The Clinical,Electrophysiological And Pathological Study Of Chronic Polyneuropathy

Objective: Chronic polyneuropathy is a group of diseases with more than 8 weeks course,which is present with multiple peripheral neuropathy,limb movement and sensory disturbance as the main performance with chronic onset form.Clinical manifestations: Most with symmetry of the distal movement,feeling,autonomic disorders,but also the performance of simple movement / sensory involvement;a few can be expressed as proximal involvement and can also be combined with other system involvement.The causes are complex,inflammatory,infectious,metabolic,nutritional,genetic,and toxic and so on.Around all kinds of chronic polyneuropathy with similar clinical features,electrophysiological examination can c lear myelin and / or axonal damage,movement and / or sensory fiber damage and the severity of disease,it provide little value in the etiological diagnosis.Sural nerve biopsy,light and electron microscopy analys is can be found in the morphological changes of the characteristics of the disease,which provide important clues.The study analysis the clinical,electrophysiological and pathological features of 152 patients with chronic polyneuropathy,aims to summarize the pathological features of various types of chronic polyneuropathy,improve the ability of etiological diagnosis and differential diagnosis,explore the value of sural nerve biopsy.Methods: All the data of patients with chronic polyneuropathy,from May 2006 to December 2016,were collected in the department of neuromuscular diseases,the Third Hospital of Hebei Medical Univers ity and all the patients were had sural nerve biopsy.Clinical data(gender,age,personal history,past history,family history,symptoms and sign),laboratory tests,and electrophysiological examination were collected.Informed consent underwent sural nerve biopsy,resin embedding semi thin sections,tolu idine blue safranin staining,light microscope and electron microscope pathological analys is.To summarize the clinical,electrophysiological and pathological features of chronic polyneuropathy with different causes.Results:1 clinical data152 cases of chronic polyneuropathy in patients with chronic immune-mediated peripheral neuropathy was 20 cases,male 13 cases,female 7 cases,the age of onset between 43-81 years old,the average onset age is about 58.3 years old,the age of treatment range from 45 to 81 years old,average 59.8 years old,dyskinesia in 19 cases,feeling obstacle in 16 cases and autonomic nerve involvement in 1 cases,1 cases with high arch foot malformation,inc luding 5 cases of lung cancer,2 cases of Sjogren syndrome,1 cases of multiple myeloma in history;hereditary peripheral neuropathy in 77 cases,male 53 cases,female 24 cases,the age of onset between 0-55 years old,the average onset age was 20.97,the age of treatment range from 0.6 to 71 years old,average 29.3,75 cases of dyskines ia,28 cases of sensory disorder,high arch foot deformity in 38 cases,27 cases had positive family history;around the nutritional and metabolic neuropathy in 14 cases,male 11 cases,female 3 cases,the age of onset at 40-75 years old,the average onset age is about 57.1,the age of treatment range from 40 to 75 years old,average 58.9,8 cases of dyskinesia,9 cases of sensory disorders,including 9 cases with diabetes,1 cases of chronic gastritis,1 cases of chronic renal failure history;neurodegenerative disease associated with peripheral neuropathy in 6 cases,4 cases were male,2 cases female,the age of onset 0-17 years old,the average onset age of 7.2 years,the treatment of age range from 3 to 24 years old,average 16.8 years old,6 cases of dyskines ia,1 cases of sensory disorder,3 cases of high arch foot;peripheral neuropathy with in 13 cases of poisoning,13 cases were male;the age of onset between 38-75 years old,the average age of onset was 48.8,age of treatment range from 31 to 77 years old,average 51 years old,8 cases of dyskinesia,13 cases of sensory disorders,including 11 cases with large quantities of alcohol,1 cases with long-term medication isoniazid,1 cases of long-term medication nitrofuran history;22 cases of unknown etiology in male patients 11 cases,female 11 cases,the onset age of 18-79 years old,the average onset age was 47.6,the treatment age range from 18 to 79 years old,the average age was 50.3 years old,the movement disorders in the case of 13 cases,sensory disorder in the case of 18 cases.2 electrophysiological results151 patients had electrophysiological examination,needle electromyography showed neurogenic damage(fibrillation,positive potential in 120 cases,wide and high potential in 116 cases);motor nerve conduction examination: normal in 19 cases,motor conduction velocity markedly decreased in 45 cases,compound muscle action potential markedly decreased 13 cases,the rest were decreased in both;sensory nerve conduction: 9 cases were normal,98 cases did not elic it SNAP,sensory conduction velocity markedly decreased in 6 cases,sensory nerve action potential markedly decreased in 8 cases,the rest were decreased in both.3 sural nerve pathology152 cases of biopsy showed pathological changes of chronic periphera l neuropathy,77 cases showed myelin lesions(myelin thinning in 93 cases,naked axon in 34 cases,myelin thickened in 95 cases,the separating lamellar structure of myelin in 47 cases,myelin fold in 57 cases,a large number of typical discount "onion bulb" structure of 29 cases);13 cases of visible markedly axon degeneration,and 62 cases showed both myelin and axon les ions,path of myelinated fiber c luster was seen in 18 cases;phagocytic cells in 23 cases;amylo id deposition in 3 cases;4 cases showed small vascular proliferation and perivascular infiltration of inflammatory cells.Conclusions:1 The clinical manifestations of chronic polyneuropathy are s imilar,and the etiology is difficult.The most common method of comfirm etiology was asking medical history: age of onset,past history,personal history,family history.The common clinical manifestations is symmetry,peripheral movement,sensory and autonomic dysfunction;chronic polyneuropathy only involved motor fiber can be seen in multifocal motor neuropathy,distal hereditary motor neuropathy and only involved sensory fiber vis ible in paraneoplastic syndrome,diabetes,Sjogren syndrome,vitamin B6 poisoning,genetic sensory neuropathy,careful examination of nervous system can be found in specific clinical manifestations.2 Standard electrophysiological is essential examination for diagnosis of chronic polyneuropathy,which can determine the scope and the degree of nerve injury,nerve fibers and myelin sheath type / axonal les ion types;when necessary to expand the scope of the inspection to detect subclinical lesions;electrophysiology can provide direction for etiological diagnosis.3 Combined with the history and electrophysiological examination results,it is an important means to choose reasonable laboratory examination.4 The pathological changes of the sural nerve biopsy can be more clearly from the morphological point of view of the type of peripheral neuropathy and the degree of injury and found that the specific pathological changes,it have great value with diagnosis and differential diagnosis.