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目的探讨慢性炎症性脱髓鞘性多神经病(CIDP)的轴索病理改变。方法对18例CIDP 患者进行电生理和腓肠神经的病理检查,分析不同患者的腓肠神经病理改变特点,并对病理改变不同的两组进行临床、电生理及病理比较。结果 5例以脱髓鞘改变为主者,主要出现薄髓鞘神经纤维和有髓神经纤维的洋葱球样结构,其中3例出现轴索损害。8例以轴索损害为主者,主要出现有髓神经纤维的 Wallerian 变性和再生簇结构。3例出现有髓神经纤维的髓鞘和轴索混合性损害。2例轻微病理改变。脱髓鞘损害为主者和轴索损害为主者的单核细胞浸润程度无明显差异,且两者可同时存在脱髓鞘和轴索损害的电生理改变特点。结论轴索损害是 CIDP 比较常见的病理改变,不应当作为该病的绝对排除标准。单核细胞的浸润是一种普遍改变。
Objective To investigate the axonal pathological changes of chronic inflammatory demyelinating polyneuropathy (CIDP). Methods 18 cases of CIDP patients were electrophysiological and sural nerve pathological examination, analysis of different patients with sural nerve pathological changes, and pathological changes in different groups of two clinical, electrophysiological and pathological comparison. Results Five cases were mainly demyelinating, mainly including onion ball-like structures of myelinated nerve fibers and myelinated nerve fibers. Axonal damage was found in 3 cases. 8 cases of axonal damage mainly composed of Wallerian degeneration and regenerative cluster structure of myelinated nerve fibers. 3 cases of myelinated nerve fibers and axonal mixed damage. 2 cases of minor pathological changes. There was no significant difference in the degree of mononuclear cell infiltration between the predominantly demyelinating lesions and axonal lesions, and the demyelination and axonal damage both had the same electrophysiological characteristics. Conclusion Axonal damage is a more common pathological change of CIDP, and should not be regarded as the absolute exclusion criterion of the disease. Monocyte infiltration is a common change.