单纤维肌电图在68例运动神经元病患者中的研究  

Single fiber electromyography in 68 patients with amyotrphy lateral sclerosis

作　　者：崔丽英[1] 汤晓芙[1] 刘明生[1] 李本红[1] 杜华[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经科,100730

出　　处：《中华神经科杂志》2002年第5期290-293,共4页Chinese Journal of Neurology

摘　　要：目的　研究运动神经元病 (MND)患者的单纤维肌电图 (SFEMG)改变、病理生理机制及临床意义。方法　对 6 8例 (男 4 3例 ,女 2 5例 )经病史、临床表现和神经电生理检查测定证实的MND患者进行了伸指总肌SFEMG测定 ,并与年龄匹配的正常人对照。结果　所有患者感觉神经传导速度测定均正常 ,肌电图为广泛神经源性损害。SFEMG检查发现 :颤抖值 (jitter)为 30～ 178μs,平均 (80 2± 32 6 ) μs ;jitter>5 5 μs占 5 0 %～ 10 0 0 % ,平均 6 0 6 %± 2 9 0 % ;阻滞 (block)所占百分比为 0 0 %～90 0 % ,平均 2 9 3%± 30 0 % ;纤维密度 (FD)为 1 4～ 4 0 ,平均 2 6± 0 6。其中 5 1例确诊和拟诊的肌萎缩侧索硬化患者jitter增宽、block和FD增高最明显。还发现伸指总肌肌无力的程度与jitter增宽和block百分比呈明显的负相关。结论　SFEMG的异常改变在确诊患者组最明显 ;jitter增宽、block百分比升高和FD增高与肌肉无力的严重程度呈明显的负相关 (P <0 0 0 1) ;jitter增宽、block百分比升高和FD增高反映进行性失神经。Objective To investigate the changes and pathophysiological mechanism and clinical values of single fiber electromyography (SFEMG) in 68 patients with amyotrophy lateral sclerosis (ALS) Methods Routine EMG, nerve conduction velocity and extensor digitorum communis SFEMG were used to measure 68 patients (male 43 and female 25) who had been comfirmly diagnosed by history, clinical features and neurophysiological tests in comparison with normal controls Results Normal sensory nerve conduction was found in all subjects Routine EMG showed diffused neurogenic lesions in muscles innervated by three spinal regions at least SFEMG showed that remarkably increased jitter, block and fiber density (FD) Jitter ranged from 30 0～178 0 μs (mean 80 2 μs); the value of jitter>55 μs ranged from 5 0%～100 0% (mean 60 6%) The ratio of block ranged from 0 0%～90 0% (mean 29 3%) FD ranged from 1 4～4 0 (mean 2 56) There were remarkably increased jitter, block and FD in 51 patients with definite or probable ALS It was also found that there was a negative correlation between extensor digitorum communis strength grades and the ncreased jitter with or without block and FD ( P <0 01) Conclusions (1) SFEMG was the most sensitive marker in diagnosing the definite or probable ALS (2) There was a negative correlation between the increased jitter and block and the FD and degrees of muscle weakness were caused by block (3) The increase of jitter, block and FD may probably indicate the continuous denervation and reinnervation in forming mature sprouts and motor end plates

关 键 词：单纤维肌电图 运动神经元病 研究 诊断 

分 类 号：R744.8[医药卫生—神经病学与精神病学]