儿童重症肌无力56例重复神经电刺激检测分析  

Analysis of repetitive nerve stimulation test in 56 children with myasthenia gravis

作　　者：张璘[1] 宋银俏 孔林河[1] 郭丹丹[1] 薛莹洁 胡勇军[1] 

机构地区：[1]郑州市儿童医院肌电图室,450053

出　　处：《中国神经免疫学和神经病学杂志》2015年第6期381-384,共4页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨儿童重症肌无力(MG)重复神经电刺激(RNS)特点及临床应用价值。方法应用肌电图/诱发电位仪对56例MG患儿分别进行双侧面神经、腋神经及尺神经1Hz、3Hz、5Hz、10Hz频率电刺激,观察其复合肌肉动作电位(CMAP)第4波与第1波比较的波幅降低百分比,比较患儿不同MG类型、不同神经以及面神经不同频率刺激的RNS阳性率,分析5Hz刺激面神经时各型患儿CMAP幅值衰减的变化及不同分型与幅值衰减的相关性。结果 56例MG患儿共检测270条神经,RNS总阳性率为73.21%(41/56)。Ⅰa型、Ⅰb型、Ⅱa型MG类型RNS阳性率分别为62.96%(17/27)、75.00%(12/16)、92.31%(12/13),组间两两比较差异均有统计学意义(均P<0.05)。面神经、腋神经、尺神经RNS阳性率分别为73.21%(41/56)、60.87%(14/23)、8.93%(5/56),组间两两比较差异均有统计学意义(均P<0.05)。1、3、5、10 Hz电刺激时面神经RNS阳性率分别为42.86%(24/56)、53.57%(30/56)、58.93%(33/56)、23.21%(13/56),组间两两比较,1Hz、3Hz、5Hz电刺激时RNS阳性率均高于10Hz电刺激时(均P<0.05),3 Hz、5 Hz电刺激时RNS阳性率均高于1 Hz电刺激时(均P<0.05),3Hz电刺激时与5Hz电刺激时比较RNS阳性率差异无统计学意义(P>0.05)。5 Hz刺激时Ⅰa型、Ⅰb型、Ⅱa型患儿面神经RNS衰减的幅值分别为(19.14±3.27)%、(24.55±5.34)%、(52.13±10.49)%,组间两两比较差异均有统计学意义(均P<0.05),并且3型患儿面神经RNS衰减的幅值与患儿分型有相关性(r=0.744,P=0.000)。结论 RNS是一项无痛无创、相对不需要患儿配合、敏感度较高的电生理检查,客观性较强且能量化观察指标;3Hz、5Hz电刺激时面神经RNS检测阳性率较高;儿童检测操作方法的改进有助于提高其阳性率。Objective To investigate the features and clinical application value of repetitive nerve stimulation（RNS）in children with myasthenia gravis（MG）.Methods Electrical stimulations with frequency of1 Hz,3Hz,5Hz,10 Hz were performed in bilateral facial nerve,axillary nerve and ulnar nerve by using the electromyogram/evoked potential instrument in 56 children with MG.The percentages of amplitude reduction were compared between the fourth wave and first wave of compound muscle action potential（CMAP）.The RNS positive rates were compared in children with different MG types and different nerves,facial nerve stimulation with different frequency.The variation of amplitude attenuation of CMAP and the correlation between MG types and amplitude attenuation in children with 5 Hz CMAP were analyzed.Results 270 nerves were detected in 56 patients with MG.The RNS positive rate was 73.21%（41/56）.The RNS positive rates of different MG types from low to high were 62.96%（typeⅠa,17/27）,75.00%（typeⅠb,12/16）,92.31%（typeⅡa,12/13）,There were significant differences between any two of the groups（P〈0.05,respectively）.RNS positive rates from high to low were 73.21%（facial nerve,41/56）,60.87%（axillary nerve,14/23）and 8.93%（ulnar nerve,5/56）.There were significant differences between any two of the groups（P〈0.05,respectively）.RNS positive rates of facial nerve at different frequencies of electrical stimulation from high to low were 58.93%（5Hz,33/56）,53.57%（3 Hz,30/56）,42.86%（1 Hz,24/56）,23.21%（10 Hz,13/56）.The pairwise comparison was performed to compare RNS positive rates.RNS positive rates of 1 Hz,3 Hz,5 Hz electrical stimulation were higher than 10 Hz（P〈0.05,respectively）.RNS positive rates of 3 Hz and 5 Hz electrical stimulation were higher than 1 Hz（P〈0.05）.There was no significant difference between 3 Hz and 5 Hz electrical stimulation（P〈0.05）.The value of facial RNS amplitude attenuation of type Ⅰa、 Ⅰb and Ⅱa patients with 5Hz stimulation we

关 键 词：儿童 重症肌无力 重复神经电刺激 

分 类 号：R746.1[医药卫生—神经病学与精神病学]