| Objective: To explore the early neuroelectrophysiological characteristics in patients with Guillain-Barré syndrome(GBS)and to search a new neuroelectrophysiological index(F chronodispersion)besides conventional detection,so as to improve the positive rate of neuroelectrophysiology in the early diagnosis of GBS.Methods: 55 inpatients diagnosed as GBS were collected from June 2015 to December2019 in the Second Hospital of Dalian Medical University who met the GBS diagnostic criteria in the Chinese guidelines for diagnosis and treatment of Guillain-Barrésyndrome.At the same time,we need excluded other causes of peripheral nerve damage,such as excessive drinking,contact poison,nervous drugs,paraneoplastic syndrome,history of cervical vertebra,lumbar disease,thyroid disease,diabetes,autoimmune diseases,kidney disease,liver disease and a history of hereditary peripheral neuropathy.The motor nerve conduction,sensory nerve conduction,F waves and H reflex of patients were measured by Viking Quest Emg/induction potentiometer of Nicolet company in the United States.The normal values of each index of nerve conduction test refer to the normal reference values of electromyography room of Peking union medical college hospital.F wave parameters normal value standard were referenced hua pan et al.2007-2011 Beijing tiantan hospital published the normal reference value of F wave in China as a control and we defined each index of F wave anomaly as exceeding the upper limit of the corresponding height group or failing to detect the value of F wave.H reflection normal value reference Lachman T formula for H reflection normal value and the predicted value of the incubation period is calculated by the following formula(H wave=2.74+0.05× age(years)+0.14× height(cm)+1.4),which was abnormal if the measured value of H reflection latency was greater than the predicted value or missing.40 healthy volunteers who underwent physical examination and had no abnormal history were collected from September 2017 to December 2019 in the Second Hospital of Dalian Medical University as the control group.F wave related indexes were tested,and calculated each F chronodispersion(Fchd),Fchd=F wave maximum latency-F wave minimum latency,the Fchd((?)+2s)value of each nerve in the control group was taken as the upper limit of normal.Results:1.There were 9 patients diagnosed with Miller Fisher syndrome.The electrophysiological indicators of 17 patients did not meet the diagnostic criteria of electrophysiological typing.Six patients had no abnormalities in electrophysiological indicators,and 11 patients had abnormal electrophysiological indicators.The electrophysiological indicators of 29 patients reached the diagnostic criteria of electrophysiological typing,12 patients were diagnosed with acute inflammatory demyelinating polyneuropathies,and 4 patients were diagnosed with acute motor axonal neuropathy,1 patients was diagnosed with acute motor-sensory axonal neuropathy and12 patients could not determine the GBS classification.Results:2.The total abnormal rate of motor nerve conduction in the case group was70.91%,the abnormal rates of conduction block(CB),waveform dispersion,motor conductive velocity(MCV),distal motor latency(DML)and compound muscle action potential(CMAP)amplitude were 3.64%,25.45%,36.36%,41.82% and 65.45%.Among them,the CMAP amplitude abnormality rate was the highest,and the difference compared with the abnormality rates of CB,MCV and waveform dispersion was statistically significant(<0.005).However,the difference between CMAP amplitude form DML abnormality rate was not statistically significant(>0.005)The abnormal rate of DML was higher than that of CB,waveform dispersion and MCV.There was no statistically significant difference among the abnormal rate of DML,MCV and waveform dispersion(>0.005).The difference of abnomal rate between DML and CB was statistically significant(<0.005).The abnormal rate of MCV was higher than that of CB and waveform dispersion,and there was statistically significant difference between the abnormal rate of MCV and CB(<0.005).There was no statistically significant difference between the abnormal rate of MCV and waveform dispersion(>0.005).The abnormal rate of waveform dispersion was higher than that of CB,and the difference was statistically significant(<0.005).In summary,the abnormal rate of CMAP amplitude was higher than that of MCV,CB and waveform in the dection of the early motion conduction neuroelectrophysiological in patients with GBS,and the difference was statistically significant(<0.005).Although,the abnormal rate of CMAP amplitude was higher than that of DML,but the difference was not statistically significant(>0.005).The abnormal rate of DML,MCV and waveform had differences,but the difference was not statistically significant(>0.005).The abnormal rate of CB was the lowest which was statistically significant(<0.005)between the above indicators.Results:3.The total abnormal rate of sensory conduction test in case group was 32.73%,and the abnormal rates of sensory conductive velocity(SCV)and sensory nerve action potential(SNAP)amplitude were 32.73% and 25.45%.The abnormal rate of SCV was higher than that of SNAP amplitude,but the difference was not statistically significant(>0.05).4.In the case group,there were 16 patients diagnosed as GBS completed H reflex examination and the abnormal rate of H reflex was 68.75%.5.In the case group,the total abnormal rate of F wave was 78.18%.The abnormal rate of F wave minimum latency,F wave maximum latency,F wave occurrence rate and F wave average latency were 60%,65.45%,65.45% and 69.09%.Although there were differences between the four abnormal rates,but the differences were not statistically significant(>0.0083).6.The abnormal rates of motor nerve conduction,sensory nerve conduction,H reflex and F wave were 68.75%,32.73%,70.91% and 78.18%.However,the results showed that there was no significant difference among the abnormal rates of motor nerve conduction,H reflex and F wave(>0.0083).The abnormal rates of motion nerve conduction and F wave were higher sensory nerve conduction which the differences were statistically significant(<0.0083).Although the abnormal rate of H reflex was higher than that of sensory nerve conduction,but the difference was not statistically significant(>0.0083).7.There was no significant difference in age,height,gender and weight between the case group and the control group(>0.05).The values of Fchd((?)+2s)of each nerve in the control group were used as the upper limit of normal value and the abnormal rate of Fchd in the case group was 89.09%.The abnormal rate of Fchd was higher than that of F wave minimum latency,F wave maximum latency,F wave occurrence rate,MCV,DML,CMAP amplitude,CB,waveform dispersion,SCV and SNAP amplitude which the differences were statistically significant(<0.0042).Although the abnormal rate of Fchd was higher than that of F wave average latency and H reflex,but the difference was not statistically significant(>0.0042).Among the 55 patients diagnosed as GBS,there were 9 patients showed Fchd abnormality without F wave abnormality and 3patients with abnormal F wave latency but normal Fchd.8.Huges score was an independent factor influencing the early neuroelectrophysiological abnormality of GBS(OR=2.367,95%CI1.142-4.909,P=0.021).Conclution: 1.The early neuroelectrophysiological abnormalities may occurred in patients with GBS,motor nerve conduction,F wave and H reflex were the sensitive indexes of early diagnosis,and the index of Fchd could be used as a benefical supplement index of early electrophysiological examination in the patients with GBS which could improve the positive rate of neuroelectrophysiology in the early diagnosis of GBS.2.Huges score was an independent factor influencing the early neuroelectrophysiological abnormality of GBS. |
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