慢性炎性脱髓鞘性多发神经根神经病的肌电图异常特点和诊断价值研究  

Characteristics of Electromyography in Patients with Chronic Inflammatory Demyelinating Multiple Radiculopathy and Its Diagnostic Value for the Severity of the Disease

作　　者：王静[1] 王艺颖[1] 董艳妮 WANG Jing;WANG Yi-ying;DONG Yan-ni(Department of Electrophysiology,Weihai Municipal Hospital,Weihai 264200,China)

机构地区：[1]山东大学附属威海市立医院电生理科,威海264200

出　　处：《中国临床神经科学》2021年第4期406-414,共9页Chinese Journal of Clinical Neurosciences

摘　　要：目的探讨慢性炎性脱髓鞘性多发神经根神经病(CIDP)的肌电图特点和评价病情严重程度的价值。方法收集39例2018年9月至2020年12月收治的CIDP患者的临床资料。采用Hughes残疾评分评估患者病情严重程度。肌电图检查①4条运动神经:正中神经、尺神经、胫神经、腓神经的复合肌肉动作电位(CMAP)波幅、运动传导速度(MCV)和F波潜伏期;②3条感觉神经:正中神经、尺神经、腓肠神经的感觉神经传导速度(SCV)、动作电位(SNAP)波幅。根据电生理检测结果将患者分为A组(所测神经均可引出波形)和B组(≥1条神经测不出波形)。用Pearson相关性分析MCV、CMAP波幅和F波潜伏期与CIDP病情严重程度的相关性;用受试者工作特征曲线(ROC)评价MCV、CMAP及F波潜伏期对CIDP的诊断价值。结果与A组比较,B组Hughes残疾评分、脑神经受累、肢体无力、腱反射减弱、肌肉萎缩比例,MCV和CMAP波幅、F波潜伏期、SNAP波幅异常率以及F波潜伏期显著增加;而MCV、CMAP波幅均显著降低(均P<0.05)。正中神经和尺神经MCV,胫神经CMAP波幅与病情严重程度呈显著负相关;正中神经、尺神经F波潜伏期与病情严重程度呈显著正相关(均P<0.05)。ROC曲线分析结果显示,4条运动神经的MCV、CMAP及F波潜伏期均在CIDP的诊断中具有一定价值(均AUC>0.07),3项指标联合可显著提高CIDP诊断的敏感度和特异度。结论CIDP神经电生理表现为MCV明显减慢、CMAP波幅降低和F波潜伏期延长,神经损伤严重的CIDP患者此3项指标异常率更高,联合MCV、CMAP及F波潜伏期3项指标可提高CIDP诊断的敏感度和特异度。Aim To investigate the characteristics of electromyography(EMG)in patients with chronic inflammatory demyelinating polyradiculoneuropathy(CIDP)and its diagnostic value in evaluating the severity of the disease.Methods The clinical data of 39 patients with CIPD admitted from September 2018 to December 2020 were collected.The severity of the patient’s condition was assessed by Hughes Disability Scale.The amplitude of compound muscle action potential(CMAP),motor conduction velocity(MCV),F-wave latency of 4 motor nerves(median nerve,ulnar nerve,tibial nerve and peronealnerve)and the sensory conduction velocity(SCV)and amplitude of sensory nerve action potential(SNAP)of 3 sensory nerves(median nerve,ulnar nerve and sural nerve)were examined by EMG.The patients were divided into group A(whose response waveform can be elicited in all nerves)and group B(those without response in one or more nerves)according to the results of electrophysiological test.Pearson correlation was carried out to analyze the correlation between MCV,amplitude of CMAP,F-wave latency and the severity of the patient’s condition.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of MCV,amplitude of CMAP and incubation period of F to the severity of CIDP patients.Results Compared with group A,Hughes disability score,cerebral nerve involvement,limb weakness,decreased tendon reflex,muscle atrophy ratio,abnormal rate of MCV,abnormal rate of CMAP amplitude,abnormal rate of F wave latency,abnormal rate of SNAP amplitude and F wave latency of group B were significantly increased,while MCV and CMAP amplitude were significantly lower than those of group A(all P<0.05).MCV of median nerve,ulnar nerve and CMAP amplitude of tibial nerve were negatively correlated with the severity of the disease,the F-wave latency of median nerve and ulnar nerve was positively correlated with the severity of the disease(all P<0.05).The results of ROC curve analysis showed that the MCV,CMAP and F-wave latency of the four nerves had certain di

关 键 词：多发神经根神经病 慢性炎性脱髓鞘 诊断 肌电图 神经电生理 

分 类 号：R745.4+3[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]