正常人和肌萎缩侧索硬化患者F波检测所需刺激次数的比较  

Sample size for the estimation of F-wave parameters in healthy volunteers and amyotrophic lateral sclerosis patients

作　　者：方佳[1] 崔丽英[1,2] 刘明生[1] 管宇宙[1] 丁青云[1] 杜华[1] 李本红[1] 吴双[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经科,北京100730 [2]中国医学科学院神经科学中心

出　　处：《中华医学杂志》2017年第9期670-674,共5页National Medical Journal of China

摘　　要：目的本研究旨在探讨不同神经﹑不同F波参数以及正常或疾病状态下F波参数所需刺激次数是否存在差异。方法对2013年8月至2014年7月就诊于北京协和医院神经科的55例肌萎缩侧索硬化（ALS）患者和52名健康受试者进行正中神经﹑尺神经﹑胫神经和腓神经F波检测，使用的刺激次数为100次。分析的F波参数包括最短﹑最长和平均F波潜伏期，F波出现率，F波时间离散度，平均和最大F波波幅。从100次刺激获得的F波参数认为是正常参考值。比较从前20次﹑40次﹑60次和80次刺激获得的F波参数与正常参考值的差异；比较不同刺激次数下ALS患者与健康受试者F波各参数的差异。结果健康受试者4条所检神经≥ 60次刺激所获时间离散度与正常参考值差异无统计学意义；正中神经﹑尺神经和胫神经≥ 40次刺激所获最大F波波幅与正常参考值差异无统计学意义。与健康受试者相比，20次刺激可以发现ALS患者四条所检神经最长（正中神经Z＝－3.560，P〈0.01；尺神经t＝5.019，P〈0.01；胫神经Z＝－2.475，P〈0.05；腓神经Z＝－2.088，P〈0.05）和平均F波潜伏期（正中神经Z＝－3.243，P〈0.01；尺神经t＝3.876，P〈0.01；胫神经Z＝－2.206，P〈0.05；腓神经Z＝－2.205，P〈0.05），尺神经时间离散度（Z＝－3.152，P〈0.01），正中神经（Z＝6.139，P〈0.01）和尺神经（Z＝5.350，P〈0.01）F波出现率，胫神经平均F波波幅（t＝2.981，P〈0.01），尺神经（Z＝－2.134，P〈0.05）和胫神经（t＝2.746，P〈0.01）最大F波波幅与健康受试者差异有统计学意义；胫神经（t＝2.551，P〈0.05）需要100次刺激，腓神经（Z＝－2.086，P〈0.05）需要至少80次刺激可发现ALS患者时间离散度显著延长；胫神经（Z＝2.119，P〈0.05）需要至少60次刺激可以发现ALS患者F波出现率显著降低；尺神经（Z＝－2.552，P〈0.05）和腓神经（Z＝－2.228�Objective The study aimed to investigate whether sample sizes of F-wave study differed according to different nerves, different F-wave parameters, and amyotrophic lateral sclerosis（ALS） patients or healthy subjects.Methods The F-waves in the median, ulnar, tibial, and deep peroneal nerves of 55 amyotrophic lateral sclerosis （ALS） patients and 52 healthy subjects were studied to assess the effect of sample size on the accuracy of measurements of the following F-wave parameters： F-wave minimum latency, maximum latency, mean latency, F-wave persistence, F-wave chronodispersion, mean and maximum F-wave amplitude. A hundred stimuli were used in F-wave study. The values obtained from 100 stimuli were considered ＂true＂ values and were compared with the corresponding values from smaller samples of 20, 40, 60 and 80 stimuli. F-wave parameters obtained from different sample sizes were compared between the ALS patients and the normal controls. Results Significant differences were not detected with samples above 60 stimuli for chronodispersion in all four nerves in normal participants. Significant differences were not detected with samples above 40 stimuli for maximum F-wave amplitude in median, ulnar and tibial nerves in normal participants. When comparing ALS patients and normal controls, significant differences were detected in the maximum （median nerve, Z=-3.560, P〈0.01; ulnar nerve, t=5.019, P〈0.01; tibial nerve, Z=-2.475, P〈0.05; peroneal nerve, Z=-2.088, P〈0.05）and mean F-wave latency （median nerve, Z=-3.243, P〈0.01; ulnar nerve, t=3.876, P〈0.01; tibial nerve, Z=-2.206, P〈0.05; peroneal nerve, Z=-2.205, P〈0.05）in all four nerves, F-wave chronodispersion （Z=-3.152, P〈0.01）in the ulnar nerve, F-wave persistence in the median （Z=6.139, P〈0.01）and ulnar nerves（Z=5.350, P〈0.01）, mean F-wave amplitude in the tibial nerve（t=2.981, P〈0.01）, maximum F-wave amplitude in the ulnar （Z=-2.134, P〈0.05）and tibial nerves （t=2.746, P〈0.01）with 20 stimuli; for c

关 键 词：肌萎缩侧索硬化 F波 潜伏期 出现率 波幅 

分 类 号：R746.4[医药卫生—神经病学与精神病学]