接触性热痛诱发电位在亚急性联合变性诊断中的应用  

Application of contact heat evoked potentials in subacute combined degeneration of the spinal cord

作　　者：靳梅[1] 谢炳均[1] 

机构地区：[1]天津医科大学总医院神经内科,300052

出　　处：《中华神经科杂志》2010年第4期277-281,共5页Chinese Journal of Neurology

摘　　要：目的应用接触性热痛诱发电位（CHEPs）技术研究亚急性脊髓联合变性（SCD）患者痛觉传导通路变化特点，探讨CHEPs在SCD中的应用价值，为其电生理诊断提供依据。方法选取确诊型SCD患者20例和健康人34名，应用CHEPs刺激器，刺激水平为51℃，对C7部位、上肢前臂掌侧前1／3处、下肢内踝及腰部进行刺激，记录点为cz，记录诱发电位主要成分的潜伏期和波幅。分析周围神经A8纤维传导速度和中枢N波峰潜伏期、N—P波波幅，同时进行躯体感觉诱发电位（SEP）及感觉传导速度（scv）测定并与CHEPs进行比较。结果（1）健康对照组予以51℃刺激，CHEPs的引出率为100％。（2）患者组中存在痛温觉减退者，视觉模拟评分[VAS，上肢6．4（5．3—8．9）分，下肢5．7（2．8—8．8）分]低于健康对照组[上肢7．6（6．4—9．2）分，下肢6．9（5．7～9．1）分，Z=3．478、3．909，P〈0．01]。（3）患者组上肢A8纤维传导速度（CV）为（9．77±4．28）m／s，下肢A8纤维CV为（8．19±0．91）m／s，与健康对照组[（12．87±1．40）m／s]比较，差异具有统计学意义（t=3．142、14．864，P〈0．01）。患者组中上肢A5纤维CV减慢13例（65％），正中神经SCV减慢4例（20％）；下肢A8纤维CV减慢19例（85％），胫神经SCV减慢12例（60％），A8纤维CV异常率高于SCV。（4）患者组下肢CHEPs异常者16例，而SEP异常者18例，两组间比较差异无统计学意义。结论CHEPs能发现SCD痛觉传导通路异常部位和程度，较SCV敏感，可以作为辅助SCD电生理诊断的方便、客观的方法。Objective To study the characteristics of nociceptive system in subacute combined degeneration （SCD） by contact heat evoked potentials （CHEPs）, and evaluate the CHEPs in the electrophysiological diagnosis of SCD. Methods Twenty definite SCD patients and 34 sex-, height- and age-matched healthy controls were included in this study. Thermal stimuli was applied at 51 ℃intensity level at four sites ： C7, volar surface of the forearm, the skin of leg at 5 cm proximal to the medial malleolus and lumbar part. The CHEPs were recorded from Cz. The latency and amplitude of the evoked potentials were recorded. The CV of Aδ fibers of peripheral nerves and N-wave latencies and N-P amplitudes of the central nerves were analyzed. The somatosensory evoked potential （SEP） and sensory conduction dsvelocity （SCV） of the limbs were also evaluated. Results （1） CHEPs were elicited reliably and stably in all controls. （2） The visual analogue scale （VAS） for pain perception was higher in controls （upper limbs： 7.6 and lower limbs ： 6. 9 ） as compared to SCD complication with hypoesthesia （ upper limbs ： 6. 4 and lower limbs ： 5.7, Z = 3. 478 and 3. 909, both P 〈 0. 01 ）. （ 3 ） The conduction velocity of A8 fibers in upper and lower limbs in the patients was significantly reduced compared to the controls （（ 9. 77 ± 4.28 ） m/s vs （ 12. 87 ± 1.40） m/s ; （8.19 ± 0. 91 ） m/s vs （ 12. 87 ± 1.40） m/s, respectively, t = 3. 142 and 14. 864, both P〈0.01 ）. Thirteen out of 20 patients （65%） had slow CV of A8 fibers, however only 4 out of 20 patients （20%） had slow SCV of median nerve; 19 out of 20 patients （95%） had slow CV of A8 fibers, however only 12 out of 20 patients （60%） had slow SCV of tibia] nerve. SCD have higher abnormality rates in CHEPs than SCV （P 〈 0. 05 ）. （4） In the lower limbs, 16 out of 20 patients （80%） had markedly prolonged CHEPs while 18 out of 20 patients （ 90% ） had markedly prolonged SEP. Conclusions The stud

关 键 词：脊髓亚急性联合变性 诱发电位 躯体感觉 疼痛感受器 神经传导 

分 类 号：R744[医药卫生—神经病学与精神病学]