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目的 研究慢性炎性脱鞘性多神经根神经病 (CIDP)的临床电生理学和病理学特点。方法 采用CounterpointMKⅡEMG肌电图仪对 16例CIDP患者进行运动神经传导速度 (MCV)、感觉神经传导速度 (SCV)、F波和常规肌电图检查 ;所有患者均取腓肠神经交通枝制作光镜和电镜切片进行病理学研究。结果 电生理结果显示受累神经以脱鞘为主 ,表现为运动神经传导阻滞 (CB)、短暂性波形离散 (TD)、F波潜伏期延长和传导速度减慢。CB和TD为CIDP神经脱鞘的重要电生理改变。病理学主要表现为神经脱鞘、雪旺细胞变性、少量单核淋巴细胞浸润 ,可以伴有神经纤维的再生和“洋葱球”样结构的形成。部分病例发现伴有轴索损害。结论 髓鞘脱失是CIDP主要的电生理学特点 ,但是对于CIDP的电生理诊断应该采用更为严格的标准。雪旺细胞变性有时可以出现在髓鞘和轴索的改变之前 ,这可能是CIDP的另一重要病理学特点
Objective To investigate the clinical electrophysiological and pathological features of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Methods The motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV), F wave and conventional EMG were measured in 16 CIDP patients by Counterpoint MKⅡEMG electromyography. All the patients underwent optical microscopy with sural nerve traffic branch And electron microscopy sections for pathological studies. Results Electrophysiological results showed that the involved nerves were mainly demyelinated, which manifested as motor nerve block (CB), transient waveform dispersion (TD), prolonged F-wave latency and conduction velocity. CB and TD are important electrophysiological changes in CIDP denervation. Pathology mainly manifested as nerve sheath, Schwann cell degeneration, a small amount of mononuclear lymphocyte infiltration, may be accompanied by nerve fiber regeneration and “onion ball” -like structure formation. Some cases were found with axonal damage. Conclusions Demyelination is a major electrophysiological feature of CIDP, but stricter criteria should be adopted for electrophysiological diagnosis of CIDP. Schwann cell degeneration can sometimes occur before changes in myelin and axons, which may be another important pathological feature of CIDP