肌电图与神经传导速度对Graves病患者神经肌肉受损的评估  

Evaluation of neuromuscular damage in Graves disease by using electromyography and nerve conduction velocity

作　　者：林少达[1] 陈小华[1] 郭美云[2] 黄芷荷[2] 

机构地区：[1]汕头大学医学院第一附属医院内分泌科,广东省汕头市515041 [2]汕头大学医学院第二附属医院电生理室,广东省汕头市515041

出　　处：《中国临床康复》2006年第26期13-15,共3页Chinese Journal of Clinical Rehabilitation

基　　金：广东省医学科研课题(A2000467)~~

摘　　要：目的:应用肌电图和神经传导速度检查探讨Graves病神经肌肉受损的临床诊断意义。方法:于2000-05/2003-12选择汕头大学医学院第一附属医院内分泌专科门诊的Graves病患者46例为研究对象,行肌电图和神经传导速度检查;正常对照组31例为健康志愿者,31例行肌电图检查,30例行神经传导速度检查。肌电图检测:用同心圆针电极观察三角肌、股四头肌自发电位及募集形式,记录及分析小力收缩时每块肌肉20个运动单位电位平均时限及去多相波平均时限、波幅和多相波百分比。神经传导速度检测:用表面电极分别在腕部刺激正中神经和内踝胫后神经,于外展拇短肌及拇展肌用表面电极记录正中神经和胫后神经运动末端潜伏期和复合肌肉动作电位。用指环电极分别刺激拇指、中指和趾1,用表面电极于腕部及内踝记录测定感觉神经传导速度及波幅,包括正中神经(拇指-腕,中指-腕)和胫后神经(趾1-内踝)。并用超强电刺激在正中神经腕部及胫后神经踝部检测F波潜伏期及出现率。结果:纳入受试对象77例,均进入结果分析。①Graves病组患者肌电图示小力收缩后时限缩短、波幅降低,大力收缩后其峰波幅降低。Graves病组胫后感觉神经复合肌肉动作电位波幅与正常对照组比较降低;正中感觉神经拇指-腕复合肌肉动作电位波幅降低;正中神经中指-腕感觉神经传导速度减慢;Graves病组正中神经F波潜伏期延长和异常出现率增加。②46例Graves病患者有神经肌肉临床症状26例(56%),肌电图异常39例(85%);神经传导速度异常41例(89%);以肌电图异常判断神经传导速度异常敏感性为83%,特异性为87%;以神经传导速度异常判断肌电图异常敏感性为87%,特异性为83%。结论:两种方法对Graves病神经肌肉损伤诊断敏感性高于临床症状,对慢性甲状腺功能亢进性肌病诊断异常率、敏感性和特异性相近;肌电图主要对肌�AIM： To evaluate the value of clinical diagnosis of the neuromuscular impairment in Graves disease （GD） by electromyography （EMG） and nerve conduction velocity （NCV）. METHODS： A total of 46 GD patients from the endocrinal specialized clinic of the First Affiliated Hospital, Medical College of Shantou University from May 2000 to December 2003 were selected as GD group, who were given the EMG and NCV; and 31 healthy volunteers as normal control group： 31 ones were all examined with EMG, but NCV was performed in 30 of them. EMG detection： The spontaneous potential and recruitment in triangular muscle and quadriceps femoris were observed by cocenric citcle needles to record and analyze the average latitude of electric potential, removal polyphasic wave, the amplitude of hump and polyphasic Wave percentage of 20 motor unit in each muscle when contracted with little strength. NCV inspection： Surface electrode put at the wrist was used to stimulate the median nerve and posterior tibial nerve of inner malleolus, and then each incubation period and complex muscular action potential at abductor hallucis and abducens short muscle of thumb were recorded, respectively. The thumb, middle finger and toe 1 were stimulated with finger ring electrode, surface electrode put at the wrist and inner malleolus was used to measure sensory NCV and amplitude of wave, including median nerve （thumb to wrist, middle finger to wrist） and tibial sensory nerve （toe 1 to inner malleolus）. F wave incubation period and abnormal rate were detected at the wrist area of median nerve and malleolus area of posterior tibial nerve by strong electric stimulation. RESULTS： All the 77 cases were involved in the result analysis. ①The shorten of latitude and decline of amplitude appeared in the EMG of the GD group after contraction with little strength, and the amplitude of the hump was decreased after contraction with strong strength. The amplitude of complex muscular action potential of posterior tibial sensory nerve and me

关 键 词：格雷夫斯病 肌电描记术 神经传导 

分 类 号：R322.5[医药卫生—人体解剖和组织胚胎学]