神經(jīng)傳導(dǎo)檢查在奧沙利鉑誘導(dǎo)性周圍神經(jīng)病中的應(yīng)用研究
發(fā)布時(shí)間：2018-09-13 16:38
【摘要】：目的:本研究通過臨床量表評(píng)估和神經(jīng)傳導(dǎo)檢查初步探討奧沙利鉑誘導(dǎo)性周圍神經(jīng)病(Oxaliplatin induced peripheral neuropathy,OXLIPN)的臨床特點(diǎn)和早期神經(jīng)傳導(dǎo)特點(diǎn),從而早期發(fā)現(xiàn)并準(zhǔn)確評(píng)價(jià)奧沙利鉑的周圍神經(jīng)毒性,以指導(dǎo)預(yù)防神經(jīng)毒性用藥。方法:本研究收集了2015年12月至2017年03月蚌埠醫(yī)學(xué)院第一附屬醫(yī)院腫瘤內(nèi)科住院的病人,經(jīng)病理檢查確診為結(jié)腸癌,計(jì)劃實(shí)施XELOX方案(第1天靜滴奧沙利鉑130mg/m2,第1-14天口服卡培他濱,后停藥1周,21天為1周期),每周期化療后對(duì)患者進(jìn)行問卷調(diào)查,了解急性O(shè)XLIPN發(fā)病情況;化療前和化療4周期后(患者入院計(jì)劃行第5周期化療前1-2天)行神經(jīng)傳導(dǎo)檢查,觀察患者的感覺神經(jīng)及運(yùn)動(dòng)神經(jīng)的傳導(dǎo)速度和波幅的變化;另外,在4周期化療結(jié)束后對(duì)患者進(jìn)行慢性O(shè)XLIPN臨床量表評(píng)估,并與神經(jīng)傳導(dǎo)檢查結(jié)果進(jìn)行對(duì)比分析。結(jié)果:1、本實(shí)驗(yàn)共完成30例,其中男性患者16例,女性患者14例,平均年齡(58.83±8.63)歲,所有患者均接受了預(yù)期的4周期化療,所有患者在治療過程中沒有致命的毒性事件發(fā)生。2、臨床觀察發(fā)現(xiàn)急性O(shè)XLIPN總發(fā)生率為90%,其中冷誘發(fā)肢體感覺異常的患者有26例(86.66%),冷誘發(fā)口周感覺異常10例(33.33%),冷誘發(fā)咽喉部感覺異常8例(26.66%),下頜僵硬5例(16.66%),肌痙攣3例(10%),喉痙攣2例(6.67%),聲音改變3例(10%),有些癥狀如憋氣、吞咽困難、肌束顫動(dòng)、眼瞼下垂、視力改變?cè)诒狙芯恐形闯霈F(xiàn)。3、與化療前相比,化療4周期后右側(cè)正中神經(jīng)及左側(cè)腓總神經(jīng)運(yùn)動(dòng)神經(jīng)復(fù)合肌肉動(dòng)作電位波幅較化療前下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),化療前后各運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度以及各神經(jīng)同期左右兩側(cè)波幅及傳導(dǎo)速度對(duì)比差異均無統(tǒng)計(jì)學(xué)意義(P0.05)�；�4周期后兩側(cè)正中神經(jīng)和兩側(cè)腓腸神經(jīng)感覺神經(jīng)動(dòng)作電位波幅均較化療前明顯下降,差異有統(tǒng)計(jì)學(xué)意義(P0.01),右側(cè)正中神經(jīng)和左側(cè)腓腸神經(jīng)感覺神經(jīng)傳導(dǎo)速度較化療前下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而各感覺神經(jīng)同期左右兩側(cè)波幅及傳導(dǎo)速度對(duì)比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4、化療后上、下肢神經(jīng)傳導(dǎo)檢查異常率比較:運(yùn)動(dòng)神經(jīng)上下肢差異無統(tǒng)計(jì)學(xué)意義(P0.05),感覺神經(jīng)上下肢差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5、化療結(jié)束后臨床量表評(píng)估慢性O(shè)XLIPN檢出率為43.33%,神經(jīng)傳導(dǎo)檢查慢性O(shè)XLIPN檢出率為66.67%,兩組間比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.臨床觀察急性O(shè)XLIPN發(fā)生率較高;與臨床量表評(píng)估相比,神經(jīng)傳導(dǎo)檢查對(duì)慢性O(shè)XLIPN檢出率更高。2.慢性O(shè)XLIPN早期神經(jīng)傳導(dǎo)特點(diǎn)是雙側(cè)、對(duì)稱性、感覺神經(jīng)軸索性損害為主,以上肢損傷為重,同時(shí)伴有輕度的運(yùn)動(dòng)神經(jīng)損傷。神經(jīng)傳導(dǎo)檢查能夠早期發(fā)現(xiàn)無明顯自覺癥狀的周圍神經(jīng)損害,從而早期診斷,以指導(dǎo)周圍神經(jīng)毒性預(yù)防用藥。
[Abstract]:Objective: to investigate the clinical and early nerve conduction characteristics of oxaliplatin induced peripheral neuropathy (Oxaliplatin induced peripheral neuropathy,OXLIPN) by clinical evaluation and nerve conduction examination. So early detection and accurate evaluation of oxaliplatin peripheral neurotoxicity, in order to guide the prevention of neurotoxicity drug. Methods: patients admitted to Department of Oncology, first affiliated Hospital of Bengbu Medical College, from December 2015 to March 2017, were diagnosed as colon cancer by pathological examination. XELOX regimen was planned to be implemented (oral administration of oxaliplatin 130 mg / m2 on day 1, oral capecitabine on day 1-14, and withdrawal for 21 days after one week). Questionnaires were conducted to investigate the incidence of acute OXLIPN after each cycle of chemotherapy. Nerve conduction tests were performed before and after 4 cycles of chemotherapy (1-2 days before admission plan for the fifth cycle) to observe the changes of conduction velocity and amplitude of sensory and motor nerves. The patients were evaluated with chronic OXLIPN scale after 4 cycles of chemotherapy and compared with the results of nerve conduction examination. Results in this study, 30 patients (16 male and 14 female, mean age (58.83 鹵8.63) years) received the expected 4-cycle chemotherapy. No fatal toxic events occurred in all patients. Clinical observation showed that the total incidence of acute OXLIPN was 90. Among them, 26 cases (86.66%) were cold induced limb sensory abnormalities, 10 cases (33.33%) were cold induced peroral sensory abnormalities, and 10 cases (33.33%) were cold induced. There were 8 cases (26.66%) with abnormal pharynx and larynx, 5 cases (16.66%) with mandibular stiffness, 3 cases (10%) with myospasm, 2 cases (6.67%) with laryngeal spasm, 3 cases (10%) with voice change. Dysphagia, fibrillation of muscle bundle, blepharoptosis, visual acuity did not appear in this study. Compared with before chemotherapy, the amplitude of motor complex muscle action potential of right median nerve and left common peroneal nerve decreased after 4 cycles of chemotherapy. The difference was statistically significant (P0.05). There was no significant difference in the conduction velocity of motor nerve before and after chemotherapy and the amplitude and conduction velocity of left and right side of nerve in the same period (P0.05). After 4 cycles of chemotherapy, the amplitude of action potential of bilateral median nerve and bilateral sural nerve decreased significantly (P0.01), and the conduction velocity of right median nerve and left sural nerve decreased compared with that before chemotherapy. The difference was statistically significant (P0.05), but there was no significant difference in amplitude and conduction velocity between the left and right sides of the sensory nerve in the same period (P0.05). Comparison of abnormal rate of nerve conduction in lower extremities: there was no significant difference in motor nerve upper and lower extremity (P0.05), but sensory nerve lower extremity difference was statistically significant (P0.05). The detection rate of chronic OXLIPN was 43.33 after chemotherapy. The detection rate of chronic OXLIPN was 66.67. The difference was statistically significant (P0.05). Conclusion 1. The incidence of acute OXLIPN was higher in clinical observation, and the detection rate of chronic OXLIPN by nerve conduction test was higher than that of clinical scale. 2. 2. In the early stage of chronic OXLIPN, bilateral, symmetrical and sensory nerve axonal damage was the main feature, with severe upper limb injury and mild motor nerve injury. Nerve conduction examination can detect the injury of peripheral nerve without obvious symptoms in the early stage, so as to diagnose early, and guide the preventive medication of peripheral nerve toxicity.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.35;R745
本文編號(hào)：2241735
[Abstract]:Objective: to investigate the clinical and early nerve conduction characteristics of oxaliplatin induced peripheral neuropathy (Oxaliplatin induced peripheral neuropathy,OXLIPN) by clinical evaluation and nerve conduction examination. So early detection and accurate evaluation of oxaliplatin peripheral neurotoxicity, in order to guide the prevention of neurotoxicity drug. Methods: patients admitted to Department of Oncology, first affiliated Hospital of Bengbu Medical College, from December 2015 to March 2017, were diagnosed as colon cancer by pathological examination. XELOX regimen was planned to be implemented (oral administration of oxaliplatin 130 mg / m2 on day 1, oral capecitabine on day 1-14, and withdrawal for 21 days after one week). Questionnaires were conducted to investigate the incidence of acute OXLIPN after each cycle of chemotherapy. Nerve conduction tests were performed before and after 4 cycles of chemotherapy (1-2 days before admission plan for the fifth cycle) to observe the changes of conduction velocity and amplitude of sensory and motor nerves. The patients were evaluated with chronic OXLIPN scale after 4 cycles of chemotherapy and compared with the results of nerve conduction examination. Results in this study, 30 patients (16 male and 14 female, mean age (58.83 鹵8.63) years) received the expected 4-cycle chemotherapy. No fatal toxic events occurred in all patients. Clinical observation showed that the total incidence of acute OXLIPN was 90. Among them, 26 cases (86.66%) were cold induced limb sensory abnormalities, 10 cases (33.33%) were cold induced peroral sensory abnormalities, and 10 cases (33.33%) were cold induced. There were 8 cases (26.66%) with abnormal pharynx and larynx, 5 cases (16.66%) with mandibular stiffness, 3 cases (10%) with myospasm, 2 cases (6.67%) with laryngeal spasm, 3 cases (10%) with voice change. Dysphagia, fibrillation of muscle bundle, blepharoptosis, visual acuity did not appear in this study. Compared with before chemotherapy, the amplitude of motor complex muscle action potential of right median nerve and left common peroneal nerve decreased after 4 cycles of chemotherapy. The difference was statistically significant (P0.05). There was no significant difference in the conduction velocity of motor nerve before and after chemotherapy and the amplitude and conduction velocity of left and right side of nerve in the same period (P0.05). After 4 cycles of chemotherapy, the amplitude of action potential of bilateral median nerve and bilateral sural nerve decreased significantly (P0.01), and the conduction velocity of right median nerve and left sural nerve decreased compared with that before chemotherapy. The difference was statistically significant (P0.05), but there was no significant difference in amplitude and conduction velocity between the left and right sides of the sensory nerve in the same period (P0.05). Comparison of abnormal rate of nerve conduction in lower extremities: there was no significant difference in motor nerve upper and lower extremity (P0.05), but sensory nerve lower extremity difference was statistically significant (P0.05). The detection rate of chronic OXLIPN was 43.33 after chemotherapy. The detection rate of chronic OXLIPN was 66.67. The difference was statistically significant (P0.05). Conclusion 1. The incidence of acute OXLIPN was higher in clinical observation, and the detection rate of chronic OXLIPN by nerve conduction test was higher than that of clinical scale. 2. 2. In the early stage of chronic OXLIPN, bilateral, symmetrical and sensory nerve axonal damage was the main feature, with severe upper limb injury and mild motor nerve injury. Nerve conduction examination can detect the injury of peripheral nerve without obvious symptoms in the early stage, so as to diagnose early, and guide the preventive medication of peripheral nerve toxicity.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.35;R745
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