电诊断新方法iMAX值测定及其在周围运动神经兴奋性评估中的应用  

To determine the value of iMAX,a new electrodiagnostic method,and its application in the evaluation of peripheral motor nerve excitability

作　　者：张朔[1] 张逸璇 徐迎胜[1] 刘小璇[1] 张华纲[1] 崔文娟 樊东升[1] Zhang Shuo;Zhang Yixuan;Xu Yingsheng;Liu Xiaoxuan;Zhang Huagang;Cui Wenjuan;Fan Dongsheng(Department of Neurology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经内科,北京100191

出　　处：《中华医学杂志》2024年第21期1987-1993,共7页National Medical Journal of China

基　　金：北京大学第三医院队列研究项目(BYSYDL2021007)

摘　　要：目的进行iMAX(即引出最大复合肌肉动作电位波幅的最小刺激电流强度)电诊断新方法的检测,并验证此方法评估周围运动轴突兴奋性的可行性、初步探讨临床应用价值。方法本研究为横断面研究,收集2022年6月至2023年3月北京大学第三医院门诊招募的健康受试者50名,男25名、女25名,年龄25~68(48±8)岁;同期收入院的腓骨肌萎缩症患者(CMT1A)11例,男7例,女4例,年龄19~55(41±13)岁;糖尿病周围神经病患者(DPN)21例,男10例,女11例,年龄28~79(53±16)岁。均检测双侧正中神经、双侧尺神经、双侧腓神经iMAX。分别测量最小运动阈值且波幅至少为0.1 mV的可重复运动反应、引出最大复合肌肉动作电位波幅的最小刺激电流强度(1 mA增量称为iUP,0.1 mA调整称为iMAX)。比较参数:阈值、iUP、iMAX值三个参数在健康受试者不同年龄组、不同性别及侧别、不同体质指数(BMI)值、不同检测时间之间进行比较,同时亦在CMT1A患者以及DPN患者与健康受试者之间进行比较。结果健康受试者中所测阈值、iUP、iMAX值分别为:正中神经(1.8±0.7)mA、(4.4±1.2)mA、(4.2±1.3)mA;尺神经(3.1±1.6)mA、(6.8±3.2)mA、(6.4±3.2)mA;腓神经(3.7±2.0)mA、(7.8±2.8)mA、(7.4±2.9)mA;不同年龄组间阈值、iUP、iMAX值差异有统计学意义(均P<0.001);随着年龄增大,不同神经组阈值、iUP、iMAX值有增加的趋势,差异有统计学意义(均P<0.001)。不同性别、侧别、检测时间阈值、iUP、iMAX值差异均无统计学意义(均P>0.05);高BMI健康受试者各参数值高于低BMI健康受试者(均P<0.05)。11例CMT1A患者各参数均显著高于健康受试者(均P<0.05),21例DPN患者仅正中神经各参数轻度高于健康受试者(P<0.05)。结论iMAX新方法反映了运动轴突的兴奋性及早期轴索功能障碍,是对传统神经传导的补充,可以用于监测运动轴突兴奋障碍。Objective To test the new method of iMAX(the minimum stimulus current that elicits the maximum compound muscle action potential amplitude)electrodiagnosis,verify the feasibility of this method in evaluating the excitability of peripheral motor axons,and preliminarily explore the clinical application value.Methods This study was a cross-sectional study.A total of 50 healthy subjects were recruited from the outpatient department of Peking University Third Hospital from June 2022 to March 2023,including 25 males and 25 females,aged 25-68(48±8)years.Eleven patients with Charcot-Marie-Pain-1A(CMT1A),7 males and 4 females,aged 19-55(41±13)years and 21 patients with diabetic peripheral neuropathy(DPN),10 males and 11 females,aged 28-79(53±16)years were enrolled in this study.iMAX of bilateral median nerves,ulnar nerves and peroneal nerves were detected in all patients.Repeatable motor responses with minimum motor threshold and amplitude of at least 0.1 mV and the minimum stimulus current intensity,at which the maximum compound muscle action potential amplitude is elicited,were measured respectively[1 mA increment is called(iUP)and,0.1 mA adjustment is called(iMAX)].Comparison of the parameters:the parameters of threshold,iUP and iMAX were compared among different age groups,genders and sides,body mass index(BMI)values and detection time,as well as between CMT1A patients,DPN patients and healthy subjects.Results In healthy subjects,the threshold,iUP value and iMAX value were(1.8±0.7)mA,(4.4±1.2)mA,and(4.2±1.3)mA respectively;ulnar nerve(3.1±1.6)mA,(6.8±3.2)mA,(6.4±3.2)mA;peroneal nerve(3.7±2.0)mA,(7.8±2.8)mA,(7.4±2.9)mA.There were statistically significant differences in threshold,iUP value and iMAX value among different age groups(all P<0.001).With the increase of age,there was a trend of increasing threshold,iUP,and iMAX values in different nerves,and the differences are statistically significant(all P<0.001).There were no significant differences in gender,side and detection time threshold,iUP value and iMA

关 键 词：周围神经 兴奋性 运动轴索 腓骨肌萎缩症 糖尿病周围神经病 横断面研究 

分 类 号：R741.044[医药卫生—神经病学与精神病学]