摘要
目的探讨神经系统副肿瘤综合征（PNS）的临床特点,结合肌电图变化提出早期诊断PNS的客观依据。方法选择健康查体15例,PNS患者15例。对两组患者进行临床分析,结合神经电生理检查：神经电图及F波测定;重复神经电刺激（RNES）测定。同时进行胸部CT、PET-CT等辅助检查进行肿瘤筛查,以期对副肿瘤综合征早期诊断。结果 1PNS组患者发病年龄45~71岁[平均（59.1±11.1）岁]。其中肺癌为原发肿瘤约占50%,且大部分PNS患者神经系统症状在肿瘤之前2~26个月出现。2PNS组与对照组比较：正中神经、腓总神经等运动潜伏期延长、波幅减低、传导速度减慢,两组比较P〈0.05。3远端刺激时两组比较：正中神经、腓浅神经等神经的感觉传导速度减慢,感觉波幅减低或消失（P〈0.05）。4刺激腕部时,病例组正中神经、胫神经、尺神经F波潜伏期延长,较对照组差异明显（P〈0.05）。5RNES结果：15例检测远端拇短展肌、小指展肌,其中有7例（46.67%）呈低频递减、高频递增现象;6影像学相关检査提示,PET和肿瘤相关抗体检查在PNS的早期诊断中可以提供依据。结论1PNS患者主要发生在中老年发病,临床表现复杂多样。肺癌是临床上与PNS关系最密切的原发肿瘤类型。2PNS患者受检神经中感觉神经和运动神经均有受损,但感觉神经受损明显重于运动神经,下肢神经重于上肢神经。3RNES是一种具有确诊价值的检测方法。4PET等相关检查在PNS的早期诊断中具有重要作用。
Objective： To study the characteristics of clinical manifestation in PNS and to provide the objective electrophysiological evidence for diagnosis and differential diagnosis of PNS. Methods： We studied 15 cases of age-matched healthy subjects and 15 cases with PNS. Electromyogram was measured： Electromyography and F-wave; Repeated nerve electric stimulation（ RNES）. Recent applications of CT,PET/CT in the diagnosis. Results： 1 The mean age in patients was 59. 1 ± 11. 1 years. Half of the PNS patients had lung cancer and neurological syndromes of 80% patients were prior to diagnosis of underlying malignancy. 2 In the comparison between the patients and the control group： the amplitude of CMAPs,the latency and MCV of median nerve,ulnar nerve,tibial nerve and peroneus nerve were significantly decreased（ P〈0. 05）. 3 Two groups： The nerve was markedly reduced or absent. And SCV of the examined nerve was in the normal range or reduced. There was also significant difference（ P〈0. 05）. 4 In the comparison of the two groups： the distal latency of F waves was prolonged or absent and there was difference（ P〈0. 05）. 5 Outcome of RNS： 15 cases stimulated the abductor pollicis braves and abductor digital minimi. The outcome of 7 patients was positive,and the other cases were negative. 6PET/CT was an image-fusion method containing anatomical and functional information and was used to obtain whole-body images by a single scan. Conclusion： 1 PNS is more likely in the elderly,and may affect the central or peripheral nervous system. Lung cancer is the most common tumor associated with PNS. 2 The examined nerves are damaged（sensory nerves and motor nerves）. But impairment of sensory nerves is markedly more serious than motor nerves,and the lower limbs are more serious than the upper limbs. 3 Repeated nerve electric stimulation suggests that RNS is the examination which has a confirmed significance. 4 The PET plays an important role in the diagnosis of PNS,and may improve early diagnosis rates.
作者
吕少萍
王佩佩
梅红
慕莹
管勇
LV Shao-ping WANG Pei-pei MEI Hong MU Ying GUAN Yong(Dept. of Rehabilitation, Qingdao Central Hospital Dept. of Ultrasound, Qingdao Central Hospital Dept. of Laboratory, Qingdao Central Hospital Dept. of Neurosurgery, Qingdao Municipal Hospital, Qingdao 266000, China)
出处
《泰山医学院学报》
CAS
2016年第11期1218-1221,共4页
Journal of Taishan Medical College
