单纤维肌电图在肌萎缩侧索硬化鉴别诊断中的价值  

Value of single fiber electromyography in diagnosis of amyotrophic lateral sclerosis

作　　者：刘明生[1] 崔丽英[1] 李晓光[1] 陈琳[1] 李本红[1] 杜华[1] 

机构地区：[1]中国医学科学院北京协和医院神经内科,100730

出　　处：《中华神经科杂志》2008年第1期12-15,共4页Chinese Journal of Neurology

摘　　要：目的探讨单纤维肌电图（SFEMG）技术在肌萎缩侧索硬化（ALS）鉴别诊断中的价值。方法对我院收治的165例ALS患者和145例下运动神经元受累为主的非ALS疾病患者进行伸指总肌SFEMG测定，并测定伸指总肌肌力，按照伸指总肌肌力进行分组，分析不同组之间SFEMG改变的特点。结果伸指总肌肌力正常者，ALS和非ALS组的平均颤抖（jitter）值分别为（66．1±20．1）、（38．04±9．2）μs（t=9．05），jitter〉55μs的百分比中位数分别为55％、0（Z=-7．81），阻滞所占百分比中位数分别为6．7％、0（Z=-6．93），ALS组各参数均明显高于非ALS组（均P〈0．01）。伸指总肌肌力医学研究委员会（MRC）评分≤4者，ALS和非ALS组平均jitter值分别为（93．5±31．2）、（52．84-25．9）μs（t=9．37），jitter〉55μs的百分比中位数分别为86％、20％（Z=-8．46），阻滞所占百分比中位数分别为20％、0（Z=-7．25），ALS组各参数均明显高于非ALS组（均P〈0．01）。在MRC评分〉4者，采用平均jitter〉55μs诊断ALS的敏感性和特异性分别为70．2％和92．7％。结论当采用SFEMG测定协助ALS的诊断和鉴别时，应尽量选择肌力正常的肌肉。平均jitter、jitter〉55μs的百分比和阻滞在ALS与其他下运动神经元疾病的鉴别诊断中具有重要价值。Objective To assess the diagnostic value of single fiber eleetromyography （SFEMG） in amyotrophic lateral sclerosis （ALS）. Methods SFEMG was performed in extensor digitorum communis muscles （EDC） of 165 patients with ALS and 145 patients with other neurogenetic disorders. Grade scale of the medical research council （MRC） in EDC was assessed simultaneously. The patients were divided into four groups according to the MRC scale （ MRC 〉 4 vs MRC ≤ 4 ） and different disease （ ALS vs other neurogenetic disorders ） . The parameters of SFEMG between different groups were compared. Results When the strength of EDC was normal （ MRC 〉 4 ）, the mean jitter was （ 66. 1 ± 20. 1 ） μs in ALS and （38. 0± 9. 2） μs in other neurogenic disorders （ t = 9. 05, P 〈 0. 01 ）, median of the percentage of jitter 〉 55 μs was 55% in ALS and 0 in other neurogenic disorders （ Z = - 7. 81, P 〈 0.01 ）, median of the percentage of block was 6. 7% in ALS and 0 in other neurogenic disorders （Z = -6.93, P 〈0. 01 ）. There was significant difference in those parameters of SFEMG between the two groups. When the strength of EDC was abnormal （ MRC ≤4）, the mean jitter was （93.5 ± 31.2 ） μs in ALS and （ 52. 8 ± 25.9 ） μs in other neurogenic disorders （ t = 9. 37, P 〈 0. 01 ） , median of the percentage of jitter 〉 55 μs was 86% in ALS and 20% in other neurogenic disorders （ Z = - 8. 46, P 〈 0.01 ） , median of the percentage of block was 20% in ALS and 0 in other neurogenic disorders （Z = -7.25, P 〈 0. 01 ）. There was significant difference in those parameters of SFEMG between the two groups. When SFEMG was performed in EDC with normal muscle strength, the sensitivity and specificity of mean jitter 〉 55 μs for diagnosis of ALS were 70. 2% and 92. 7 % respectively. Conclusions When SFEMG is studied for diagnosis of ALS, it is recommended to perform in muscles with normal strength. The mean jitter, the percentage of jitter 〉 55 μs and block are of gr

关 键 词：肌萎缩侧索硬化 肌电描记术 运动神经元 诊断 鉴别 

分 类 号：R686[医药卫生—骨科学]