棘波触发平均肌电图新参数对神经原性损害的诊断意义  

The new parameters of motor unit potential in the diagnosis of neurogenic lesions in spiketriggered averaging electromyography

作　　者：刘兴洲[1,2] 王国相[1,2] 邱浩彰 毛坤[1,2] 孙少杰[1,2] 汪仁彬 孙瑞华[1,2] 焦劲松[1,2] 杨秉贤[1,2] 

机构地区：[1]中日友好医院神经科 [2]台湾新光吴火狮纪念医院神经科

出　　处：《中华医学杂志》1997年第11期838-842,共5页National Medical Journal of China

摘　　要：目的证实定量肌电图运动单位电位（ＭＵＰ）新参数的临床神经生理意义，探讨对神经原性损害的诊断作用。方法采用棘波触发平均技术，在轻度用力肌肉收缩下记录胫前肌、拇短展肌、股四头肌神经病组的１７４３个ＭＵＰ，正常组的１９０３个ＭＵＰ，并对多项参数进行判别分析。结果单一参数分析中，面积、波幅、时限可分别判别８０．０％～８２．１％，７７．４％～７８．１％，６６．９％～７３．６％的神经病组ＭＵＰ。两项参数组合，包括波幅和面积：波幅比值组合，波幅和时限组合，判别敏感性比其原参数明显增加，可分别判别７９．０％～８２．３％，８０．７％～８２．８％的神经病变组ＭＵＰ。简化的此种组合判别方程，２×Ｌｇ（波幅）＋Ｌｇ（面积／波幅）－４，形成大小指数；５×Ｌｇ（时限）＋３×Ｌｇ（波幅）－１０，形成宽度－高度指数，与其原始方程具有相同的判别作用，可以替代原始方程。结论这一分析结果与传统肌电图或新近的模式匹配肌电图均有所不同。bjective To evaluate the clinical significance of the new parameters of motor unit potential (MUP) to the diagnosis of neurogenic lesions. Methods Three groups of muscles, anterior tibialis, abductor pollicis brevis and vastus medialis were studied with spiketriggered averaging electromyography (EMG). A total of 3 646 MUPs, 1 903 from normal group and 1 743 from neurogenic group, were recorded under slight muscle contraction. Results The area, as a single parameter, produced the most significant result in discriminant analysis, about 80% MUPs from neurogenic muscles being judged to be abnormal. Compared with the area, the amplitude and duration were less sensitive, being able to assign about 77% and 70% of MUPs in the neurogenic group as abnormal. A combination of the area/amplitude ratio (thickness) and the amplitude, and a combination of the duration (width) and the amplitude could further improve the discriminating ability, around 80% and 81% MUPs in the neurogenic muscles being classified as abnormal by the combinations. The simplified discriminant functions, 2×Log10 (amplitude)+Log10 (area/amplitude)-4 for size index, and 5×Log10 (duration)+3×Log10 (amplitude)10 for widthheight index had same discriminating ability as the real discriminant function. Conclusions The new parameters, SI, WHI and area in spiketriggered EMG seemed to be promising, since they produced a better yield in the diagnosis of neurogenic lesions than amplitude or duration alone in the discriminant analysis.

关 键 词：神经缺肉疾病 判别分析 神经元 肌电图 MUP 诊断 

分 类 号：R746.04[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]