| Objective To study the clinical characteristics of patients with peripheral neurotype brucellosis(PNB),and to explore the diagnostic value of neuroelectrophysiology and highfrequency ultrasound.Methods From July 2018 to December 2019,patients with brucellosis admitted to the department of neurology,affiliated hospital of Inner Mongolia medical university were given detailed consultation and physical examination,as well as relevant laboratory tests,neuroimaging tests and empirical treatment.Eventually,22 PNB patients who met the diagnostic criteria were included in the case group.At the same time,20 normal health checkups were collected and listed as the control group.Then the peripheral nerves of the above case group and control group were examined by neuroelectrophysiology and highfrequency ultrasound.The neurophysiological examination method is: using Danish(Keypoint 9031A070 DK-2740 Denmark)electromyography/evoked potentiometer and surface electrodes to perform electrophysiological detection of peripheral nerves in case group and control group,sensory nerve(median,ulnar,sural and superficial peroneal nerves)measured parameters include sensory nerve action potential latency(SL),sensory nerve action potential(SNAP),and sensory nerve conduction velocity(SCV).Motor nerve(median nerve,ulnar nerve,common peroneal nerve and tibial nerve)measured parameters include distal motor latency(DML)、 compound motor active potential(CMAP),and motor nerve conduction velocity(MCV)and recorded the above measured parameter values.The high-frequency ultrasound examination of the nerve is: using a portable ultrasound diagnostic apparatus(the frequency range of the high-frequency ultrasound probe is between 5 and 12 MHz,and the model is LOGIQ e)produced by General Electric Company(GE)to scan and explore the peripheral nerves(median nerve,sciatic nerve,common peroneal nerve,tibial nerve,sural nerve,ulnar nerve)of the case group and the control group at the corresponding positions(carpal tunnel entrance,mid thigh level,slightly below the sciatic nerve branch,slightly below the sciatic nerve branch,lateral ankle of the calf,entrance of the elbow canal)one by one.The measurement parameter was the cross-sectional area of the nerve,and the cross-sectional area of each nerve was recorded.The original data of all neuroelectrophysiological and high-frequency ultrasound detection results of the case group and the control group were input into SPSS 23.0 statistical software for statistical analysis.The measurement data were expressed as mean ± standard deviation.T test is used for comparison.Use Pearson to analyze the correlation between two continuous variables.All the above statistical methods adopt the two-sided test,according to the level of α = 0.05,with P <0.05 as the difference is statistically significant.Finally,all clinical characteristics of 22 patients with PNB were summarized.Results ⑴General characteristics:22 patients with PNB had epidemiological characteristics such as contact history of cattle and sheep to varying degrees,but were mainly dominated by farmers raising cattle and sheep at home,followed by herders working in pastoral areas.The age of onset was 21-71 years old,the average age was 46.0 years old,and the male-to-female incidence ratio was 15: 7.The course of disease is from January to 8 years,with an average course of 4.0 years.Chronic disease is more common than acute disease.The symptoms of mainly include numbness of the extremities of the limbs,general weakness,migraine joint pain,and fever.The signs of mainly include straight leg elevation test,positive pathological signs,and muscle weakness.Most of the indicators of infection in blood tests are mainly elevated C-reactive protein and procalcitonin.Brucellosis serology antibody positive results were mainly Ig G(human brucella Ig G antibody)> 20 u / ml,followed by RBPT(rose bengal precipitation test)+.⑵Characteristics of neuroelectrophysiology examination:(1)Compared with sensory nerve and motor nerve,the former is more vulnerable.The sensory nerves are mainly prolonged by the SL of the median nerve,reduced by SNAP amplitude,and reduced by SCV mainly,followed by the superficial peroneal nerves.The sensory nerve parameters are mostly reduced by SNAP amplitude.The motor nerve is mainly by the extension of DML,CMAP amplitude and MCV of the median nerve,followed by the tibial nerve.Most of the parameters are mainly MCV slowdown.The evoked potentials are mainly the prolongation of P40 incubation period of both lower extremities.(2)The t test was used to compare the parameters of each sensory nerve(SL,SNAP volatility,and SCV)and the parameters of each motor nerve(DML,CMAP amplitude,and MCV)corresponding to the case group and the control group,and it was found that the difference was statistically significant.⑶Neural high-frequency ultrasound examination features:(1)In the case group,the peripheral nerves of the patients were mostly increased in the cross-sectional area of the median nerve.(2)The t test was used to compare the increase in the cross-sectional area of each peripheral nerve between the case group and the control group,then the difference was statistically significant.⑷Correlation analysis between neuroelectrophysiology and high-frequency ultrasonography results in the case group: The pearson test was used to analyze the correlation between the SL value of the median nerve at the entrance of the carpal tunnel and the corresponding crosssectional area value of the patient group.Results r = 0.789,P <0.05,the difference was statistically significant.Similarly,the correlation coefficient between the SL value of the sural nerve at the lateral ankle of the calf and the corresponding cross-sectional area value was calculated.The result was r = 0.556,P <0.05,the difference was statistically significant.Conclusion ⑴22 cases of PNB patients were mainly middle-aged and elderly male farmers who raised cattle and sheep in their homes,most of which were chronic onset and brucella antibodies were mostly elevated by Ig G.The main symptoms and signs were numbness of the extremities of limbs,general weakness,painful joint pain,fever,positive straight leg elevation test,positive pathological signs,and muscle weakness.Blood tests showed elevated infection indicators.⑵ Peripheral nerves in 22 patients with PNB showed neurotransmission dysfunction in electrophysiology,and the structure showed a thickened neuroedema.The more severe the nerve conduction dysfunction,the more severe the neuroedema becomes. |
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