Clinical, Electrophysiological And Neuropathological Studies Of Chronic Inflammatory Demyelinating Polyradiculoneuropathy With Diabetes Mellitus

ObjectiveTo investigate the characteristics of clinical manifestations,electrophysiology and nerve pathology of three different groups of diseases: diabetes mellitus-chronic inflammatory demyelinating polyradiculoneuropathy(DM-CIDP),diabetic peripheral neuropathy(DPN)and chronic inflammatory demyelinating polyradiculoneuropathy(CIDP).Materials and MethodsMaterials of 9 DM-CIDP,13 DPN and 10 simple CIDP patients,a total of 32 patients,hospitalized from January 2009 to December 2015 in department of neurology of Navy General Hospital and Peking University First Affiliatied Hospital were retrieved.Nerve electrophysiology and sural nerve biopsy were conducted in all 32 patients;Clinical materials(disease onset age,disease course,disease onset pattern,symptoms and signs,exams of cerebrospinal fluids),nerve electrophysiology(motor nerve conduction velocity,sensory nerve conduction velocity and F wave)and sural nerve biopsy(“onionskin change”,thin myelin nerve,density of nerve fiber,axon degeneration,axon regeneration cluster,vessel basement membrane thickening and inflammatory cell infiltration)were compared and analyzed among three groups of patients,to exlore similarities and differences.Results? Clinic characteriscs:(1)There were no satistical significances in age,sex and course of disease among three groups of patients;(2)Onset pattern: remission-recurrence occurred in 4 patients of CIDP,which was not appeared in patients of DPN and DM-CIDP.There was satistical significance compared(P<0.05)that CIDP have more remission-recurrence and onset pattern patients than DPN and DM-CIDP.(3)Clinical symptoms: affected lower limbs were most seen in the onset of DPN(n=9,69.2%),secondly in DM-CIDP(n=6,55.6%)and least in CIDP(n=4,40%).In DM-CIDP,there were 7 patients affected by limb sensory dysfunction(77.8%),8 patients by dyskinesia(88.9%),6 patients by atrophy(66.7%),9 patients by weakened or disappeared tendinous reflect(100%);in DPN,there were 12 patients affected by limb sensory dysfunction(92.3%),11 patients by dyskinesia(84.6%),1 patients by atrophy(7.7%),8 patients by weakened or disappeared tendinous reflect(61.5%);in CIDP,there were 8 patients affected by limb sensory dysfunction(80.0%),10 patients by dyskinesia(100.0%),4 patients by atrophy(40.0%),8 patients by weakened or disappeared tendinous reflect(80.0%).(4)Examination of cerebrospinal fluids(CSF): 5 patients in DM-CIDP received examination of CSF(protein-cell seperation phenomenon was detected in 3 patients);4 patients in DPN received examination of CSF(slight increase of protein in 2 patients and normal level of protein in 2 patients were detected respectively);6 patients in CIDP received examination of CSF and protein-cell seperation phenomenon was detected in each patient.? Characteristics of nerve electrophysiology:(1)In DPN,abnormal motor nerve conduction velocity(MNCV)were found in 9 patients(90.0%),abnormal sensory nerve conduction velocity(SNCV)in 7 patients(70.0%)and abnormal F wave in 8 patients(80.0%);(2)In DM-CIDP,MNCV were found in 7 patients(77.8%),SNCV in 9 patients(100%)and abnormal F wave in 9 patients(100%);(3)In CIDP,MNCV were found in 9 patients(100.0%),SNCV in 8 patients(88.9%)and abnormal F wave in 9 patients(100%).Statistic analysis showed there was no significant difference in data of motor nerve conduction,sensory nerve conduction and F wave among DPN,DM-CIDP and CIDP patient groups(P>0.05).? Characteristics of pathology of sural nerve biopsy: results of nerve pathology of DM-CIDP(9 patients),DPN(13 patients)and CIDP(10 patients)were as follows respectively: “onionskin change”(2/9,0/13,4/10),thin myelin(6/9,6/13,10/10),non-medullated nerve decrease(4/9,9/13,4/10),axon degeneration(8/9,5/13,1/10),myelinated nerve fiber regeneration cluster(6/9,13/13,7/10),vessel basement membrane thickening(7/9,13/13,3/10),inflammatory cell infiltration(8/9,1/13,8/10).Statistic analysis showed there were significant differences among DPN,DM-CIDP and CIDP patient groups in results of “onionskin change”,thin myelin,non-medullated nerve decrease,axon degeneration,myelinated nerve fiber regeneration cluster,vessel basement membrane thickening and compositional proportion of inflammatory cells(P<0.05).Comparsions between DM-CIDP and the other two groups revealed:(1)Thin myelin was more common in CIDP than DM-CIDP(P<0.05);(2)Axon degeneration was more common in DM-CIDP than DPN(P<0.05)and CIDP(P<0.01);(3)Myelinated nerve fiber regeneration cluster was more common in DPN than DM-CIDP(P<0.05);(4)Vessel basement membrane thickening was more common in DM-CIDP than CIDP(P<0.05);(5)Inflammatory cell infiltration was more common in DM-CIDP than DPN(P<0.05).Conclusion? Remission-recurrence cases were mostly seen in CIDP,and protein-cell seperation phenomenon was more common in DM-CIDP and CIDP than DPN;? As to nerve pathology:(1)Thin myelin nerve fiber was more common in CIDP than DM-CIDP;(2)Axon degeneration was more common in DM-CIDP than DPN and CIDP;(3)Myelinated nerve fiber regeneration cluster was more common in DPN than DM-CIDP;(4)Vessel basement membrane thickening was more common in DM-CIDP than CIDP;(5)Inflammatory cell infiltration was more common in DM-CIDP than DPN.