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目的研究神经电生理F波检测时A波出现在急性吉兰-巴雷综合征(GBS)病程不同阶段中的特点,探索其对于GBS的诊断价值。方法回顾性分析62例GBS患者(GBS组)和26名健康对照者(对照组)的尺神经、正中神经、腓神经及胫神经在电生理F波检测时A波出现情况。对A波在GBS组与对照组上/下肢中的出现情况、以及不同病程的急性炎性脱髓鞘性多发神经根神经病(AIDP亚组)与轴索型GBS患者(轴索型亚组)的A波出现情况进行χ~2检验分析。结果 GBS组与对照组上肢A波出现情况的差异有统计学意义(P=0.002);GBS病程及AIDP亚组对上肢A波出现的影响无统计学意义(P_(GBS)=0.781,P_(轴索型)=0.389),而轴索型亚组病程对上肢A波出现的影响有统计学意义(P=0.028);病程2周内,GBS分型对上肢A波出现的影响差异无统计学意义(P=0.065),病程3~6周时,GBS分型对上肢A波出现的影响差异有统计学意义(P<0.001)。AIDP患者中A波出现率低于F波异常率,但高于运动神经传导速度、远端运动潜伏期和复合肌肉动作电位波幅的异常率,且均差异有统计学意义(P<0.005);轴索型亚组患者中A波的出现率低于复合肌肉动作电位波幅和F波的异常率,高于运动神经传导速度和远端运动潜伏期的异常率,但仅复合肌肉动作电位波幅和A波间的出现率差异有统计学意义(P<0.001)。结论上肢A波对于GBS早期诊断具有一定的参考价值,对AIDP和轴索型的诊断具有鉴别意义。
Objective To study the characteristics of A-waves in different stages of acute Guillain-Barre syndrome (GBS) in neurophysiological F-wave detection and to explore their diagnostic value for GBS. Methods The A wave of ulnar nerve, median nerve, peroneal nerve and tibial nerve of 62 GBS patients (GBS group) and 26 healthy controls (control group) were retrospectively analyzed. A wave in the GBS group and the control group on the upper limb / lower extremity, as well as the different course of acute inflammatory demyelinating multiple nerve root neuropathy (AIDP subgroup) and axonal GBS patients (axonal subgroup) A wave appeared χ ~ 2 test analysis. Results There was significant difference of A wave appearance between the GBS group and the control group (P = 0.002). There was no significant difference in GBS duration and AIDP subgroup between the two groups (P_ (GBS) = 0.781, P_ (P = 0.038). There was no significant difference in the effects of GBS classification on A-wave of upper extremity within 2 weeks (P = 0.065). The course of the course of 3 ~ 6 weeks, GBS classification of upper limb A wave was significantly different (P <0.001). The frequency of A wave in AIDP patients was lower than that of F wave, but higher than those in motor nerve conduction velocity, remote motor latency and composite muscle action potential amplitude (P <0.005) A-wave subgroup patients in the incidence of A wave lower than the compound muscle action potential amplitude and F wave anomalies, higher than the motor nerve conduction velocity and distal motor latency anomalies, but only the compound muscle action potential amplitude and A wave There was significant difference between the two groups (P <0.001). Conclusion A wave of upper extremity has certain reference value for the early diagnosis of GBS, and is of great significance in the diagnosis of AIDP and axonal type.