肌萎缩侧索硬化患者巨大F波特点研究  

Characteristics of giant F-waves in amyotrophic lateral sclerosis

作　　者：方佳[1] 崔丽英[1,2] 刘明生 李晓光[1] 管宇宙[1] 丁青云[1] 

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

出　　处：《中华神经科杂志》2017年第10期740-744,共5页Chinese Journal of Neurology

摘　　要：目的 探讨肌萎缩侧索硬化（amyotrophic lateral sclerosis,ALS）患者巨大F波的特点及其与疾病表型的相关性.方法 对2014年9月至2015年3月就诊于北京协和医院神经科门诊的55例ALS患者和52名健康志愿者行四肢运动神经传导和F波检测.使用100次电刺激获得正中神经、尺神经、胫神经和腓神经F波.分析的F波参数包括巨大F波出现率、出现巨大F波受试者比例、巨大F波与下运动神经元损害的相关性、与上运动神经元损害的相关性、与疾病病程的关系、与疾病严重程度的关系以及与疾病进展速度（disease progression rate,DPR）的关系等.结果 ALS患者正中神经、尺神经、胫神经和腓神经巨大F波出现率[正中神经0.00（0.00）%,尺神经0.00（1.02）%,胫神经0.00（0.00）%,腓神经0.00（0.00）%]高于健康志愿者[正中神经0.00（0.00）%,Z=-2.360,P=0.018;尺神经0.00（0.00）%,Z=-3.997,P〈0.01;胫神经0.00（0.00）%,Z=-3.006,P=0.003,腓神经0.00（0.00）%,Z=-3.006,P=0.003].ALS患者出现巨大F波受试者比例（正中神经13/55,23.6%,尺神经26/55,47.2%,胫神经18/55,32.7%,腓神经16/55,29.1%）也高于健康志愿者（正中神经4/52,7.7%,χ2=0.024,P=0.024;尺神经7/52,13.5%,χ2=14.326,P〈0.01;胫神经6/52,11.5%,χ2=6.897,P=0.009;腓神经6/52,11.5%,χ2=5.042,P=0.025）,差异均有统计学意义.ALS患者正中神经、尺神经、胫神经和腓神经出现巨大F波与未出现巨大F波神经上运动神经元受累比率差异无统计学意义.ALS患者正中神经[11.20（5.80）mV]和胫神经[（13.20±4.61）mV]出现巨大F波神经复合肌肉动作电位波幅高于未出现巨大F波神经[正中神经5.90（8.50）mV,Z=2.883,P=0.004;胫神经（10.69±4.76）mV,t=-2.222,P=0.028],差异有统计学意义.ALS患者巨大F波出现率与疾病病程和ALS功能评分无相关性,与DPR呈负相关（r=-0.287,P=0.034）.出现巨大F波与未出现巨大F波的ALS患者病程比较差异无统计学意义;与未出现Objective To investigate the characteristics of giant F-waves in patients with amyotrophic lateral sclerosis （ ALS ） and the relationship between giant F-waves and disease phenotype . Methods Motor nerve conduction study and F-waves were performed to the median , ulnar, tibial and peroneal nerves of 55 patients with ALS and 52 healthy volunteers.A series of 100 electrical stimuli were employed to obtain F-waves.The following F-wave variables were estimated： frequency of giant F-waves, frequency of patients with giant F-waves, the relationship between giant F-waves and lower motor neuron dysfunction , the relationship between giant F-waves and upper motor neuron dysfunction , the relationship between giant F-waves and disease duration , the relationship between giant F-waves and disease severity , and the relationship between giant F-waves and disease progression rate （ DPR）.Results The frequencies of giant F-waves （ ALS： median nerve 0.00 （ 0.00 ）%, ulnar nerve 0.00 （ 1.02 ）%, tibial nerve 0.00 （0.00）%,peroneal nerve 0.00（0.00）%.Normal controls：median nerve 0.00（0.00）%,Z=-2.360, P=0.018;ulnar nerve 0.00（0.00）%,Z=-3.997,P〈0.01;tibial nerve 0.00（0.00）%,Z=-3.006, P=0.003;peroneal nerve 0.00（0.00）%,Z=-3.006,P=0.003） and the frequencies of patients with giant F-waves （ALS：median nerve 13/55,23.6%,ulnar nerve 26/55,47.2%,tibial nerve 18/55,32.7%, peroneal nerve 16/55, 29.1%.Normal controls：median nerve 4/52,7.7%,χ2 =0.024,P=0.024;ulnar nerve 7/52,13.5%, χ2 =14.326,P〈0.01; tibial nerve 6/52,11.5%, χ2 =6.897,P=0.009; peroneal nerve 6/52,11.5%,χ2 =5.042,P=0.025） in the median nerve, ulnar nerve, tibial nerve and peroneal nerve were significantly increased compared with those of the normal controls .No significant differences were found in the frequencies of upper motor neuron dysfunction between nerves with giant F -waves and nerves without giant F-waves in the median nerves , ulnar nerves , tibial nerves and peroneal nerves of ALS patients . The compound m

关 键 词：肌萎缩侧索硬化 神经传导 F波 

分 类 号：R744.8[医药卫生—神经病学与精神病学]