腓肠神经传导速度检测在评估奥沙利铂诱导性周围神经病中的价值

Clinical value of sural nerve conduction velocity measurement in the evaluation of oxaliplatin induced peripheral neuropathy

关键词:  腓肠神经  奥沙利铂  神经传导速度检查

Key words:  sural nerve  oxaliplatin  nerve conduction studies

摘要:

目的 通过腓肠神经传导速度检测技术评估慢性奥沙利铂诱导性周围神经病（oxaliplatin-induced peripheral neuropathy，OXLIPN）患者感觉神经功能。方法 选择2017年6月至2018年5月经病理证实为消化道恶性肿瘤，且计划实施奥沙利铂+卡培他滨（XELOX）方案治疗的患者，分别于化疗前及化疗6周期结束后半年进行腓肠神经传导速度检查，记录峰峰值波幅（amplitude of sensory nerve action potential，a-SNAP）、传导速度（sensory conduction velocity，SCV），同时分析患者化疗前后总神经病评分量表临床版（clinical version of the total neuropathy score，TNSc）评分情况，对OXLIPN患者及其化疗前后神经损害程度进行量化评估。结果 对比同一患者化疗前后腓肠神经a-SNAP波幅下降率的百分比，按下降比率将患者分为3组，第1组腓肠神经a-SNAP下降为70%以内，共11例（34%）；第2组腓肠神经a-SNAP下降为70%~90%，共13例（41%）；第3组腓肠神经a-SNAP下降为90%以上，共8例（25%），第2组患者比例最高。所有入组患者化疗后腓肠神经波幅较化疗前均有减低，差异具有统计学意义（P<0.01）。化疗后各组腓肠神经SCV较化疗前减低，差异具有统计学意义（P<0.05）。化疗前后患者进行TNSc量表评估，其中感觉症状，针刺觉，腱反射，自主神经症状，振动觉异常率较化疗前增加，差异具有统计学意义（（P<0.05）。结论 腓肠神经传导速度检查技术可以敏感地客观评价OXLIPN的轴索损害情况，为OXLIPN神经毒性反应程度分级提供敏感指标。

Abstract:

Objective To evaluate the sensory nerve function of patients with oxaliplin-induced peripheral neuropathy (OXLIPN) by sural nerve conduction velocity detection. Methods Patients with pathologically confirmed malignant tumors of the digestive tract and planned for XELOX adjuvant program were selected for examination of sural nerve conduction velocity before chemotherapy and half a year after completion of 6 cycles of chemotherapy. The amplitude (AMP) and conduction velocity were recorded. Clinical version of the Total Neuropathy Score (TNSc) before and after chemotherapy was analyzed, and the nerve damage degree of OXLIPN patients before and after chemotherapy was quantitatively evaluated. Results By comparing the percentage of a-snap amplitude decline rate of sural nerve before and after chemotherapy in the same patient, the patients were divided into 3 groups according to the decline rate, including group 1 (11 patients, 34%) with a sural nerve a-snap decline rate less than 70%, group 2 (13 patients, 41%) with a decline rate 70%-90%, and group 3 (8 patients, 25%) with a decline more than 90%. The sural nerve amplitude of all enrolled patients decreased after chemotherapy compared with that before chemotherapy, and the difference was statistically significant (P<0.01). After chemotherapy, sural nerve SCV of each group decreased compared with that before chemotherapy, and the difference was statistically significant (P<0.05). Patients were evaluated by TNSc scale before and after chemotherapy, among which sensory symptoms, acupuncture sensation, tendon reflex, autonomic nerve symptoms, and abnormal rates of vibration sensation increased compared with those before chemotherapy (P<0.05). Conclusion Sural nerve conduction velocity can be used to evaluate axonal damage of OXLIPN sensitively and objectively, and provide a sensitive index for grading of OXLIPN neurotoxic reaction.