实践参数：远端对称性多发性神经病的评估：自主神经检测、神经活检和皮肤活检的作用（循证综述）。美国神经病学学会、美国神经肌肉与电诊断医学协会以及美国物理医学与康复学会报告。

Practice parameter: the evaluation of distal symmetric polyneuropathy: the role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

作者信息

England J D, Gronseth G S, Franklin G, Carter G T, Kinsella L J, Cohen J A, Asbury A K, Szigeti K, Lupski J R, Latov N, Lewis R A, Low P A, Fisher M A, Herrmann D, Howard J F, Lauria G, Miller R G, Polydefkis M, Sumner A J

机构信息

Louisiana State University Health Sciences Center, New Orleans, USA.

出版信息

PM R. 2009 Jan;1(1):14-22. doi: 10.1016/j.pmrj.2008.11.011.

DOI:10.1016/j.pmrj.2008.11.011

PMID:19627868

Abstract

BACKGROUND

Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, nerve biopsy and skin biopsy for the assessment of polyneuropathy.

METHODS

A literature review using MEDLINE, EMBASE, Science Citation Index and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence.

RESULTS AND CONCLUSIONS

Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2. Nerve biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a nerve biopsy may be useful in the evaluation of DSP (Level U). 3. Skin biopsy is a validated technique for determining intraepidermal nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

摘要

背景

远端对称性多发性神经病（DSP）是最常见的神经病类型。由于对该疾病的评估尚未标准化，因此对现有文献进行了综述，以提供关于自主神经检测、神经活检和皮肤活检在多发性神经病评估中作用的循证指南。

方法

利用医学索引数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、科学引文索引和现刊目次进行文献综述，以确定1980年至2007年3月间发表的关于多发性神经病评估的最佳证据。文章根据四级证据方案进行分类，建议基于证据水平给出。

结果与结论

在评估多发性神经病患者时可考虑进行自主神经检测，以记录自主神经系统功能障碍（B级）。尤其在评估疑似自主神经病（B级）和远端小纤维感觉性多发性神经病（SFSN）（C级）时应考虑进行此类检测。建议采用一系列经过验证的检测方法以实现最高的诊断准确性（B级）。2. 神经活检在评估某些神经病时通常被认为是有用的，如疑似淀粉样神经病、血管炎所致的多发性单神经病或非典型慢性炎症性脱髓鞘性多发性神经病（CIDP）患者。然而，关于神经活检在DSP评估中何时有用的文献不足，无法给出推荐意见（U级）。3. 皮肤活检是确定表皮内神经纤维（IENF）密度的一种经过验证的技术，可考虑用于DSP的诊断，尤其是SFSN（C级）。需要更多前瞻性研究来确定评估多发性神经病的更确切指南。