中山大學(xué)附屬第一醫(yī)院

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公立三甲綜合醫(yī)院

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疾?。? 腓骨肌萎縮癥
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腓骨肌萎縮癥(Charcot-Marie-Tooth, CMT)腓骨肌萎縮癥(Charcot-Marie-Tooth,CMT)譯者：陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）腓骨肌萎縮癥(CMT)是一種控制肌肉的周圍神經(jīng)疾病，可導(dǎo)致手指、上肢手臂、下肢和足部的功能和感覺進行性喪失。腓骨肌萎縮癥(CMT)是遺傳性周圍神經(jīng)病的一種形式。CMT這個名字從何而來？CMT是腓骨肌萎縮癥(Charcot-Marie-Tooth)的縮寫，以首先描述該病的三位醫(yī)生命名：Drs.Jean-MartinCharcot和PierreMarie（均來自法國）和HowardHenryTooth（英國）。目前全世界有多少人患有腓骨肌萎縮癥(CMT)？腓骨肌萎縮癥(CMT)影響美國133,000人，全球約300萬人。誰可能患有腓骨肌萎縮癥(CMT)？腓骨肌萎縮癥(CMT)可以影響任何人，無論種族、性別、民族等。腓骨肌萎縮癥(CMT)是否遺傳（傾向）？腓骨肌萎縮癥(CMT)是最常見的遺傳性周圍神經(jīng)病。腓骨肌萎縮癥(CMT)可以代代相傳。它也可以作為新的或自發(fā)的（從頭）突變發(fā)生。有多少基因突變會導(dǎo)致腓骨肌萎縮癥(CMT)？科學(xué)家們已經(jīng)鑒定出超過100種不同的基因突變會導(dǎo)致腓骨肌萎縮癥(CMT)。大多數(shù)人(90%)患有四種類型的腓骨肌萎縮癥(CMT)之一：CMT1A(PMP22)；CMT1B（MPZ）；CMT2A(MFN2)和CMT1X(GJB1)。腓骨肌萎縮癥(CMT)有多少種類型？腓骨肌萎縮癥(CMT)分為三種主要類型：脫髓鞘型（1型和4型）、軸突型（2型）和中間型。腓骨肌萎縮癥(CMT)是會進展的疾病嗎？腓骨肌萎縮癥(CMT)緩慢進展，導(dǎo)致小腿/腳和手/手臂失去正常功能和/或感覺。腓骨肌萎縮癥(CMT)周圍神經(jīng)病變有哪些癥狀？腓骨肌萎縮癥(CMT)癥狀????腓骨肌萎縮癥(CMT)周圍神經(jīng)病變的最初癥狀可能包括用腳趾走路、頻繁絆倒、踝關(guān)節(jié)扭傷、笨拙以及腳和/或手的“灼燒感”或針刺感?；加须韫羌∥s癥(CMT)的兒童可能會更頻繁地跌倒，并且延遲達(dá)到某些標(biāo)準(zhǔn)的兒童身體發(fā)育階段。????高足弓和錘狀趾（卷曲腳趾）等足部結(jié)構(gòu)畸形很常見，但有些人有扁平足和直腳趾。在疾病過程的后期，手指和手部可能會出現(xiàn)攣縮。????由于腳部和腿部肌肉萎縮，可能會出現(xiàn)足下垂（腳踝處無法抬起腳）、平衡不良和行走問題，有些人可能患有髖關(guān)節(jié)發(fā)育不良。????隨著手部萎縮的發(fā)生和進展，涉及手動靈巧性的任務(wù)（例如書寫、抓握或撿起小物體或操縱拉鏈和紐扣）可能會出現(xiàn)困難。????在腓骨肌萎縮癥(CMT)中，感覺異常、輕觸感覺能力喪失、整體觸覺以及感知溫度變化的能力可能會減弱，甚至喪失。喪失感知身體在空間中的位置（本體感覺）的能力也很常見，許多人會經(jīng)歷肌肉骨骼或神經(jīng)性疼痛。????對冷、冷和/或熱溫度的耐受性較差是典型的。許多人長期手腳冰涼。其他癥狀可能包括彎曲的手指、攣縮、震顫、膝關(guān)節(jié)和/或髖關(guān)節(jié)問題、肌肉痙攣、肌肉痙攣、大魚際肌肉萎縮（拇指和食指之間的肌肉質(zhì)量損失）、手部整體力量喪失、反射缺失或減弱，慢性疲勞、阻塞性睡眠呼吸暫停、血液循環(huán)不良、脊柱側(cè)凸、脊柱后凸、髖關(guān)節(jié)發(fā)育不良。????罕見癥狀包括呼吸肌無力引起的呼吸困難、吞咽或說話困難、神經(jīng)源性膀胱、聽力喪失、視神經(jīng)病變和聲帶麻痹。????腓骨肌萎縮癥(CMT)的心理影響不容忽視，它會導(dǎo)致煩躁、抑郁、焦慮、絕望和內(nèi)疚感。如何診斷腓骨肌萎縮癥(CMT)？腓骨肌萎縮癥(CMT)診斷涉及肌肉功能和萎縮的臨床評估、感覺反應(yīng)測試以及肌電圖和神經(jīng)傳導(dǎo)研究。許多類型的腓骨肌萎縮癥(CMT)也可以通過基因檢測來診斷。腓骨肌萎縮癥(CMT)與肌肉萎縮癥有何不同？腓骨肌萎縮癥(CMT)是一種控制肌肉的周圍神經(jīng)疾病。肌營養(yǎng)不良癥是肌肉本身的疾病。腓骨肌萎縮癥(CMT)有治療方法嗎？盡管腓骨肌萎縮癥(CMT)沒有藥物治療，但物理治療和適度活動（但不要過度勞累）可以幫助保持肌肉力量、耐力和靈活性。AFO（踝足矯形器）和定制鞋等機械支撐可以改善步態(tài)和平衡。當(dāng)有醫(yī)學(xué)指征時，整形外科手術(shù)可以矯正畸形并幫助保持活動能力和功能。職業(yè)治療和適應(yīng)性設(shè)備可以幫助人們進行日常生活活動。腓骨肌萎縮癥(CMT)有治愈方法嗎？腓骨肌萎縮癥(CMT)目前無法治愈，但通常不會導(dǎo)致肥胖等，盡管在一小部分情況下它會嚴(yán)重致殘。腓骨肌萎縮癥(CMT)患者應(yīng)避免服用哪些藥物？有些藥物對所有人都有神經(jīng)毒性。一些神經(jīng)毒性藥物對腓骨肌萎縮癥患者構(gòu)成更大的風(fēng)險。長春新堿已被證明是危險的，所有腓骨肌萎縮癥(CMT)患者都應(yīng)避免使用。服用任何藥物或更換藥物之前，請確保您的醫(yī)生充分了解您的健康狀況，并討論他們可能對腓骨肌萎縮癥(CMT)產(chǎn)生的任何可能的副作用。?WhatisCharcot-Marie-Toothdisease?Charcot-Marie-Tooth(CMT)isadiseaseoftheperipheralnervesthatcontrolmusclesthatcancauseprogressivelossoffunctionandsensationinthehands,arms,legs,andfeet.CMTisaformofinheritedperipheralneuropathy.WheredidthenameCMTcomefrom?CMTistheacronymforCharcot-Marie-Toothdisease,namedafterthethreephysicianswhofirstdescribedit:Drs.Jean-MartinCharcotandPierreMarie(bothfromFrance)andHowardHenryTooth(oftheUnitedKingdom).HowmanypeoplehaveCMT?CMTaffects133,000peopleintheUnitedStatesandroughly3millionworldwide.WhogetsCMT?CMTcanaffectanyoneregardlessofrace,gender,ethnicity,etc.IsCMTgenetic?CMTisthemostcommonlyinheritedperipheralneuropathy.CMTcanbepassedonfromonegenerationtothenext.Itcanalsooccurasaneworspontaneous(denovo)mutation.LearnaboutCMTinheritancepatterns.HowmanygenemutationscauseCMT?Scientistshaveidentifiedover100differentgenemutationscausingCMT.Mostpeople(90%)haveoneoffourtypesofCMT:CMT1A(PMP22);CMT1B(MPZ);CMT2A(MFN2)andCMT1X(GJB1).HowmanytypesofCMTarethere?TherearethreemaintypesofCMT–demyelinating(types1&4),axonal(type2),andintermediate.LearnmoreaboutCMTTypesandSubtypesIsCMTprogressive?CMTisslowlyprogressive,causinglossofnormalfunctionand/orsensationinthelowerlegs/feetandhands/arms.?WhatarethesymptomsofCMTperipheralneuropathy?CMTSymptoms???FirstsignsofCMTperipheralneuropathymayincludetoe-walking,frequenttripping,anklesprains,clumsiness,and“burning”orpins-and-needlessensationsinthefeetand/orhands.ChildrenwithCMTmayfallmorefrequentlyandbedelayedinreachingsomeofthestandardchildhoodphysicalmilestones.???Structuralfootdeformitiessuchashigharchesandhammertoes(curledtoes)arecommon,butsomepeoplehaveflatfeetandstraighttoes.Laterinthediseaseprocess,contracturesmaydevelopinthefingersandhands.???Footdrop(inabilitytoliftfootatankle),poorbalance,andproblemswalkingmaydevelopasmusclesatrophyinthefeetandlegs,andsomepeoplemayhavehipdysplasia.???Difficultywithtasksinvolvingmanualdexterity,suchaswriting,graspingorpickingupsmallobjectormanipulatingzippersandbuttonscandevelopasatrophyinthehandssetsinandprogresses.???Abnormalsensation,lossofabilitytofeellighttouch,theoverallsenseoftouch,andtheabilitytoperceivetemperaturechangecanbecomediminished,orevenlost,inCMT.Thelossoftheabilitytosensewhereone’sbodyisinspace(proprioception)isalsocommon,andmanypeopleexperiencemusculoskeletalorneuropathicpain.???Poortoleranceforcool,coldand/orhottemperaturesistypical.Manypeoplehavechronicallycoldhandsandfeet.Additionalsymptomsmayincludeflexedfingers,contractures,tremor,kneeand/orhipproblems,musclecramps,musclespasms,thenarmuscleatrophy(lossofmusclemassbetweenthethumbandforefinger),lossofoverallhandstrength,absentorreducedreflexes,chronicfatigue,obstructivesleepapnea,poorcirculation,scoliosis,kyphosis,hipdysplasia.???Raresymptomsincludebreathingdifficultiescausedbyrespiratorymuscleweakness,swallowingorspeakingdifficulties,neurogenicbladder,hearingloss,opticneuropathyandvocalcordparalysis.???ThepsychologicalimpactofhavingCMTcan’tbeignored,leadingtoirritability,depression,anxiety,feelingsofhopelessnessandguilt.Ifyouarehavingsuicidalthoughts,immediatelycallyourlocalsuicidehotlineortheNationalSuicidePreventionLifeline:1-800-273-TALK(1-800-273-8255),orseekhelprightawayatalocalemergencyroom.HowisCMTdiagnosed?ACMTdiagnosisinvolvesclinicalevaluationofmusclefunctionandatrophy,testingofsensoryresponses,andelectromyographicandnerveconductionstudies.ManytypesofCMTcanalsobediagnosedbygenetictesting.LearnmoreabouttheCMTDiagnosisProcessHowisCMTdifferentfromMuscularDystrophy?CMTisadiseaseoftheperipheralnervesthatcontrolmuscles.Musculardystrophyisadiseaseofthemusclesthemselves.IsthereaTreatmentforCMT?AlthoughthereisnodrugtreatmentforCMT,physicaltherapyandmoderateactivity(butnotoverexertion)canhelpmaintainmusclestrength,enduranceandflexibility.MechanicalsupportslikeAFOs(ankle-footorthoses)andcustom-madeshoescanimprovegaitandbalance.Whenmedicallyindicated,orthopedicsurgerycancorrectdeformityandhelpmaintainmobilityandfunction.Occupationaltherapyandadaptivedevicescanhelppeopleperformactivitiesofdailyliving.IsthereacureforCMT?CMTiscurrentlyincurable,butnotusuallyfatal,thoughitisseverelydisablinginasmallproportionofcases.AnymedicationspeoplewithCMTshouldavoid?Somemedicationsareneurotoxictoallhumans.SomeneurotoxicmedicationsposeagreaterrisktopeoplelivingwithCharcot-Marie-Toothdisease.VincristinehasbeenprovenhazardousandshouldbeavoidedbyallCMTpatients.Visitthispageformoreinformationaboutpotentiallyneurotoxicmedications.Beforetakinganymedicationorchangingmedications,besureyourphysicianisfullyawareofyourmedicalconditionanddiscussanypossiblesideeffectstheymayhaveonCMT.Haveadrug/medicationquestion?Emailusatinfo@cmtausa.org.文獻(xiàn)出處：https://www.cmtausa.org/understanding-cmt/what-is-cmt/