尺神经与正中神经复合肌肉动作电位波幅比值在运动神经元病变中的诊断价值  被引量:8

Diagnostic significance of ulnar/median compound muscle action potentials amplitude ratio in motor neuron disorders

在线阅读下载全文

作  者:王文华[1,2] 罗瑛[1] 解燕春[1] 初红[1] 董红娟[1] 肖哲曼[1] 卢祖能[1] 

机构地区:[1]武汉大学人民医院神经内科,430060 [2]华中科技大学同济医学院附属普爱医院神经内科

出  处:《中华神经科杂志》2013年第5期304-307,共4页Chinese Journal of Neurology

基  金:湖北省自然科学基金重点项目(2009CDA070);武汉市科学技术局“医院重点专学科建设及公共事业项目”(201161038342-03)

摘  要:目的前瞻性研究尺神经与正中神经复合肌肉动作电位(CMAP)波幅比值在运动神经元病变中的诊断价值。方法2009年5月至2012年2月因无力、不灵活、肉跳、肌萎缩就诊于我科的患者,均进行四肢常规神经传导检测(表面电极刺激和记录)和针电极肌电图检测,检测者固定。对连续入组且符合诊断标准的确诊型肌萎缩侧索硬化(ALS)和平山病患者,主要分析在其腕部刺激尺神经、正中神经,分别于小指展肌(ADM)、拇短展肌(APB)记录的CMAP,并计算二者的波幅比值,即ADM/APB;吉兰一巴雷综合征(GBS)、其他多发性神经病(PN)患者作为病例对照,34名健康志愿者作为健康对照。结果(1)ALS78例、平山病25例、GBS51例、其他PN140例,年龄(岁)分别为54.7±11.6、17.6±2.2、41.3±18.4、57.1±14.3;健康对照组为45.7±16.3。(2)ADM/APB在ALS为2.28±2.87(0.12~22.38),平山病0.66±0.36(0.05~1.34),GBS1.42.4-1.33(0.25~9.85),其他PN1.36±1.48(0.08~14.44),健康对照1.07±0.28(0.61~1.64,F=6.872,P=0.000)。(3)接受者操作特征曲线下面积在ALS为0.830(标准误=0.039),在平山病为0.691(标准误=0.039,P=0.000);ADM/APB为2.0时,诊断ALS的敏感度和特异度分别为36.7%和93.3%;ADM/APB为0.7时,诊断平山病的敏感度和特异度分别为53.6%和89.0%。结论尺神经与正中神经的CMAP波幅比值在ALS增大、平山病减小,可能为相对特异的电生理指标;建议以比值大于2.0、小于0.7分别作为ALS、平山病的电生理诊断参数。Objective To investigate prospectively the diagnostic significance of ulnar/median nerve amplitude ratio in motor neuron disorders. Methods Patients referral to our department between May 2009 and February 2012, due to muscle weakness, inflexible, cramps and atrophy, were consecutively enrolled. Conventional nerve conduction studies of 4 extremities (using surface electrodes ) and needle clcctromyography were performed in all patients with fixed examiner. The compound muscle action potentials (CMAP) were recorded from abductor digiti minimi (ADM) and abductor pollieis brevis ( APB ) with stimulation of ulnar and median nerve at wrist, respectively. Moreover, the ratio of CMAP amplitude between ADM and APB ( ADM/APB ) was calculated in the patients who met the diagnostic criteria for definite amyotrophie lateral sclerosis (ALS) and Hirayama disease (HD). The patients with Guillain-Barre syndrome (GBS) and other popynenropathies (PN) were setved as case-controls, and 34 healthy volunteers ( aged (45.7 ± 16. 3 ) years) as normal-controls. Results ( 1 ) There were 78 cases with ALS, 25 HD, 51 GBS and 140 other PN, with the mean age(years) of 54. 7 ± 11. 6, 17.6±2.2, 41.3± 18. 4 and 57.1 ± 14. 3, respectively. (2) ADM/APB in the ALS subgroup was 2. 28 ± 2. 87 (0. 12--22. 38 ), HD0.66_+0.36 (0.05--1.34), GBS 1.42 ± 1.33 (0.25-9.85), other PN 1.36 ± 1.48 (0.08- 14.44) and normal-controls 1.07 ± 0. 28 (0. 61--1.64, F = 6. 872, P = 0. 000) , respectively. (3) The areas under receiver operator characteristic curve in patients with ALS was 0. 830 ( sx = 0. 039 ) and HD 0. 691 (sx = 0. 039,P = 0. 000) ; the diagnostic sensitivity and specificity for ALS patients were 36. 7% and 93.3% , respectively, with cutoff value of ADM/APB = 2; and the diagnostic sensitivity and specificity for HD patients were 53.6% and 89. 0%, respectively, with cutoff value of ADM/APB = 0. 7. Conclusions The ulnar/median CMAP amplitude ratio increases i

关 键 词:肌萎缩侧索硬化 动作电位 尺神经 正中神经 

分 类 号:R651.3[医药卫生—外科学]

 

参考文献:

正在载入数据...

 

二级参考文献:

正在载入数据...

 

耦合文献:

正在载入数据...

 

引证文献:

正在载入数据...

 

二级引证文献:

正在载入数据...

 

同被引文献:

正在载入数据...

 

相关期刊文献:

正在载入数据...

相关的主题
相关的作者对象
相关的机构对象