H反射、F波及神经传导速度在早期诊断格林-巴利综合征中作用.docVIP

H反射、F波及神经传导速度在早期诊断格林-巴利综合征中作用 　 作者：黄沚荷，罗映晖，许洁松，郭美云 【摘要】 目的：分析比较H反射、F波(FW)和神经传导速度(NCV)在早期诊断格林-巴利综合征以及判断预后中三者的作用和灵敏度。方法：对44例格林-巴利综合征患者采用表面电极法常规顺向检测正中神经、尺神经、胫后神经、腓总神经和腓肠神经共141条感觉神经传导速度(SCV)及波幅、133条运动末端潜伏期(ML)及波幅；85条FW潜伏期及出现率、44条H波(HW)潜伏期及出现率。结果：共有107条神经SCV减慢或波幅降低；113条ML延长或波幅降低。55条FW潜伏期延长或出现率降低;31条HW潜伏期延长或消失。H反射、FW和NCV分别反映了神经远、近端功能状态，其检测异常程度与病情严重程度呈正相关。结论：H反射、FW和NCV在早期诊断格林-巴利综合征及了解神经远、近端受损程度从而客观评价相应病情及估价预后中具有重要作用。 【关键词】 H反射;F波;神经传导速度;格林-巴利综合征 　　［Abstract］Objective: To investigate the significance of H reflex,F wave(FW)and nerve conductive velocity(NCV)in early diagnosis of Guillain-barre syndrome. Methods: The othodromic surface stimulation and recording were used for nerve conduction studies in 44 cases with Guillain-barre syndrome. The sensory conduction velocity and the motor distal latency were recorded in 141 nerves including median nerves, ulner nerves, posterior tibial nerves,sural nerve and pe-roneal nerves. In median nerves and posterior tibial nerves, the rate of occurrence of FW and FW latency were obtained. In posterior tibial nerves, the rate of occurrence of H wave(HW)and HW latency were obtained too. Results: Abnormalities were noted in 113 out of 133 motor nerves and in 106 out of 141 sensory nerves. There were prolonged FW latencies and decreased occurance rate of FW in 55 out of 85 motor nerves. Meanwhile, there were prolonged HW latencies and decreased occurance rate of HW in 55 out of 85 motor nerves. The results of H Reflex, FW, NCV and the data of clinic demonstrated that the nerve dysfunction was relating to the status of Guillain-barre syndrome, if the treatment was effectual, the lesion of nerves was resume. Conclusion: H Reflex,FW and NCV have been very helpful in early diagnosis of Guillain-barre syndrome and it can be used to objectively evaluate the effect of management. 　　［Key Words］H reflex; F wave; nerve conductive velocity; Guillain-barre syndrome 格林-巴利综合征是急性或亚急性发病的颅神经及周围神经疾病,常以上呼吸道和胃肠道的感染为前驱症状［1］。本病可发生于任何年龄，但有2个发病高峰(青年人和50～80岁老年人)。男性患