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1、 周周 围围 神神 经经 病病 Peripheral Neuropathy中国协和医科大学 周围神经病中国协和医科大学周围神经病中国协和医科大学Peripheral neuropathy is a large group of diseases: Damage of nerves outside of the spinal cord and brain. Dysfunction of these nerves. Caused by any of risk factors周围神经病中国协和医科大学周围神经病中国协和医科大学Anatomyandfunctionofperipheralnerveba
2、sictounderstandneuropathy周围神经病中国协和医科大学周围神经病中国协和医科大学Anatomy cranial nerve olfactory nerve olfactory nerve optic nerveoptic nerve oculomotor nerveoculomotor nerve trochlear nervetrochlear nerve trigeminal nervetrigeminal nerve abducent nerve facial abducent nerve facial nervenerve vestibulocochlear ne
3、rve vestibulocochlear nerve glossopharyngeal nerve glossopharyngeal nerve vagus nerve vagus nerve accessory nerve accessory nerve hypoglossal nerve hypoglossal nerve周围神经病中国协和医科大学周围神经病中国协和医科大学Spinalnerves周围神经病中国协和医科大学周围神经病中国协和医科大学Histology周围神经病中国协和医科大学周围神经病中国协和医科大学ElectrophysiologyUnmyelinated nerve
4、fiberUnmyelinated nerve fiberMyelinated nerve fiberMyelinated nerve fiber周围神经病中国协和医科大学周围神经病中国协和医科大学FunctionsMotor nerveMotor nerveMotor nerveMotor nerveSensory nerveSensory nerveSensory nerveSensory nerveAutonomic nerveAutonomic nerveAutonomic nerveAutonomic nervereflexreflexreflexreflex周围神经病中国协和医科大
5、学周围神经病中国协和医科大学Step 1: Clinicalfeaturesofneuropathieshistoryandexaminationofpatientisthecluestodiagnosisofneuropathy周围神经病中国协和医科大学周围神经病中国协和医科大学Muscle weaknessWeaknessinthearmsorlegsWeaknessinthearmsorlegs：difficultywalking,difficultywalking,running,climbstairs,Stumblingortiringeasily.running,climbstai
6、rs,Stumblingortiringeasily.Difficultieswithcarryingaloadofgroceries,Difficultieswithcarryingaloadofgroceries,openingjars,turningdoorknobs,orcombinghair.openingjars,turningdoorknobs,orcombinghair. Cranialnerveparalysis:Cranialnerveparalysis:ophthalmoplegia,ophthalmoplegia,facialweakness,dysarthria,fa
7、cialweakness,dysarthria, RespiratoryinsufficientRespiratoryinsufficientMuscleatrophy.Muscleatrophy.Reflexlost.Reflexlost.周围神经病中国协和医科大学周围神经病中国协和医科大学tips:tips: Lower motor Lower motor neurogenic neurogenic damagedamageAnatomic Anatomic distributiondistributionSymmetricSymmetric proximal proximal dista
8、l distalAsymmetricAsymmetricsingle nerve single nerve multiple nervemultiple nerveplexus plexus nerve rootnerve root周围神经病中国协和医科大学周围神经病中国协和医科大学Sensory abnormalitiesParesthesias Paresthesias Spontaneous sensations, Spontaneous sensations, numbness, tingling, pins and needles, prickling, numbness, ting
9、ling, pins and needles, prickling, burning, cold, pinching, sharp deep stabs, and burning, cold, pinching, sharp deep stabs, and electric shocks or buzzing. electric shocks or buzzing. Dysesthesias Dysesthesias Unpleasant abnormal sensations Unpleasant abnormal sensations brought on by touching or o
10、ther stimuli. brought on by touching or other stimuli. Anesthesia Anesthesia a lack of sensation, leading to a lack of sensation, leading to injuries, cuts and burns due to the lack of injuries, cuts and burns due to the lack of normal warning sensations. a lack of sensation normal warning sensation
11、s. a lack of sensation of position, which leads to uncoordinated and of position, which leads to uncoordinated and unsteady walking.unsteady walking.周围神经病中国协和医科大学周围神经病中国协和医科大学tips:tips:l lHearing patientHearing patient s s descriptiondescriptionl lAnatomic Anatomic distributiondistributionSymmetricS
12、ymmetric “ “Glove and StockingGlove and Stocking” ” distributiondistributionAsymmetricAsymmetric single nerve single nerve multiple nervemultiple nerve plexus plexus nerve root nerve root周围神经病中国协和医科大学周围神经病中国协和医科大学Autonomic Nerve Damageblurred visionblurred visiondecreased ability to sweat (anhidrosi
13、s)decreased ability to sweat (anhidrosis)decreased ability to regulate body temperaturedecreased ability to regulate body temperaturedisturbances of bladder functiondisturbances of bladder functionorthostatic hypotensionorthostatic hypotensionConstipationConstipationdiarrhea, nausea after meals, abd
14、ominal bloatingdiarrhea, nausea after meals, abdominal bloatingsexual dysfunction (impotence)sexual dysfunction (impotence)thinning of the skin, with easy bruisability and thinning of the skin, with easy bruisability and poor healing. poor healing. 周围神经病中国协和医科大学周围神经病中国协和医科大学Step 2: Laboratory findin
15、gsnerve conductionnerve conduction study can confirm study can confirm neuropathy and distinguish between neuropathy and distinguish between damage to axons or the myelin sheath. damage to axons or the myelin sheath. electromyographyelectromyography differentiates myogenic differentiates myogenic (m
16、uscle tissue) from neurogenic (nerve (muscle tissue) from neurogenic (nerve tissue) causes of weakness and can tissue) causes of weakness and can confirm abnormal neuromuscular confirm abnormal neuromuscular junctions. junctions. nerve biopsynerve biopsy is needed only when other is needed only when
17、 other tests are inconclusive.tests are inconclusive. 周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学Step3: causes Disease炎症性炎症性炎症性炎症性/ /免疫介导型神经病免疫介导型神经病免疫介导型神经病免疫介导型神经病中毒性神经病中毒性神经病中毒性神经病中毒性神经病维生素缺乏维生素缺乏维生素缺乏维生素缺乏遗传性神经病遗传性神经病遗传性神经病遗传性神经病神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤异常球蛋白血征相关的神经病异常球蛋白血征相关的神经病异常球蛋白血征相
18、关的神经病异常球蛋白血征相关的神经病感染相关的神经病感染相关的神经病感染相关的神经病感染相关的神经病系统性疾病系统性疾病系统性疾病系统性疾病外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压周围神经病中国协和医科大学周围神经病中国协和医科大学神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤肿瘤的远隔效应肿瘤的远隔效应肿瘤直接浸润肿瘤直接浸润异常球蛋白血征相关的异常球蛋白血征相关的异常球蛋白血征相关的异常球蛋白血征相关的神经病神经病神经病神经病感染相关的神经病感染相关的神经病感染相关的神经病感染相关的神经病 HIVHIV 麻风麻风 Lyme Lyme 病病 带状疱疹
19、带状疱疹系统性疾病系统性疾病系统性疾病系统性疾病糖尿病神经病糖尿病神经病 甲状腺功能低下甲状腺功能低下肾脏、肺、肝脏衰竭肾脏、肺、肝脏衰竭危重病神经病危重病神经病器官移植相关神经病器官移植相关神经病外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压周围神经病中国协和医科大学周围神经病中国协和医科大学PathomechanismWalleriandegenerationWalleriandegenerationaxonaldegenerationaxonaldegenerationneuronaldegenerationneuronaldegenerationseg
20、mentaldemyelinationsegmentaldemyelinationonion-bulbformationonion-bulbformationInterstitialneuropathyInterstitialneuropathyVasculiticneuropathyVasculiticneuropathy周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病的临床病理分类周围神经病的临床病理分类对称性广泛性多神经病对称性广泛性多神经病对称性广泛性多神经病对称性广泛性多神经病l l四肢远端对称性感觉四肢远端对称性感觉四肢远端对称性感觉四肢远端对称性感觉运动障碍和皮肤植
21、物运动障碍和皮肤植物运动障碍和皮肤植物运动障碍和皮肤植物神经功能异常。神经功能异常。神经功能异常。神经功能异常。l l电生理检查：广泛神电生理检查：广泛神电生理检查：广泛神电生理检查：广泛神经传导异常和失神经经传导异常和失神经经传导异常和失神经经传导异常和失神经电位。电位。电位。电位。l l常见病因：中毒，代常见病因：中毒，代常见病因：中毒，代常见病因：中毒，代谢，遗传，免疫，结谢，遗传，免疫，结谢，遗传，免疫，结谢，遗传，免疫，结缔组织病等缔组织病等缔组织病等缔组织病等单神经病单神经病单神经病单神经病/ /多发单神经病多发单神经病多发单神经病多发单神经病l l单个神经支配区域感觉单个神经支配
22、区域感觉单个神经支配区域感觉单个神经支配区域感觉异常，局部肌肉无力萎异常，局部肌肉无力萎异常，局部肌肉无力萎异常，局部肌肉无力萎缩，非对称性。缩，非对称性。缩，非对称性。缩，非对称性。l l电生理检查：单神经电生理检查：单神经电生理检查：单神经电生理检查：单神经l l常见原因：外伤，血管常见原因：外伤，血管常见原因：外伤，血管常见原因：外伤，血管病，感染，肿瘤浸润，病，感染，肿瘤浸润，病，感染，肿瘤浸润，病，感染，肿瘤浸润，结缔组织病，甲低，等结缔组织病，甲低，等结缔组织病，甲低，等结缔组织病，甲低，等周围神经病中国协和医科大学周围神经病中国协和医科大学吉兰吉兰巴雷综合征巴雷综合征Guilla
23、in-Barresyndrome周围神经病中国协和医科大学周围神经病中国协和医科大学Guillain-Barresyndromel l18591859年年 LandryLandry s s AcendingAcending paralysis paralysis l l18921892年年 acute febrile acute febrile polyneuroritispolyneuroritis l l19181918年年 acute infective acute infective polineuritispolineuritis l l19161916年年 GuillainGuil
24、lain- - Barre-StrohlBarre-Strohl syndrome syndrome 周围神经病中国协和医科大学周围神经病中国协和医科大学Pathologic changes of AIDPPathologic changes of AIDP周围神经病中国协和医科大学周围神经病中国协和医科大学MechanismAntecedenteventsforGBSInfectionsInfections virusesviruses E-B virus E-B virus Cytomegalovirus Cytomegalovirus HIV HIV Infuenza virus Inf
25、uenza virus Coxsackie viruses Coxsackie viruses Herpes simplex Herpes simplex Hepatitis Hepatitis A A and and C C virusesviruses Others OthersBacterial infectionBacterial infection Campylobacter jejuniCampylobacter jejuni Mycoplasma Mycoplasma pneumoniacpneumoniac Escherichia coli Escherichia coli O
26、thers Others ParasticParastic Mararia Mararia Toxoplasmosis Toxoplasmosis周围神经病中国协和医科大学周围神经病中国协和医科大学AntecedenteventsforGBSSystemic illnessesSystemic illnesses HodgkinHodgkin s diseases disease lymphocytic leukemia lymphocytic leukemia Hyperthoidism Hyperthoidism Collagen vascular diseases Collagen va
27、scular diseases Sarcoidosis Sarcoidosis Renal disease Renal diseaseOther medical conditionOther medical condition PregnancyPregnancy Surgical procedures Surgical procedures Bone marrow transplantation Bone marrow transplantation Immunizations Immunizations Envenomization Envenomization Drug ingestio
28、n Drug ingestion周围神经病中国协和医科大学周围神经病中国协和医科大学Immunopathology Mechanism molecular mimicry 周围神经病中国协和医科大学周围神经病中国协和医科大学Classification of GBSAIDPAIDP A Acutecute I Inflammatory nflammatory D Demyelinating emyelinating P PolyneuropathyolyneuropathyMiller FisherMiller FisherMiller FisherMiller Fisher syndrome
29、 syndromeAcuteAcute panautonomic neuropathy(APN)panautonomic neuropathy(APN)acute sensory neuropathy, ASNacute sensory neuropathy, ASN AMAN/AMSANAMAN/AMSAN A Acutecute MMotor / otor / S Sensoryensory A Axonalxonal NNeuropathyeuropathy周围神经病中国协和医科大学周围神经病中国协和医科大学Concept of GBSAcute or subacute onsetAcu
30、te or subacute onsetPeripheral neuropathyPeripheral neuropathyalbuminocytologic dissociation in CSF albuminocytologic dissociation in CSF Immune-mediated neuropathyImmune-mediated neuropathyspontaneous recovery in most cases spontaneous recovery in most cases Monophasic courseMonophasic course周围神经病中
31、国协和医科大学周围神经病中国协和医科大学EpidemiologyIncidence 1-2 cases per 100,000 general Incidence 1-2 cases per 100,000 general populationpopulationAll ages, mean age is 40yAll ages, mean age is 40yAll races and nationalitiesAll races and nationalitiesA slight male predominanceA slight male predominance 周围神经病中国协和医科
32、大学周围神经病中国协和医科大学ClinicalfeaturesofAIDP(1)50% have 50% have paresthesias and painparesthesias and pain at beginning at beginningfollowed by followed by weaknessweakness most begin in the legs most begin in the legs 10% begin in the arm 10% begin in the arm rarely begins in the face rarely begins in th
33、e faceweaknessweakness may involve: may involve: proximal of lower limbs proximal of lower limbs upper limbs, upper limbs, facial muscle, facial muscle, pharyngeal and neck muscle pharyngeal and neck muscle， respiratory respiratory muscles muscles , , 1/3 1/3 of of patients patients require require
34、ventilator !ventilator !周围神经病中国协和医科大学周围神经病中国协和医科大学ClinicalfeaturesofAIDP(2)3-5% have complete ophthalmoplegia3-5% have complete ophthalmoplegia15% have autonomic manifestation15% have autonomic manifestation labile blood pressure, labile blood pressure, cardiac arrhythmias, cardiac arrhythmias, blad
35、der dysfunction, bladder dysfunction, constipation, constipation, abdominal distension, abdominal distension, bloating bloating周围神经病中国协和医科大学周围神经病中国协和医科大学Neurologic examinationQuadriplegiaQuadriplegia: Muscle weakness and : Muscle weakness and atrophyatrophyMuscle stretch Muscle stretch reflexes are
36、absentreflexes are absent or or depresseddepressedCranial nerve paralysis Cranial nerve paralysis Sensory loss in a stocking-glove Sensory loss in a stocking-glove distributiondistributionPain in low back, buttocks, thighPain in low back, buttocks, thigh Exacerbated by straight leg raising Exacerbat
37、ed by straight leg raisingAutonomic dysfunctionAutonomic dysfunction周围神经病中国协和医科大学周围神经病中国协和医科大学CSF90% 90% of of cases, cases, protein protein is is elevated elevated by by the the nadir of illness nadir of illness without leukocytosiswithout leukocytosis. .5% 5% of of cases, cases, pleocytosis pleocy
38、tosis 10 10 (10-20) (10-20) cells/mmcells/mm3 3. .OB OB (oligoclonal bands) (oligoclonal bands) IgGIgG/24h increasing/24h increasingMBPMBP increasing increasingSpecial Antibodies Special Antibodies : GM1: GM1周围神经病中国协和医科大学周围神经病中国协和医科大学Electro-diagnostic studies AIDP: AIDP: Demyelination Axonal Demyel
39、ination Axonal AMAN/AMSAN: AMAN/AMSAN: Axonal Demyelination Axonal Demyelination周围神经病中国协和医科大学周围神经病中国协和医科大学Sural nerve biopsydemyelinating and remyelinatingdemyelinating and remyelinatingaxonal degenerationaxonal degenerationInfiltration of inflammatory cells : Infiltration of inflammatory cells : ly
40、mphocytes,macrophageslymphocytes,macrophagesdeposition of Ig and complementsdeposition of Ig and complements周围神经病中国协和医科大学周围神经病中国协和医科大学Course Most Most patients patients of of AIDP AIDP become become maximally maximally weak weak within within 11-12 11-12 daysdays of of onset. onset. AMSN AMSN and an
41、d AMAN AMAN usually usually reach reach nadir within 6 days.nadir within 6 days.Most Most patients patients progressprogress steadily, steadily, occasionally, occasionally, stuttering stuttering or or stepwise stepwise course.course.The The average average time time to to onset onset of of recovery
42、recovery is 4 weeksis 4 weeks. .周围神经病中国协和医科大学周围神经病中国协和医科大学DiagnosisClinical feature: acute progressive Clinical feature: acute progressive quadriplegia quadriplegia CSF: dissociation of protein/leukocytesCSF: dissociation of protein/leukocytesF-wave, NCV, EMG, MEPF-wave, NCV, EMG, MEPSural nerve bio
43、psySural nerve biopsySpecial antibodies in serum and CSF周围神经病中国协和医科大学周围神经病中国协和医科大学Differential diagnosisPeriodic paralysisPeriodic paralysisPoliomyelitisPoliomyelitisMyelitisMyelitisToxic neuropathyToxic neuropathyLymeLyme s diseases diseaseMyositisMyositis周围神经病中国协和医科大学周围神经病中国协和医科大学Treatment of GBS
44、（1）Support careSupport carePrevent complicationsPrevent complicationsRehabilitationRehabilitationPsychology supportPsychology supportimmunotherapyimmunotherapy周围神经病中国协和医科大学周围神经病中国协和医科大学Treatment of GBS （2）ImmunotherapyImmunotherapyPlasma exchange (PE)Plasma exchange (PE)Iv Iv IgIgPE + IV PE + IV IgI
45、g? ?Corticosteroid? Corticosteroid? IV IV IgIg CorticosteroidCorticosteroid？周围神经病中国协和医科大学周围神经病中国协和医科大学Prognosis80% recovery within 6 months80% recovery within 6 months15% have severe residual disability15% have severe residual disabilityMortality rate is 3%-5%. Mortality rate is 3%-5%. Cause Cause o
46、f of death: death: ARDS ARDS with with or or without sepsis, dysautonomia.without sepsis, dysautonomia.周围神经病中国协和医科大学周围神经病中国协和医科大学Chronic inflammatory demyelinating polyradiculoneuritis (CIDP)Similar with AIDPCourses: chronic progressive 2 months or relapse-remissionPathology: demyelination, axonal d
47、egeneration, onion bulb formationCauses:Therapy: IVIg, plasma exchange, steroid周围神经病中国协和医科大学周围神经病中国协和医科大学单神经病和多发单神经病单神经病和多发单神经病mononeuropathy and multiple mononeuropathies周围神经病中国协和医科大学周围神经病中国协和医科大学常见疾病举例：常见疾病举例：常见疾病举例：常见疾病举例：1 1 1 1、颅神经：、颅神经：、颅神经：、颅神经：动眼神经麻痹，动眼神经麻痹，动眼神经麻痹，动眼神经麻痹，面神经麻痹面神经麻痹面神经麻痹面神经麻痹
48、，面肌痉挛，面肌痉挛，面肌痉挛，面肌痉挛，三叉神经痛三叉神经痛三叉神经痛三叉神经痛周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病中国协和医科大学2 2、臂丛神经炎，、臂丛神经炎，肘管综合症肘管综合症（尺神经麻痹），（尺神经麻痹），腕管综合症腕管综合症（正中神经麻痹），桡神经麻痹（正中神经麻痹），桡神经麻痹周围神经病中国协和医科大学周围神经病中国协和医科大学3 3、肋间神经、躯干神经肋间神经、躯干神经
49、4 4、坐骨神经痛，坐骨神经痛，股外侧皮神经股外侧皮神经炎，炎，腓总神经麻痹，腓总神经麻痹，胫神经麻痹胫神经麻痹周围神经病中国协和医科大学周围神经病中国协和医科大学周围神经病常见病因周围神经病常见病因炎症性炎症性/免疫介导型神经病免疫介导型神经病Guillain-Barre 综合征综合征CIDP血管炎性神经病血管炎性神经病肉芽肿性神经病肉芽肿性神经病结缔组织疾病伴神经病结缔组织疾病伴神经病周围神经病中国协和医科大学周围神经病中国协和医科大学血管炎血管炎周围神经病中国协和医科大学周围神经病中国协和医科大学中毒性神经病中毒性神经病中毒性神经病中毒性神经病药物药物药物药物酒精酒精酒精酒精金属金属金属
50、金属 化学物质化学物质化学物质化学物质维生素缺乏维生素缺乏维生素缺乏维生素缺乏维生素维生素维生素维生素B1B1维生素维生素维生素维生素B12B12 维生素维生素维生素维生素 E E周围神经病中国协和医科大学周围神经病中国协和医科大学遗传性神经病遗传性神经病遗传性运动感觉神经遗传性运动感觉神经遗传性运动感觉神经遗传性运动感觉神经病病病病 遗传性压迫易感性神遗传性压迫易感性神遗传性压迫易感性神遗传性压迫易感性神经病经病经病经病巨轴索性神经病巨轴索性神经病巨轴索性神经病巨轴索性神经病遗传性感觉和植物神遗传性感觉和植物神遗传性感觉和植物神遗传性感觉和植物神经病经病经病经病家族遗传性淀粉样变性家族遗传性
51、淀粉样变性家族遗传性淀粉样变性家族遗传性淀粉样变性神经病神经病神经病神经病过氧化性疾病（肾上腺过氧化性疾病（肾上腺过氧化性疾病（肾上腺过氧化性疾病（肾上腺白质营养不良，白质营养不良，白质营养不良，白质营养不良，Refsum Refsum 病）病）病）病）卟啉病卟啉病卟啉病卟啉病脂蛋白病（脂蛋白病（脂蛋白病（脂蛋白病（TangierTangier病，病，病，病， Abetaliproteinemia)Abetaliproteinemia)溶酶体酶缺陷溶酶体酶缺陷溶酶体酶缺陷溶酶体酶缺陷 ( (Fabry Fabry 病病病病) ) 周围神经病中国协和医科大学周围神经病中国协和医科大学遗传性运动感
52、觉神经病遗传性运动感觉神经病遗传性运动感觉神经病遗传性运动感觉神经病（hereditary motor hereditary motor sensory neuropathy, sensory neuropathy, HMSNHMSN）又称腓骨肌萎缩症又称腓骨肌萎缩症又称腓骨肌萎缩症又称腓骨肌萎缩症（Charcot-Merie-Tooth Charcot-Merie-Tooth 综综综综合征合征合征合征CMTCMT）周围神经病中国协和医科大学周围神经病中国协和医科大学遗传性压迫易感性神经病遗传性压迫易感性神经病周围神经病中国协和医科大学周围神经病中国协和医科大学Fabry病病周围神经病中国协和
53、医科大学周围神经病中国协和医科大学家族遗传性淀粉样变性神经病家族遗传性淀粉样变性神经病周围神经病中国协和医科大学周围神经病中国协和医科大学神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤肿瘤的远隔效应肿瘤的远隔效应肿瘤直接浸润肿瘤直接浸润异常球蛋白血征相关的异常球蛋白血征相关的异常球蛋白血征相关的异常球蛋白血征相关的神经病神经病神经病神经病感染相关的神经病感染相关的神经病感染相关的神经病感染相关的神经病 HIVHIV 麻风麻风 Lyme Lyme 病病 带状疱疹带状疱疹系统性疾病系统性疾病系统性疾病系统性疾病糖尿病神经病糖尿病神经病 甲状腺功能低下甲状腺功能低下肾脏、肺、肝脏衰竭肾脏、肺、肝脏衰竭危重病神经病危重病神经病器官移植相关神经病器官移植相关神经病外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压周围神经病中国协和医科大学周围神经病中国协和医科大学麻风病神经病麻风病神经病麻风病神经病麻风病神经病周围神经病中国协和医科大学周围神经病中国协和医科大学治疗治疗病因治疗病因治疗神经营养治疗神经营养治疗对症治疗对症治疗功能康复和并发症的治疗功能康复和并发症的治疗周围神经病中国协和医科大学周围神经病中国协和医科大学
