交感皮肤反应联合肛门括约肌肌电图对多系统萎缩与帕金森病的诊断价值  

Value of sympathetic skin response combined with anal sphincter electromyography in diagnosis of MSA and PD

作　　者：王雪梅[1] 曹振汤 刘亘梁[1] 马惠姿[1] 王展[1] 杨雅琴[1] 冯涛[1] Wang Xuemei;Cao Zhentang;Liu Genliang;Ma Huizi;Wang Zhan;Yang Yaqin;Feng Tao(Center for Movement Disorders Disease,Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心运动障碍性疾病科,国家神经系统疾病临床医学研究中心,北京脑重大疾病研究院帕金森病研究所,100070

出　　处：《中华老年心脑血管病杂志》2021年第1期47-50,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家重点研发计划项目(2018YFC1312001,2016YFC1306501);国家自然科学基金(81771367);北京市科技计划项目(Z171100001017041)。

摘　　要：目的探讨交感皮肤反应(SSR)及肛门括约肌肌电图(EAS-EMG)在多系统萎缩(MSA)与帕金森病(PD)中的诊断价值。方法对108例MSA患者(MSA组)及171例PD患者(PD组)进行SSR和EAS-EMG检查,采用ROC曲线分析两种检查的诊断价值。结果与PD组比较,MSA组上、下肢SSR潜伏期明显延长,波幅明显下降[(1528.73±390.32)ms vs(1286.95±180.39)ms;(2226.98±499.23)ms vs(1832.65±271.09)ms;(1082.44±834.41)μV vs(2626.16±1539.60)μV;(499.01±308.18)μV vs(1734.64±1258.92)μV,P=0.000];MSA组上肢潜伏期、波幅与直立性低血压(OH)明显相关,下肢潜伏期、波幅与病程、OH明显相关(P<0.05,P<0.01)。与PD组比较,MSA组EAS-EMG平均时限、波幅、平均位相、多相波百分比、卫星电位百分比明显升高(P<0.05,P<0.01)。SSR联合EAS-EMG检查的曲线下面积为0.92,敏感性0.73。结论SSR联合EAS-EMG可提高对MSA与PD患者的鉴别诊断,可作为MSA患者早期自主神经功能障碍量化的诊断及鉴别诊断指标。Objective To study the value of SSR and EAS-EMG in diagnosis of MSA and PD.Methods One hundred and eight MSA patients served as a MSA group and 171 PD patients served as a PD group.They underwent SSR and EAS-EMG.The value of SSR and EAS-EMG in diagnosis of MSA and PD was analyzed by ROC curve analysis.Results The latency of SSR was longer and the amplitude of SSR was lower in MSA group than in PD group(1528.73±390.32 ms vs 1286.95±180.39 ms,2226.98±499.23 ms vs 1832.65±271.09 ms,1082.44±834.41μV vs 2626.16±1539.60μV,499.01±308.18μV vs 1734.64±1258.92μV,P=0.000).The latency and amplitude of SSR in upper extremities were closely related with OH in MSA group and the latency and amplitude of SSR in lower extremities were closely related with the course of MSA and OH in MSA group(P<0.05,P<0.01).The mean time,percentage of amplitude,mean phase,multiphase wave and saterllite potential were significantly higher in MSA group than in PD group(P<0.05,P<0.01).The AUC for SSR combined with EAS-EMG in diagnosis of MSA and PD was 0.92 with a sensitivity of 0.73.Conclusion SSR combined with EAS-EMG can improve the differential diagnosis of MSA and PD,and can thus be used as an index for quantitative diagnosis of early autonomic nervous dysfunction and differential diagnosis of MSA and PD.

关 键 词：肛管 肌电描记术 多系统萎缩 帕金森病 

分 类 号：R742.5[医药卫生—神经病学与精神病学]