F 波更常缺失（45.6% vs. 31.8%，P=0.011）。在 S-AIDP 中，存在 dCMAP 持续时间增加且 DML 正常或轻度延长的神经更为常见（31.1% vs. 2.8%，P=0.000），11 例 S-AIDP 患者在 2 根神经中存在这种表现。
认为是获得性脱髓鞘的标志物的 dCMAP 持续时间增加，也可以在危重病性肌病中观察到。在 S-AIDP 患者中，与 DML 延长分离的 dCMAP 持续时间增加提示肌肉纤维传导进一步减慢，可能是由于 COVID-19 相关的过度炎症状态。至少在一些 S-AIDP 患者中 F 波缺失可能反映了 ICU 住院期间的α运动神经元兴奋性降低。在 SARS-CoV-2 相关肌无力患者的电诊断中应考虑这些特征，以避免误诊。
