UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

脊髓灰质炎后综合征

Authors
Laura Simionescu, MD
Burk Jubelt, MD
Section Editors
Jeremy M Shefner, MD, PhD
Ira N Targoff, MD
Deputy Editor
John F Dashe, MD, PhD
Translators
薛群, 主任医师，副教授

引言与背景

麻痹型脊髓灰质炎是20世纪前半叶全世界范围内并发症和死亡的主要病因之一。1952年，在脊髓灰质炎疫苗引入前不久，美国报告的病例数超过20,000例。在1954年引入灭活的脊髓灰质炎疫苗后，脊髓灰质炎的新发病例显著减少。 (参见“脊髓灰质炎和前角感染性疾病”，关于‘脊髓灰质炎病毒和脊髓灰质炎’一节)

尽管脊髓灰质炎已不再是发达国家主要的公共卫生威胁问题，但1987年的一项调查研究估计，有640,000例美国人承受着脊髓灰质炎后遗症的折磨[1]。许多患者的后遗症是稳定的，并反映了最初发病后所达到的恢复状态。尽管尚未充分研究，但大多数脊髓灰质炎生存者的功能和肌力在数年内会出现轻度减退，这可能反映了脊髓灰质炎后的自然病程[2]。

然而，其他患者通常在脊髓灰质炎数十年后发生新的或进行性失能的综合征。这些新发症状有很大差异，包括肌无力加重、局部或广泛的肌萎缩、乏力、疼痛以及行走能力降低。该疾病称为脊髓灰质炎后综合征(post-polio syndrome, PPS)，现在越来越清晰的认识到其涵盖了神经系统和非神经系统部分。

PPS的临床表现、病因和治疗将总结在此。脊髓灰质炎疫苗的相关问题将单独讨论。 (参见“脊髓灰质炎病毒疫苗接种”)

病因

PPS进行性神经功能恶化的原因尚不明确。有关发病机制的主要理论包括：神经再支配的运动单位的进行性变性、脊髓灰质炎病毒长期存在于神经组织中，以及诱导自身免疫及其所造成的神经系统结构破坏。

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-12-08.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Jubelt B, Drucker J. Poliomyelitis and the Post-Polio Syndrome in Motor Disorders, Younger D (Ed), Lippincott Williams and Wilkins, Philadelphia 1999. p.381.
  2. Sorenson EJ, Daube JR, Windebank AJ. A 15-year follow-up of neuromuscular function in patients with prior poliomyelitis. Neurology 2005; 64:1070.
  3. Cashman NR, Maselli R, Wollmann RL, et al. Late denervation in patients with antecedent paralytic poliomyelitis. N Engl J Med 1987; 317:7.
  4. Emeryk B, Rowińska-Marcińska K, Ryniewicz B, Hausmanowa-Petrusewicz I. Disintegration of the motor unit in post-polio syndrome. Part II. Electrophysiological findings in patients with post-polio syndrome. Electromyogr Clin Neurophysiol 1990; 30:451.
  5. Klingman J, Chui H, Corgiat M, Perry J. Functional recovery. A major risk factor for the development of postpoliomyelitis muscular atrophy. Arch Neurol 1988; 45:645.
  6. Trojan DA, Cashman NR, Shapiro S, et al. Predictive factors for post-poliomyelitis syndrome. Arch Phys Med Rehabil 1994; 75:770.
  7. Dalakas M, Illa I. Post-polio syndrome: concepts in clinical diagnosis, pathogenesis, and etiology. Adv Neurol 1991; 56:495.
  8. Gordon T, Hegedus J, Tam SL. Adaptive and maladaptive motor axonal sprouting in aging and motoneuron disease. Neurol Res 2004; 26:174.
  9. Gonzalez H, Ottervald J, Nilsson KC, et al. Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation. J Proteomics 2009; 71:670.
  10. Jubelt B, Salazar-Grueso EF, Roos RP, Cashman NR. Antibody titer to the poliovirus in blood and cerebrospinal fluid of patients with post-polio syndrome. Ann N Y Acad Sci 1995; 753:201.
  11. Jubelt B, Cashman NR. Neurological manifestations of the post-polio syndrome. Crit Rev Neurobiol 1987; 3:199.
  12. Colbére-Garapin F, Duncan G, Pavio N, et al. An approach to understanding the mechanisms of poliovirus persistence in infected cells of neural or non-neural origin. Clin Diagn Virol 1998; 9:107.
  13. Sharief MK, Hentges R, Ciardi M. Intrathecal immune response in patients with the post-polio syndrome. N Engl J Med 1991; 325:749.
  14. Salazar-Grueso EF, Grimaldi LM, Roos RP, et al. Isoelectric focusing studies of serum and cerebrospinal fluid in patients with antecedent poliomyelitis. Ann Neurol 1989; 26:709.
  15. Dalakas MC, Elder G, Hallett M, et al. A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. N Engl J Med 1986; 314:959.
  16. Leon-Monzon ME, Dalakas MC. Detection of poliovirus antibodies and poliovirus genome in patients with the post-polio syndrome. Ann N Y Acad Sci 1995; 753:208.
  17. Muir P, Nicholson F, Spencer GT, et al. Enterovirus infection of the central nervous system of humans: lack of association with chronic neurological disease. J Gen Virol 1996; 77 ( Pt 7):1469.
  18. Pezeshkpour GH, Dalakas MC. Long-term changes in the spinal cords of patients with old poliomyelitis. Signs of continuous disease activity. Arch Neurol 1988; 45:505.
  19. Gonzalez H, Khademi M, Andersson M, et al. Prior poliomyelitis-evidence of cytokine production in the central nervous system. J Neurol Sci 2002; 205:9.
  20. Fordyce CB, Gagne D, Jalili F, et al. Elevated serum inflammatory markers in post-poliomyelitis syndrome. J Neurol Sci 2008; 271:80.
  21. Farbu E, Rekand T, Tysnes OB, et al. GM1 antibodies in post-polio syndrome and previous paralytic polio. J Neuroimmunol 2003; 139:141.
  22. Bruno RL. Post-polio sequelae: research and treatment in the second decade. Orthopedics 1991; 14:1169.
  23. Kidd D, Howard RS, Williams AJ, et al. Late functional deterioration following paralytic poliomyelitis. QJM 1997; 90:189.
  24. Ramlow J, Alexander M, LaPorte R, et al. Epidemiology of the post-polio syndrome. Am J Epidemiol 1992; 136:769.
  25. Miranda-Pfeilsticker B, Figarella-Branger D, Pellissier JF, Serratrice G. [Post-poliomyelitis syndrome: 29 cases]. Rev Neurol (Paris) 1992; 148:355.
  26. Halstead L, Wiechers D, Rossi D. Late effects of poliomyelitis: a national survey. In: Late Effects of Poliomyelitis, Halstead L, Wiechers D (Eds), Symposia Foundati, Miami 1985. p.11.
  27. Jubelt B, Drucker J. Post-polio syndrome: an update. Semin Neurol 1993; 13:283.
  28. Mulder DW, Rosenbaum RA, Layton DD Jr. Late progression of poliomyelitis or forme fruste amyotrophic lateral sclerosis? Mayo Clin Proc 1972; 47:756.
  29. Halstead LS, Rossi CD. Post-polio syndrome: clinical experience with 132 consecutive outpatients. Birth Defects Orig Artic Ser 1987; 23:13.
  30. Dean E, Ross J, Road JD, et al. Pulmonary function in individuals with a history of poliomyelitis. Chest 1991; 100:118.
  31. Blomstrand A, Bake B. Post-polio lung function. Scand J Rehabil Med 1992; 24:43.
  32. Bach JR, Alba AS. Pulmonary dysfunction and sleep disordered breathing as post-polio sequelae: evaluation and management. Orthopedics 1991; 14:1329.
  33. Bach JR. Management of post-polio respiratory sequelae. Ann N Y Acad Sci 1995; 753:96.
  34. Sonies BC, Dalakas MC. Dysphagia in patients with the post-polio syndrome. N Engl J Med 1991; 324:1162.
  35. Sonies BC, Dalakas MC. Progression of oral-motor and swallowing symptoms in the post-polio syndrome. Ann N Y Acad Sci 1995; 753:87.
  36. Sonies BC. Dysphagia and post-polio syndrome: past, present, and future. Semin Neurol 1996; 16:365.
  37. Buchholz DW, Jones B. Post-polio dysphagia: alarm or caution? Orthopedics 1991; 14:1303.
  38. Cannon S, Ritter FN. Vocal cord paralysis in postpoliomyelitis syndrome. Laryngoscope 1987; 97:981.
  39. Agre JC, Grimby G, Rodriquez AA, et al. A comparison of symptoms between Swedish and American post-polio individuals and assessment of lower limb strength--a four-year cohort study. Scand J Rehabil Med 1995; 27:183.
  40. Norris F, Denys E. UK: Differential diagnosis of adult motor neuron disease. In: The Diagnosis and Treatment of Amyotrophic Lateral Sclerosis, Mulder D (Ed), Houghton Mifflin, Boston 1980. p.53.
  41. Windebank AJ, Litchy WJ, Daube JR, et al. Late effects of paralytic poliomyelitis in Olmsted County, Minnesota. Neurology 1991; 41:501.
  42. Peach PE. Overwork weakness with evidence of muscle damage in a patient with residual paralysis from polio. Arch Phys Med Rehabil 1990; 71:248.
  43. Feldman RM. The use of EMG in the differential diagnosis of muscle weakness in post-polio syndrome. Electromyogr Clin Neurophysiol 1988; 28:269.
  44. Trojan DA, Gendron D, Cashman NR. Electrophysiology and electrodiagnosis of the post-polio motor unit. Orthopedics 1991; 14:1353.
  45. Rodriquez AA, Agre JC, Harmon RL, et al. Electromyographic and neuromuscular variables in post-polio subjects. Arch Phys Med Rehabil 1995; 76:989.
  46. Daube JR, Windebank AJ, Litchy WJ. Electrophysiologic changes in neuromuscular function over five years in polio survivors. Ann N Y Acad Sci 1995; 753:120.
  47. McComas AJ, Quartly C, Griggs RC. Early and late losses of motor units after poliomyelitis. Brain 1997; 120 ( Pt 8):1415.
  48. Halstead LS, Rossi CD. New problems in old polio patients: results of a survey of 539 polio survivors. Orthopedics 1985; 8:845.
  49. Halstead LS. Diagnosing postpolio syndrome: inclusion and exclusion criteria. In: Postpolio Syndrome, Silver JK, Gawne AC (Eds), Hanley & Belfus, Philadelphia 2004. p.1.
  50. Farbu E, Gilhus NE, Barnes MP, et al. EFNS guideline on diagnosis and management of post-polio syndrome. Report of an EFNS task force. Eur J Neurol 2006; 13:795.
  51. Jubelt B. Post-Polio Syndrome. Curr Treat Options Neurol 2004; 6:87.
  52. Gonzalez H, Olsson T, Borg K. Management of postpolio syndrome. Lancet Neurol 2010; 9:634.
  53. Chan KM, Amirjani N, Sumrain M, et al. Randomized controlled trial of strength training in post-polio patients. Muscle Nerve 2003; 27:332.
  54. Feldman RM, Soskolne CL. The use of nonfatiguing strengthening exercises in post-polio syndrome. Birth Defects Orig Artic Ser 1987; 23:335.
  55. Fillyaw MJ, Badger GJ, Goodwin GD, et al. The effects of long-term non-fatiguing resistance exercise in subjects with post-polio syndrome. Orthopedics 1991; 14:1253.
  56. Agre JC, Rodriquez AA, Franke TM, et al. Low-intensity, alternate-day exercise improves muscle performance without apparent adverse effect in postpolio patients. Am J Phys Med Rehabil 1996; 75:50.
  57. Ernstoff B, Wetterqvist H, Kvist H, Grimby G. Endurance training effect on individuals with postpoliomyelitis. Arch Phys Med Rehabil 1996; 77:843.
  58. Spector SA, Gordon PL, Feuerstein IM, et al. Strength gains without muscle injury after strength training in patients with postpolio muscular atrophy. Muscle Nerve 1996; 19:1282.
  59. Agre JC, Rodriquez AA, Franke TM. Strength, endurance, and work capacity after muscle strengthening exercise in postpolio subjects. Arch Phys Med Rehabil 1997; 78:681.
  60. Agre JC, Rodriquez AA. Intermittent isometric activity: its effect on muscle fatigue in postpolio subjects. Arch Phys Med Rehabil 1991; 72:971.
  61. Trojan DA, Collet JP, Shapiro S, et al. A multicenter, randomized, double-blinded trial of pyridostigmine in postpolio syndrome. Neurology 1999; 53:1225.
  62. Dalakas MC. Why drugs fail in postpolio syndrome: lessons from another clinical trial. Neurology 1999; 53:1166.
  63. Horemans HL, Nollet F, Beelen A, et al. Pyridostigmine in postpolio syndrome: no decline in fatigue and limited functional improvement. J Neurol Neurosurg Psychiatry 2003; 74:1655.
  64. Oncu J, Durmaz B, Karapolat H. Short-term effects of aerobic exercise on functional capacity, fatigue, and quality of life in patients with post-polio syndrome. Clin Rehabil 2009; 23:155.
  65. Stein DP, Dambrosia JM, Dalakas MC. A double-blind, placebo-controlled trial of amantadine for the treatment of fatigue in patients with the post-polio syndrome. Ann N Y Acad Sci 1995; 753:296.
  66. Koopman FS, Uegaki K, Gilhus NE, et al. Treatment for postpolio syndrome. Cochrane Database Syst Rev 2011; :CD007818.
  67. Vasconcelos OM, Prokhorenko OA, Salajegheh MK, et al. Modafinil for treatment of fatigue in post-polio syndrome: a randomized controlled trial. Neurology 2007; 68:1680.
  68. Chan KM, Strohschein FJ, Rydz D, et al. Randomized controlled trial of modafinil for the treatment of fatigue in postpolio patients. Muscle Nerve 2006; 33:138.
  69. Waring WP, Maynard F, Grady W, et al. Influence of appropriate lower extremity orthotic management on ambulation, pain, and fatigue in a postpolio population. Arch Phys Med Rehabil 1989; 70:371.
  70. Jones DR, Speier J, Canine K, et al. Cardiorespiratory responses to aerobic training by patients with postpoliomyelitis sequelae. JAMA 1989; 261:3255.
  71. Willén C, Sunnerhagen KS, Grimby G. Dynamic water exercise in individuals with late poliomyelitis. Arch Phys Med Rehabil 2001; 82:66.
  72. Soliman MG, Higgins SE, El-Kabir DR, et al. Non-invasive assessment of respiratory muscle strength in patients with previous poliomyelitis. Respir Med 2005; 99:1217.
  73. Gillis-Haegerstrand C, Markström A, Barle H. Bi-level positive airway pressure ventilation maintains adequate ventilation in post-polio patients with respiratory failure. Acta Anaesthesiol Scand 2006; 50:580.
  74. Steljes DG, Kryger MH, Kirk BW, Millar TW. Sleep in postpolio syndrome. Chest 1990; 98:133.
  75. Silbergleit AK, Waring WP, Sullivan MJ, Maynard FM. Evaluation, treatment, and follow-up results of post polio patients with dysphagia. Otolaryngol Head Neck Surg 1991; 104:333.
  76. Abaza MM, Sataloff RT, Hawkshaw MJ, Mandel S. Laryngeal manifestations of postpoliomyelitis syndrome. J Voice 2001; 15:291.
  77. Gonzalez H, Sunnerhagen KS, Sjöberg I, et al. Intravenous immunoglobulin for post-polio syndrome: a randomised controlled trial. Lancet Neurol 2006; 5:493.
  78. Farbu E, Rekand T, Vik-Mo E, et al. Post-polio syndrome patients treated with intravenous immunoglobulin: a double-blinded randomized controlled pilot study. Eur J Neurol 2007; 14:60.
  79. Werhagen L, Borg K. Effect of intravenous immunoglobulin on pain in patients with post-polio syndrome. J Rehabil Med 2011; 43:1038.
  80. Gyermek L. Increased potency of nondepolarizing relaxants after poliomyelitis. J Clin Pharmacol 1990; 30:170.
  81. Lambert DA, Giannouli E, Schmidt BJ. Postpolio syndrome and anesthesia. Anesthesiology 2005; 103:638.
  82. Wernet A, Bougeois B, Merckx P, et al. Successful use of succinylcholine for cesarean delivery in a patient with postpolio syndrome. Anesthesiology 2007; 107:680.