远端复合肌肉动作电位时限在急性炎症性脱髓鞘性多发性神经根神经病诊断中的应用  

Utility of the distal compound muscle action potential duration for the diagnosis of acute inflammatory demyelinating polyradiculoneuritis

作　　者：羊洁[1] 刘英[1] 冯建华[1] YANG Jie;LIU Ying;FENG Jianhua(Department of Neurology,Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital,Chengdu,610072,China)

机构地区：[1]四川省医学科学院四川省人民医院神经内科

出　　处：《中国神经免疫学和神经病学杂志》2019年第3期184-188,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨远端复合肌肉动作电位时限(distalcompound muscle action potential duration,DCMAPD)在急性炎症性脱髓鞘性多发性神经根神经病(acute inflammatory demyelinating polyradiculoneuritis,AIDP)诊断中的应用价值。方法选取2013年1月至2018年12月作者医院收治的AIDP患者78例,并选取同期健康人群106名为对照组。比较两组正中神经、尺神经、胫神经及腓神经远端运动潜伏期(distalmotorla-tency,DML)、运动传导速度(motor conduction velocity,MCV)及DCMAPD的差异,采用受试者工作特征(ROC)曲线分析各神经MCV、DML以及DCMAPD诊断AIDP的价值,并分析DCMAPD最佳临界值。结果与对照组比较,AIDP组正中神经、尺神经、胫神经及腓神经DML、DCMAPD明显延长(均P< 0.01),MCV明显减慢(均P< 0.01)。ROC曲线分析结果显示,4条神经的DML、MCV和DCMAPD均具有较好的诊断价值(均AUC>0.7)。正中神经、尺神经、胫神经及腓神经的DCMAPD最佳临界值分别为5.85、6.85、6.65、5.25ms,其对应的敏感度/特异度分别为0.731/0.877、0.641/0.943、0.718/0.858、0.872/0.660。DML、MCV与DCMAPD三者联合可明显提高AIDP诊断的敏感性,达93.59%。结论 DCMAPD对AIDP具有较好的诊断价值,尤其与DML、MCV联合应用时可为 AIDP早期免疫治疗提供更多支持依据。Objective To investigate the value of distal compound muscle action potential duration(DCMAPD) for the diagnosis of acute inflammatory dmyclinating polyradiculoneuritis(AIDP).Methods 78 patients with AIDP admitted to Sichuan Provincial People's Hospital from 2013-01 to 2018-12 were selected as the AIDP group,and 106 healthy subjects were selected as healthy controls.Motor conduction tests of median nerves,ulnar nerves,tibial nerves and peroneal nerves were performed in all the subjects to obtain distal motor latency(DML),motor conduction velocity(MCV) and DCMAPD.All the results were compared between the two groups,and receiver operating characteristic(ROC) curve was used to analyze the value of DCMAPD in the diagnosis of AIDP.Results DMLs and DCMAPD of the median,ulnar,tibial and peroncal nerves in the AIDP group were both significantly longer than those in the healthy control group(all P0.01).MCV of the median,ulnar,tibial and peroneal nerves in the AIDP group were significantly slower than those in the healthy control group(all P0.01).ROC curve analysis showed that DML,MCV and DCMAPD were effective parameters for the diagnosis of AIDP(all AUC0.7).The best cut-off values of DCMAPD in median nerves,ulnar nerves,tibial nerves and peroneal nerves were 5.85 ms,6.85 ms,6.65 ms,5.25 ms respectively,and the sensitivities/specificitics were 0.731/0.877,0.641/0.943,0.718/0.858,0.872/0.660 respectively.The combination of DML,MCV and DCMAPD can significantly increase the sensitivity to 93.59%.Conclusions DCMAPD is valuable for the diagnosis of AIDP,especially when it is combined with DML.Thus,it can be used to support the immunotherapy in the early stage of AIDP.

关 键 词：格林-巴利综合征 远端复合肌肉动作电位时限 ROC曲线 曲线下面积 神经传导 诊断 

分 类 号：R745.43[医药卫生—神经病学与精神病学]