154例肌萎缩侧索硬化神经传导特点分析  

An analysis of characteristics of nerve conduction in 154 cases of amyotrophic lateral sclerosis

作　　者：任雨婷 崔芳[1] 杨飞[1] 陈朝晖[1] 凌丽[1] 黄旭升[1] 

机构地区：[1]解放军总医院神经内科,北京100853

出　　处：《中华内科杂志》2016年第10期755-758,共4页Chinese Journal of Internal Medicine

基　　金：解放军总医院百项优势项目（YS201415）

摘　　要：目的 分析肌萎缩侧索硬化（ALS）患者神经传导的特点,并探讨ALS患者复合肌肉动作电位（CMAP）波幅与ALS病程、修订版肌萎缩侧索硬化功能评分（ALSFRS-R）的关系.方法 154例ALS患者进行常规运动神经传导和感觉神经传导测定,对CMAP波幅、远端运动潜伏期（DML）、运动神经传导速度（MCV）及感觉神经传导速度（SCV）和感觉神经动作电位（SNAP）波幅进行分析,并探讨ALS患者CMAP波幅与病程及ALSFRS-R的相关性.结果 本组患者绝大多数出现运动神经传导异常,其中胫神经、正中神经和尺神经传导异常均以DML延长最为多见（61.06％ ～81.42％）,然后依次为CMAP波幅降低（30.12％ ～ 53.98％）、MCV减慢（12.05％ ～ 16.81％）和CMAP未引出（2.65％ ～9.73％）.感觉神经传导异常发生率相对较低,其中腓肠神经、正中神经和尺神经的SCV减慢发生率为1.22％ ～2.73％,SNAP波幅降低发生率为0～1.82％,SNAP未引出发生率仅为0 ～1.22％.相关性分析显示,腓总神经、胫神经、正中神经和尺神经的CMAP波幅与ALS病程无相关性（P值均＞0.05）;正中神经和尺神经的CMAP波幅与ALSFRS-R呈正相关（r=0.273,P=0.016;r=0.357,P=0.001）.结论 绝大多数ALS患者存在运动神经传导异常,以DML延长最为常见,极少数患者可伴感觉神经传导异常.正中神经和尺神经CMAP波幅对判断ALS患者病情严重程度具有一定临床意义.Objective To analyze the features of nerve conduction in patients with amyotrophic lateral sclerosis （ALS）,and explore the correlation between compound muscle action potential （CMAP）amplitude and disease duration and revised amyotrophic lateral sclerosis functional rating scale （ALSFRSR）.Methods Standard motor and sensory nerve conduction studies were performed in 154 patients with ALS.The following parameters were collected including CMAP amplitude,distal motor latency （DML）,motor conduction velocity,sensory conduction velocity and sensory nerve action potential amplitude.Regression study was done to explore the correlation between CMAP amplitude and disease duration and ALSFRS-R.Results Motor nerve conduction abnormalities were presented in a majority of the patients with prolonged DML in the tibial nerve,median nerve and ulnar nerve as the most common form （61.06%-81.42%）,followed by decreased CMAP amplitude （30.12%-53.98%）,decreased MCV （12.05%-16.81%） and absence of CMAP （2.65%-9.73%）.Sensory nerve conduction abnormalities were detected in a small proportion of patients and the decreased SCV,decreased SNAP amplitude and absence of SNAP in the sural nerve,median nerve and ulnar nerve were found in 1.22%-2.73%,0-1.82% and 0-1.22%patients respectively.No correlation was found between CMAP of the common peroneal nerve,tibial nerve,median nerve and ulnar nerve and the disease duration （P 〉 0.05）,while significant positive correlation was established between CMAP amplitude of the median nerve and ulnar nerve and ALSFRS-R （r =0.273,P =0.016;r =0.357,P =0.001）.Conclusions Motor nerve conduction is abnormal in a majority of ALS patients with prolonged DML as the most common form,while abnormal sensory nerve conduction is only found in a few of ALS patients.CMAP amplitude of the median nerve and ulnar nerve might be of certain clinical value in evaluating the severity of ALS.

关 键 词：肌萎缩侧索硬化 动作电位 神经传导 

分 类 号：R744.8[医药卫生—神经病学与精神病学]