应用视频眼震电图分析新斯的明试验中的睑裂变化  

Analysis on the changes of palpebral fissure caused by neostigmine test with videonystagmography

作　　者：赵桂萍[1] 周红[1] 张淑琴[1] 杜玉曼[1] 黄一宁[1] 

机构地区：[1]北京大学第一医院神经内科,100034

出　　处：《中华神经科杂志》2011年第12期844-847,共4页Chinese Journal of Neurology

摘　　要：目的应用视频眼震电图定量分析新斯的明试验中的睑裂变化。方法对35例重症肌无力（MG）患者、21例非MG（其他疾病）患者以及23名健康对照者进行了新斯的明试验，并利用视频眼震电图检查系统测量试验前及试验后1h（每10分钟1次）内受试者睑裂大小的变化。使用重复测量方差分析同一组内不同时间点之间及不同组间的睑裂差异。结果MG组组内不同时间点睑裂大小变化（mm）差异有统计学意义（试验前：4．67±1．87；试验后10min：0．88±0．96，20min：1．49±1．38，30min：1．71±1．53，40min：1．77±1．82，50min：1．79±1．52，60min：1．62±1．68；F=11．202，P=0．002）；MG组与非MG组及MG组与健康对照组间睑裂变化比较差异均有统计学意义（F=15．569，P〈0．01；F=15．104，P〈0．01）。各组变化率的改变及统计学意义也具有同样的特点。受试者工作曲线分析表明，1．17mm（变化值）或17．5％（变化率）对新斯的明试验有较好的诊断能力。结论视频眼震电图检查系统为新斯的明试验中睑裂大小的观察提供了客观、可靠的测量方法。睑裂变化值大于1．17mm或变化率大于17．5％者高度怀疑MG的可能。Objective To quantitatively analyze the palpebral fissure changes in the neostigmine tests with videonystagmography. Methods Thirty-five patients with myasthenia gravis （MG）, 21 non-MG patients and 23 healthy volunteers were intramuscular injected with neostigmine methylsulfate（0. 02 mg/kg） and atropine（0. 5 rag）. The width of palpebral fissure was measured before and after the injection for one hour（ once every 10 minutes）. The differences of palpebral fissure width of each time point within each group and between groups were analyzed quantitatively with repetitive measure ANOVA. Results There was a significant difference of palpebral fissures （mm） width at different time points within the MG group（ before the test：4. 67 ± 1.87,after the test： 10 min：0.88 ±0.96,20 min：1.49 ± 1.38,30 min：1.71 ＋ 1.53, 40 min：1. 77 ：l： 1.82,50 min：1. 79 ± 1.52, 60 min：1. 62 ＋ 1.68;F = 11. 202,P =0. 002）. There were also significant changes of palpebral fissures width in the MG group compared to the non-MG group and the normal control group （F = 15. 569,P 〈 0. 01 ; F = 15. 104,P 〈 0. 01 ）. There was alsostatistical significance in the rate of change between these groups. Receiver operating characteristic analytical procedure indicated that＇l. 17 mm or 17.5% was of better diagnostic capability in the neostigmine test. Conclusions Measuring palpebral fissure width with videonystagmography could be seen as an objective and accurate method. A patient with palpebral fissure width higher than 1.17 mm or 17.5% should be highly suspected as MG.

关 键 词：眼震电图描记术 新斯的明 重症肌无力 眼睑下垂 

分 类 号：R746.1[医药卫生—神经病学与精神病学]