经颅磁刺激运动诱发电位对脊髓亚急性联合变性的诊断意义  

Diagnostic significance of TMS-MEP in subacute combined degeneration

作　　者：耿文静[1] 张哲成[2] 刘娜[2] 

机构地区：[1]天津医科大学三中心临床学院/天津市天津医院神经电生理室,天津300120 [2]天津市第三中心医院神经内科,天津300170

出　　处：《重庆医学》2017年第3期356-358,共3页Chongqing medicine

摘　　要：目的探讨经颅磁刺激运动诱发电位(TMS-MEP)对脊髓亚急性联合变性(SCD)脊髓侧索早期病变的评价作用,初步分析其在SCD定位诊断中的应用。方法选取天津市第三中心医院2010-2014年确诊的SCD患者20例为确诊组,并选取同期14例拟诊断为SCD的患者为拟诊组,健康人21例为对照组。入选患者及对照组均进行TMS-MEP检查,分别比较确诊组、拟诊组与对照组MEP皮层潜伏期和中枢传导时间(CMCT)的差异。结果拟诊组14例患者中10例出现MEP异常,异常率为71.4%。确诊组中患者上肢MEP皮层潜伏期为(24.49±1.87)ms,CMCT为(12.08±1.43)ms;下肢MEP皮层潜伏期为(33.81±2.09)ms,CMCT为(19.88±1.89)ms,均较对照组明显延长(P<0.05)。拟诊组中患者上肢MEP皮层潜伏期为(24.05±1.94)ms,CMCT为(11.68±1.71)ms;下肢MEP皮层潜伏期为(33.00±2.52)ms,CMCT为(19.36±2.06)ms,也较对照组明显延长(P<0.05)。结论 TMS-MEP异常在SCD患者未出现脊髓侧索受累临床体征前即可出现,其可发现脊髓侧索亚临床病变,并提供SCD的早期锥体束损害证据。Objective To investigate the evaluation effect of transcranial magnetic stimulation motor evoked potential（TMSMEP）in early lesion of spinal lateral cord of subacute combined degeneration（SCD）of spinal cord.Methods A total of 20 patients with SCD in the Tianjin Municipal Third Central Hospital form January 2010 to January 2014 were selected as the SCD group,contemporaneous 14 cases of suspected SCD were selected as the suspected diagnosis group,and 21 healthy people as the control group.All the selected subjects were examined by TMS-MEP,and the differences of MEP cortical latency and central motor conduction time（CMCT）were compared among the SCD group,suspected diagnosis group and control group.Results In14 cases of the suspected SCD group,10 cases had abnormal MEP,the abnormal rate was 71.4%.In the SCD diagnosis group,the cortical latency of MEP in upper limb was（24.49±1.87）ms,CMCT was（12.08±1.43）ms;the cortical latency of MEP in lower limb was（33.81±2.09）ms,CMCT was（19.88±1.89）ms,which were significantly extended compared with the control group（P0.05）.In the suspected diagnosis group,the cortical latency of MEP in upper limb was（24.05±1.94）ms,CMCT was（11.68±1.71）ms;the cortical latency of MEP in lower limb was（33.00±2.52）ms,CMCT was（19.36±2.06）ms,which were also significantly extended compared with the control group（P0.05）.Conclusion TMS-MEP abnormalities in SCD patients without clinical signs of spinal cord involvement can occur,TMS-MEP can find the spinal cord subclinical lesions and provides the evidence of early pyramidal tract damage in SCD.

关 键 词：诱发电位 运动 脊髓亚急性联合变性 经颅磁刺激运动诱发电位 锥体束 

分 类 号：R744.6[医药卫生—神经病学与精神病学]