New criteria for early electrodiagnosis of acute inflammatory demyelinating polyneuropathy
New criteria for early electrodiagnosis of acute inflammatory demyelinating polyneuropathy
复制标题
DOI：
10.1002/mus.20342
复制
发表时间：
2005-07-01
期刊：
影响因子：
3.4
通讯作者：
Katirji, B
中科院分区：
文献类型：
--
作者：
Al-Shekhlee, A;Hachwi, RN;Katirji, B
各种电诊断方法被用来确认急性炎性脱髓鞘性多发性神经病（AIDP）的诊断，但困难是在虚弱的最初几周频繁。我们比较了AIDP患者与危重病多发性神经病（CIP）（一种亚急性轴突多发性神经病）患者的神经传导研究（NCS）。新的电诊断标准与分级确定性（正常，非诊断性，提示性，高度提示性和明确）的设计和应用在两组盲的方式。在AIDP患者中，64%符合高度提示和明确的标准（特异性95- 100%，P < 0.01），而CIP组中80%属于非诊断标准（P < 0.001）。尽管上肢至少有两个异常的感觉NCS，但腓肠神经感觉反应的相对保留表明急性脱髓鞘（敏感性48%，特异性96%，P < 0.001），当与F波缺失或延长相关时，更是结论性的。CIP组的运动和感觉反应幅度较低，平均运动和感觉远端潜伏期和运动传导速度相当。运动传导阻滞存在于10%的神经AIDP和CIP没有遇到。F波消失或延迟以及H反射消失的频率在两组中相似。AIDP组脑脊液蛋白浓度与设计标准的相关系数较高（r = 0.9）。我们的结论是，一个新的标准与分级的确定性是更高的特异性，在大多数早期AIDP患者。
A variety of electrodiagnostic methods are used to confirm the diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP), but difficulties are frequent during the first few weeks of weakness. We compared the nerve conduction studies (NCS) of patients with AIDP to those with critical illness polyneuropathy (CIP), a subacute axonal polyneuropathy. New electrodiagnostic criteria with graded certainty (normal, nondiagnostic, suggestive, highly suggestive, and definite) were designed and applied in a blinded manner to both groups. Among the AIDP patients, 64% met the highly suggestive and definite criteria (specificity 95-100%, P < 0.01), whereas 80% of the CIP group fell in the nondiagnostic criteria (P < 0.001). The relative preservation of the sural sensory response in spite of at least two abnormal sensory NCS in the upper limb suggested acute demyelination (sensitivity 48%, specificity 96%, P < 0.001) and was even more conclusive when associated with absent or prolonged F waves. Motor and sensory response amplitudes were lower in the CIP group, with comparable mean motor and sensory distal latencies and motor conduction velocities. Motor conduction blocks were present in 10% of nerves in AIDP and were not encountered in CIP. The frequency of absent or delayed F waves and absent H reflex was similar in both groups. The correlation coefficient of the cerebrospinal fluid protein concentration with the designed criteria was higher in the AIDP group (r = 0.9). We conclude that a new criterion with graded certainty is of higher specificity in the majority of patients with early AIDP.