腓骨肌萎缩症1A型患者和慢性炎性脱髓鞘性多发性神经病患者F波改变的比较

doi:10.19723/j.issn.1671-167X.2023.01.025

Abstract

Abstract:

Objective: To analyze and compare the characteristics and causes of F wave changes in patients with Charcot-Marie-Tooth1A (CMT1A) and chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: Thirty patients with CMT1A and 30 patients with CIDP were enrolled in Peking University Third Hospital from January 2012 to December 2018. Their clinical data, electrophysiological data(nerve conduction velocity, F wave and H reflex) and neurological function scores were recorded. Some patients underwent magnetic resonance imaging of brachial plexus and lumbar plexus, and the results were analyzed and compared. Results: The average motor conduction velocity (MCV) of median nerve was (21.10±10.60) m/s in CMT1A and (31.52±12.46) m/s in CIDP. There was a significant difference between the two groups (t=-6.75, P < 0.001). About 43.3% (13/30) of the patients with CMT1A did not elicit F wave in ulnar nerve, which was significantly higher than that of the patients with CIDP (4/30, 13.3%), χ²=6.65, P=0.010. Among the patients who could elicit F wave, the latency of F wave in CMT1A group was (52.40±17.56) ms and that in CIDP group was (42.20±12.73) ms. There was a significant difference between the two groups (t=2.96, P=0.006). The occurrence rate of F wave in CMT1A group was 34.6%±39%, and that in CIDP group was 70.7%±15.2%. There was a significant difference between the two groups (t=-5.13, P < 0.001). The MCV of median nerve in a patient with anti neurofascin 155 (NF155) was 23.22 m/s, the latency of F wave was 62.9-70.7 ms, and the occurrence rate was 85%-95%. The proportion of brachial plexus and lumbar plexus thickening in CMT1A was 83.3% (5/6) and 85.7% (6/7), respectively. The proportion of brachial plexus and lumbar plexus thickening in the CIDP patients was only 25.0% (1/4, 2/8). The nerve roots of brachial plexus and lumbar plexus were significantly thickened in a patient with anti NF155 antibody. Conclusion: The prolonged latency of F wave in patients with CMT1A reflects the homogenous changes in both proximal and distal peripheral nerves, which can be used as a method to differentiate the CIDP patients characterized by focal demyelinating pathology. Moreover, attention should be paid to differentiate it from the peripheral neuropathy caused by anti NF155 CIDP. Although F wave is often used as an indicator of proximal nerve injury, motor neuron excitability, anterior horn cells, and motor nerve myelin sheath lesions can affect its latency and occurrence rate. F wave abnormalities need to be comprehensively analyzed in combination with the etiology, other electrophysiological results, and MRI imaging.

Key words: Charcot-Marie-Tooth, Chronic inflammatory demyelinating polyneuropathy, Electromyography

CLC Number:

R745.4

Xiao-xuan LIU,Shuo ZHANG,Yan MA,A-ping SUN,Ying-shuang ZHANG,Dong-sheng FAN. Diagnostic value of F wave changes in patients with Charcot-Marie-Tooth1A and chronic inflammatory demyelinating polyneuropathy[J].Journal of Peking University (Health Sciences), 2023, 55(1): 160-166.

Figures/Tables 4

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References 24

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Items	CMT1A (n=30)	CIDP (n=30)	t/χ²	P
Age of onset/years, $\bar x \pm s$	22.19±15.79	45.17±17.78	4.27	< 0.001^*
Male/female, n	17/13	16/14	0.07	0.795
Disease duration/months, $\bar x \pm s$	90.77±82.90	37.71±25.63	4.36	< 0.001^*
Muscle weakness
Upper limb, n	15	16	0.07	0.796
Lower limb, n	28	19	7.95	0.005^*
Foot drop, n	25	10	15.43	< 0.001^*
Pain sensation loss, n	10	22	9.64	0.002^*
Vibration sensation loss, n	13	19	2.41	0.121

Items	CMT1A (n=30)	CIDP (n=30)	t/χ²	P
Median nerve
MCV/(m/s)	21.10±10.60	31.52±12.46	-6.75	< 0.001^*
CMAP amplitude/mV	3.16(0, 9.40)	3.55 (0, 10.10)	0.94	0.351
F wave absent, n	12	3	7.20	0.007^*
F wave occurrence rate/%	41.37±41.98	62.82±13.50	-2.35	0.023^*
F wave latency /ms	47.78±17.21	41.30±9.80	2.64	0.013^*
F wave latency < 50 ms, n	9	20	8.08	0.004^*
Ulnar nerve
MCV/(m/s)	19.31±10.60	36.24±10.76	-7.61	< 0.001^*
CMAP amplitude/mV	3.08±2.40	3.28±2.56	1.29	0.201
F wave absent, n	13	4	6.65	0.010
F wave occurrence rate/%	34.60±39.00	70.70±15.20	-5.13	< 0.001^*
F wave latency/ms	52.40±17.56	42.20±12.73	2.96	0.006^*
F wave latency < 50 ms, n	6	20	13.30	< 0.001^*

Items	CMT1A (n=30)	CIDP (n=30)	χ²	P
Median nerve, n
< 30 ms	1	5		0.195
30-40 ms	3	8	2.78	0.095
41-50 ms	5	7	0.42	0.519
51-60 ms	5	6	0.11	0.739
>60 ms	4	1		0.353
Absent	12	3	7.20	0.007^*
Ulnar nerve, n
< 30 ms	0	6		0.024^*
30-40 ms	3	7	1.92	0.166
41-50 ms	3	7	1.92	0.166
51-60 ms	5	5	0	1
>60 ms	6	1		0.103
Absent	13	4	6.65	0.010^*

Diagnostic value of F wave changes in patients with Charcot-Marie-Tooth1A and chronic inflammatory demyelinating polyneuropathy

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