Das K B, Taly A B, Gupta S K, Suresh T G, Rao S, Nagaraja D
Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore.
Electromyogr Clin Neurophysiol. 1995 Dec;35(8):451-5.
There is agreement on the clinical diagnostic criteria for acute inflammatory demyelinating polyneuropathy (AIDP/GBS) however, there is lack of consensus for detection of demyelination. In order to critically evaluate the prevailing criteria, sixty-six patients who fulfilled NINCDS criteria and had typical features of GBS were studied for electrophysiological abnormalities of peripheral nerves by using standard methods (median, common peroneal, sural and ulnar) between 1 to 12 weeks after the onset of symptoms. The commonest abnormality on motor nerve conduction study was prolonged distal latency (75%-83%) followed by reduction in CMAP amplitude (63%-82%), decreased velocity (48%-62%), conduction block (17%-39%) and f-wave abnormalities (37.8%-59%). Sensory conduction abnormalities were detected in over 20% of median, 25% of ulnar and 33% of sural nerves. All the patients had abnormality of at least two motor conduction parameters in one nerve when values beyond 2 SD of the mean were considered abnormal and over 70% of patients had three abnormalities in two nerves or two abnormalities in three nerves. Comparison with the prevailing criteria for demyelination revealed that the number of patients fulfilling them varied widely: Albers et al. (1985): 74.2%, Albers et al. (1989): 40.9% and Cornblath: 30.3%. We believe that the current criteria for detection of demyelination in acute neuropathy are too strict, underestimate the underlying pathology in GBS and need reassessment.
目前对于急性炎性脱髓鞘性多发性神经病（AIDP/GBS）的临床诊断标准已达成共识，然而，在脱髓鞘检测方面尚未形成统一意见。为了严格评估现行标准，对66例符合美国国立神经病学、语言障碍和卒中研究所（NINCDS）标准且具有GBS典型特征的患者，在症状出现后1至12周内采用标准方法（正中神经、腓总神经、腓肠神经和尺神经）研究其周围神经的电生理异常情况。运动神经传导研究中最常见的异常是远端潜伏期延长（75%-83%），其次是复合肌肉动作电位（CMAP）波幅降低（63%-82%）、速度减慢（48%-62%）、传导阻滞（17%-39%）和F波异常（37.8%-59%）。在超过20%的正中神经、25%的尺神经和33%的腓肠神经中检测到感觉传导异常。当将超出平均值2个标准差的值视为异常时，所有患者的一条神经中至少有两个运动传导参数异常，超过70%的患者在两条神经中有三个异常或在三条神经中有两个异常。与现行脱髓鞘标准进行比较发现，符合这些标准的患者数量差异很大：阿尔伯斯等人（1985年）：74.2%，阿尔伯斯等人（1989年）：40.9%，科恩布拉思：30.3%。我们认为，目前急性神经病中脱髓鞘检测标准过于严格，低估了GBS的潜在病理情况，需要重新评估。
