32例多系统萎缩患者的头部磁共振及神经电生理特点研究  

The study of cranial magnetic resonance and neurophysiological characteristics in 32 patients with multiple system atrophy

作　　者：徐天阳 刘恒方[1] 张敏[1] 石磊[1] 李明磊 

机构地区：[1]郑州大学第五附属医院神经内三科,河南郑州450052

出　　处：《中风与神经疾病杂志》2018年第2期149-151,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的分析多系统萎缩(MSA)患者的临床表现、头部常规磁共振、肛门括约肌肌电图(EAS-EMG)和交感神经皮肤反应(SSR)特点,探讨EAS-EMG、SSR对于MSA早期临床诊断的价值。方法回顾性分析自2015年1月-2017年6月于郑州大学第五附属医院就诊的资料完整的MSA门诊及住院患者共32例,所有患者均于入院后行头部常规磁共振(MRI)及肛门括约肌肌电图、交感神经皮肤反应检查,将MSA患者一般资料、MRI、神经电生理检查结果进行统计学分析。结果 32例患者中MSA-P型20例,主要临床表现为帕金森样症状;MSA-C型12例,主要临床表现为小脑性共济失调。32例患者均完成头部常规磁共振检查,28例存在MRI异常。T2WI序列上的壳核"裂隙征"主要见于MSA-P型(P<0.05);而脑桥"十字征"主要见于MSA-C型(P<0.05)。30例MSA患者完成EAS-EMG检查,28例呈现神经源性损害,主要表现为运动单位电位(MUPs)平均时限延长、多相波比例增多、出现卫星电位。31例MSA患者完成SSR检查,27例呈现自主神经功能损害,主要表现为起始潜伏时平均值延长、波形缺失。结论结合临床特点、头部常规磁共振检查结果及EAS-EMG、SSR检查,可提高MSA的诊断率。当EAS-EMG检查受到限制时,SSR检查可以提供补充诊断及可靠的参考依据。Objective Analysis of multiple system atrophy clinical manifestations,imaging and electromyography of anal sphincter,sympathetic skin reaction examination results,explore the value of EAS-EMG and SSR for early clinical diagnosis of MSA. Methods Retrospective analysis which were treated in Fifth Affiliated Hospital of Zhengzhou University from January 2015 to June 2017,and analysis of the complete data MSA outpatient and inpatients with a total of 32 cases,20 patients with MSA-P,12 patients with MSA-C. All patients were admitted to hospital after head of routine magnetic resonance imaging（ MRI） and anal sphincter electromyography,sympathetic skin response,the general data of MSA patients,MRI,neural electrophysiological results were statistically analyzed. Results Among the 32 patients,MSA-P type 20 cases,the main clinical manifestations were Parkinson-like symptoms,MSA-C type 12 cases,the main clinical manifestations of cerebellar ataxia. 32 patients underwent routine magnetic resonance imaging,and 28 presented MRI abnormalities. The fissure sign of the putamen in the T2 WI sequence was mainly seen in type MSA-P（ P 0. 05）,whereas the pontine cross sign was mainly seen in type MSA-C（ P 0. 05）. 30 patients with MSA underwent EAS-EMG examination,and 28 patients showed neurogenic damage. The main manifestation was the prolongation of the motor unit potential（ MUPs）,the prolongation of the average time,the increase of the multi-phase wave,and the occurrence of the satellite potential. 31 patients with MSA underwent SSR examination,and 27 patients showed autonomic nerve dysfunction. The main finding was the prolongation of the initial latency and the absence of waveform. Conclusion Combined with clinical features,craniocerebral conventional magnetic resonance examination results and EAS-EMG,SSR examination,can improve the diagnostic rate of MSA. When EASEMG examination is limited,SSR examination can provide supplementary diagnosis and reliable reference.

关 键 词：多系统萎缩 磁共振成像 肛门括约肌肌电图 交感神经皮肤反应 

分 类 号：R742.5[医药卫生—神经病学与精神病学]