Ackil A A, Shahani B T, Young R R
Arch Phys Med Rehabil. 1981 Oct;62(10):487-91.
Physiologic evidence of peripheral neuropathy has been described previously in children undergoing hemodialysis. In order to detect early or subclinical evidence of peripheral neuropathy, several newer electrophysiologic techniques, including latencies of late responses (H reflex and F response) and sural nerve sensory studies, were evaluated in addition to routine motor and sensory conduction in 17 randomly selected children (mean age 14.2 years) undergoing hemodialysis (12 of whom had no clinical evidence of peripheral neuropathy) and 20 age-matched normal control subjects. Conventional motor and sensory conduction studies of median and ulnar nerves and motor conduction of peroneal and tibial nerves showed abnormalities of motor conduction in 5 (29%) and abnormalities of sensory conduction in 2 (12%). Sural nerve sensory potentials were abnormal in 10 (59%) patients. Late response were significantly abnormal in 10 (59%) patients, 5 (29%) of whom had normal routine motor conduction studies in the same nerve distribution. The abnormalities of late responses and motor and sensory conduction were more evident in lower limbs. Studies of late responses and sural sensory conduction provide a method of detecting subclinical neuropathy in this patient population at a time when results of conventional motor and sensory conduction tests are within normal limits. Effects of dialysis may then be followed quantitatively in patients whose neuropathy would otherwise be undetectable.
先前已有文献描述了接受血液透析的儿童出现周围神经病变的生理学证据。为了检测周围神经病变的早期或亚临床证据，除了对17名随机选取的接受血液透析的儿童（平均年龄14.2岁，其中12名无周围神经病变的临床证据）和20名年龄匹配 的正常对照者进行常规运动和感觉传导检测外，还评估了几种更新的电生理技术，包括迟发反应（H反射和F反应）潜伏期以及腓肠神经感觉检测。正中神经和尺神经的常规运动和感觉传导检测以及腓总神经和胫神经的运动传导检测显示，5名（29%）存在运动传导异常，2名（12%）存在感觉传导异常。10名（59%）患者的腓肠神经感觉电位异常。10名（59%）患者的迟发反应显著异常，其中5名（29%）在相同神经分布区域的常规运动传导检测结果正常。迟发反应以及运动和感觉传导的异常在下肢更为明显。迟发反应和腓肠感觉传导检测提供了一种在常规运动和感觉传导检测结果在正常范围内时检测该患者群体亚临床神经病变的方法。这样一来，对于那些否则神经病变无法检测到的患者，可以定量跟踪透析的效果。
