多系统萎缩患者52例的自主神经功能障碍与肛门括约肌肌电图的关系  

Relationship between the autonomic dysfunction of multiple system atrophy and external anal sphincter electromyography

作　　者：王含[1] 崔丽英[1] 杜华[1] 李本红[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经科,100730

出　　处：《中华神经科杂志》2006年第2期109-112,共4页Chinese Journal of Neurology

摘　　要：目的探讨肛门括约肌肌电图(EAS-EMG)在评价多系统萎缩(MSA)患者自主神经功能障碍方面的作用。方法对52例临床诊断MSA(可能MSA 9例,拟诊MSA 43例)的患者进行自主神经功能障碍的临床特点分析(膀胱直肠功能、卧立位血压、性功能)和EAS-EMG检查,并分析两者的关系。结果44例(84.6%)患者早期出现自主神经功能障碍,但仅少数患者(38.5%)因此就诊。12例无卧立位血压异常的患者均有不同程度的尿便障碍和性功能障碍。EAS-EMG结果全部异常。尿频、尿失禁、排尿困难、夜尿增多患者的EAS-EMG指标异常均不同程度地高于无相应症状的患者,部分指标异常的差异有统计学意义。卧立位血压异常的有无并未造成EAS-EMG各项指标的显著性差异。EAS-EMG的平均时限在阳痿早期出现的患者[(13.30±0.14)m s]明显长于后期出现者[(15.31±2.50)m s,P=0.000]。结论MSA患者的自主神经功能障碍多数早于其他症状出现。卧立位血压的异常和尿失禁均非最早出现的自主神经功能障碍,对早期出现的各种难以解释的自主神经功能障碍均应加以重视。EAS-EMG对于临床怀疑MSA而无卧立位血压异常的患者更具诊断价值,有尿失禁等排尿障碍的患者更易出现EAS-EMG的异常。Objective To discuss the role of external anal sphincter electromyography （EAS-EMG） in evaluating the autonomic system dysfunction of multiple system atrophy （MSA）. Methods EAS-EMG was performed in 52 patients who were diagnosed as having possible （n = 9） and probable MSA （n = 43） according to the guideline of consensus conference. Autonomic dysfunctions were analyzed in respects of bladder and rectal function, orthostatic hypotension and erectile dysfunction. The relationship between autonomic system dysfunction and EAS-EMG abnormalities was evaluated. Results Autonomic dysfunctions of 44 patients （84.6%） were present earlier than or together with other neurological symptoms. Only minority of them showed their autonomic dysfunction as their main complaints. The bladder and rectal dysfunction and erectile dysfunction were found in most of the twelve patients without orthostatic hypotensiun. All of the results of EAS-EMG were abnormal The abnormalities in patients with urgency, incontinence, incomplete bladder emptying and nocturia were more prominent than in patients without those symptoms. Some of the differences were of statistical significance. No difference was found in EAS-EMG between patients with and without orthostatic hypotension. The mean duration of patients with erectile dysfunction presented before other symptoms was exceedingly longer than those presented after （（13.30±0.14） ms vs （15.31±2.50） ms, P = 0.000）. Conclusion The autonomic dysfunction of MSA should be presented earlier than the other symptoms mostly. As comparing to other symptoms of autonomic dysfunction, neither orthostatic hypotensiun nor incontinence should be very familiar in early stage. EAS-EMG might be valuable in patients suspected as MSA but without orthostatic hypotension. The abnormality of EAS-EMG in patients with bladder dysfunction is more prominent than those with other autonomic dysfunctions.

关 键 词：肛门 肌电描记术 多系统萎缩 自主神经系统疾病 

分 类 号：R744[医药卫生—神经病学与精神病学]