Labordiagnostik immunvermittelter Polyneuropathien

Zusammenfassung

Immunvermittelte Polyneuropathien sind eine wichtige Differenzialdiagnose in der Abklärung peripherer Nervenkrankheiten, da sie häufig erfolgreich behandelbar sind. Die minimale Labordiagnostik umfasst die Untersuchung von Blutbild und Differenzialblutbild, die Blutsenkungsgeschwindigkeit, die Eiweißelektrophorese sowie die Bestimmung der antinukleären Antikörper (ANA) und des ACE (Angiotensin Converting Enzyme). Der Umfang der zusätzlichen Labordiagnostik orientiert sich an der klinisch führenden Symptomatik: Stehen Paresen im Vordergrund, ist die Bestimmung der GM1-Antikörper (Multifokale Motorische Neuropathie) zu empfehlen, bei Schmerzen die Vaskulitisdiagnostik und bei einer sensiblen Ataxie die Suche nach Hu-, Yo-, SS-B-, MAG- und GQ1b-Antikörpern. Eine breite Untersuchung nach Auto-Antikörpern ohne Berücksichtigung der klinisch führenden Symptome ist wegen der geringen Erfolgsrate und hohen Kosten nicht vertretbar.

Summary

Investigation of peripheral neuropathies must include the search of an inflammatory etiology since inflammations can frequently be treated successfully. The first step of the diagnostic algorithm includes blood picture, sedimentation rate, protein electrophoresis, and determination of antinuclear antibodies and angiotensin converting enzyme (ACE). The extent of the second step depends essentially from the clinical symptoms: In the case of pareses, multifocal motor-neuropathy, and consequently the determination of antibodies against GM1 should be considered. In the case of ataxia, antibodies against Hu, Yo, SS-B, MAG, and GQ1b should be determined. Regarding the low success rate and the high costs, a general investigation of auto-antibodies or other indicators of an inflammation is not recommended.

Schlüsselwörter

Polyneuropathie - Auto-Antikörper - Neurosarkoidose - Kollagenose - Vaskulitis

keywords

Polyneuropathy - auto-antibodies - neurosarcoidosis - collagenosis - vasculitis

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