目的:麻风病是由麻风分枝杆菌(M.麻风),系统地侵入周围神经的细胞内杆菌。诊断麻风病神经病仍然是一项挑战技能,晚期诊断和治疗仍然是现实。基于麻风分枝杆菌的生物学特性,特别是它对侵入位于人体最冷区域的施万细胞的偏好,我们假设这些区域存在局灶性脱髓鞘,通过标准神经传导研究(NCSs)方案可能无法检测到.
方法:访问了25例确诊的多杆菌麻风病患者和14例对照。执行了多段NCS协议(MP),瞄准穿过最冷区域的短距离,确定传导速度减慢的焦点区域。将该多分段方案的有效性与标准协议(SP)进行比较以检测异常。
结果:所有麻风病患者的MP研究异常,与SP形成对比的是19。最常见的NCS模式是不对称神经病变,传导速度局灶性减慢,25名麻风病人中有23人被发现.当将MP与SP进行比较时,观察到有利于所提出的方法的显著差异。值得注意的是,MP将检测异常的灵敏度提高了122%,133%,中位数为257%,腓骨,和胫神经,分别。MP还增加检测尺神经局灶性异常的灵敏度。
结论:MP方案显著提高了NCSs检测麻风神经病中神经生理异常的敏感性。
OBJECTIVE: Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), an intracellular bacillus that systematically invades the peripheral nerves. Diagnosing leprosy neuropathy is still a defying skill, and late diagnosis and treatment are still a reality. Based on the biological characteristics of M. leprae, particularly its preference for invading the Schwann cells localized at the coldest areas of human body, we hypothesized that these areas have focal demyelination that may escape detection through standard nerve conduction studies (NCSs) protocols.
METHODS: Twenty-five patients with confirmed multibacillary leprosy and 14 controls were accessed. A multisegmented NCS protocol (MP) was performed, targeting short segments through the coldest areas, to identify focal areas of slowed conduction velocity. The effectiveness of this multisegmented protocol was compared to the standard protocol (SP) to detect abnormalities.
RESULTS: All leprosy patients presented an abnormal study with the MP, contrasting to 19 with the SP. The most frequent NCS pattern was an asymmetric neuropathy with focal slowing of conduction velocity, found in 23 out of 25 leprosy patients. Significant differences favoring the proposed method were observed when comparing the MP with the SP. Notably, the MP increased the sensitivity to detect abnormalities by 122%, 133%, and 257% for the median, peroneal, and tibial nerves, respectively. MP also increases sensitivity to detect focal abnormalities in the ulnar nerve.
CONCLUSIONS: The MP protocol significantly increases the sensitivity of NCSs to detect neurophysiological abnormalities in leprosy neuropathy.