颈部肌张力障碍病感觉诡计现象的临床及神经电生理研究价值  

Clinical and electrophysiological value of sensory tricks in cervical dystonia

作　　者：李涛[1] 宋春莉[2] 周丽娜[2] 荆璐 周璐 梁战华[1] 

机构地区：[1]大连医科大学附属第一医院神经内科,116011 [2]大连医科大学附属第一医院神经电生理检查科,116011

出　　处：《中华神经科杂志》2017年第9期660-664,共5页Chinese Journal of Neurology

基　　金：辽宁省省直医院改革重点临床科室诊疗能力建设项目（LNCCC.C06-2015）;辽宁省自然科学基金资助项目（2015020292,201102052）

摘　　要：目的 分析感觉诡计左颈部肌张力障碍患者中的表现,探讨感觉诡计与大脑皮质辅助运动区功能的关系及其相关神经电生理改变.方法 收集2006年3月至2013年4月于大连医科大学附属第一医院神经内科肌张力障碍病门诊首次且连续就诊的原发性颈部肌张力障碍患者75例,进行感觉诡计的现象学调查.其中男性23例,女性52例,男女比例1：2.26;发病年龄19 ～ 72岁,平均（42.5±13.1）岁.根据感觉诡计类型,分为经典组、力量组、无诡计组和负性组.对首次就诊时表现为单纯扭转型的43例患者行皮质多点记录的正中神经体感诱发电位检查.结果 首次就诊时,感觉诡计存在于85.53％ （64/75）的患者.随病程进展,感觉诡计类型可能发生改变.使用不同类型感觉诡计（经典组、力量组、无诡计组）患者间发病年龄差异无统计学意义.患者疾病复杂程度在各组间有增高趋势.经典组患者头部扭转方向对侧皮质辅助运动区P22/N30峰峰幅度与同侧比较差异无统计学意义,力量组及无诡计组患者头部扭转方向对侧P22/N30峰峰幅度[力量组（3.16±1.71）μV,无诡计组（3.62±1.58）μV]较同侧[力量组（2.47 ±1.28） μV,t=2.243,P=0.038;无诡计组（2.73±1.14）μV,=2.893,P =0.023]高.经典组[（9.36±3.52）分]与力量组[（12.67±5.00）分]或无诡计组[（15.18±4.07）分]患者首次就诊时Tsui评分差异有统计学意义（经典组比力量组,t=-3.020,P=0.004;经典组比无诡计组,t=-4.452,P=0.000）.结论 不同类型感觉诡计患者的疾病严重程度从经典组、力量组到无诡计组依次加重.不同感觉诡计类型可能提示大脑皮质辅助运动区功能处于代偿（经典组）或失代偿（力量组、无诡计组）阶段.Objective To investigate demography of sensory tricks in cervical dystonia （CD）,and to discuss the relationship between sensory tricks and the function of sensorimotor integration of cerebral cortex,meanwhile to explore potential worthiness using sensory tricks in the management of CD.Methods We recruited 75 patients （23 male,52 female,male female ratio：1：2.26;aged 19-72 years,mean （42.45 ± 13.09） years） admitted to the Dystonia Clinic Center of the First Affiliated Hospital of Dalian Medical University from March 2016 to April 2013.Standardized questionnaire on sensory tricks was used to investigate the sensory tricks first recognized in 75 patients retrospectively.Median nerve somatosensory evoked potential via multipoint recording was measured in 43 CD patients who manifested as simple rotation of neck.Bilateral amplitudes of P22/N30 derived from F （3,4） were compared.Results Frequency of sensory tricks in CD was 85.53% （64/75） in our research.As disease progressed,the type of sensory tricks used by patients may transform from one to another or even disappear.No statistically significant differences were found in ages among patients using classic sensory tricks,forcible tricks and patients without sensory tricks,whereas the complexity of the disease showed increased tendency among the three groups.Bilateral P22/N30 amplitudes of patients with classic sensory tricks showed no significant differences.P22/N30 amplitudes contralateral to the head turn were significantly higher than ipsilateral in patients using forcible tricks （（3.16 ± 1.71） μV vs （2.47 ± 1.28） μV,t =2.243,P=0.038） and patients without sensory tricks （（3.62 ±1.58） μV vs （2.73 ±1.14） μV,t=2.893,P=0.023）.Tsui scores among patients using classic sensory tricks （9.36 ± 3.52） and forcible tricks （12.67 ± 5.00） or patients without sensory tricks （15.18 ± 4.07） had statistically significant differences （classic sensory tricks vs forcible tricks,t =-3.020,P =0.004;classic sensory tr

关 键 词：斜颈 感觉诡计 诱发电位 躯体感觉 

分 类 号：R746[医药卫生—神经病学与精神病学]