神经肌肉病患者电生理神经传导检测和超声下神经横截面面积的关系研究  

Correlating nerve conduction studies with cross-sectional area measured using ultrasound in patients with neuromuscular disease

作　　者：胡臻娴 陈娜[1] 陈琳 杨硕[1] 王颖[1] 张磊[1] 张在强[1] 潘华[1] Hu Zhenxian;Chen Na;Chen Lin;Yang Shuo;Wang Ying;Zhang Lei;Zhang Zaiqiang;Pan Hua(Department of Neurology,Beijing Tiantan Hospital of 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,北京100070

出　　处：《中华神经科杂志》2023年第8期876-880,共5页Chinese Journal of Neurology

摘　　要：目的探讨神经肌肉病患者电生理神经传导检测各参数和神经横截面面积(CSA)的关系。方法记录2022年3月3日至2023年5月4日就诊于北京天坛医院的21例神经肌肉病患者正中神经和尺神经不同位点的CSA,同时进行常规神经传导检测,分别记录每个位点附近正中神经和尺神经的运动神经传导速度(MCV)、复合肌肉动作电位(CMAP)波幅,记录正中神经和尺神经腕部的感觉神经传导速度(SCV)及感觉神经动作电位波幅(SNAP)。分析同一位点MCV、CMAP波幅、SCV、SNAP波幅与CSA的关系。采用线性回归模型进行数据分析。结果共记录了180组同一位点的MCV和CSA,其中正中神经102组,尺神经78组;220组同一位点的CMAP波幅和CSA,其中正中神经104组,尺神经116组;60组腕部的SCV和CSA、SNAP波幅和CSA,其中正中神经32组,尺神经28组。正中神经和尺神经MCV与CSA的线性相关均有统计学意义(正中神经r^(2)=0.10,调整r^(2)=0.09,P=0.001;尺神经r^(2)=0.18,调整r^(2)=0.17,P<0.001)。CSA>10 mm2时,正中神经和尺神经CMAP波幅和CSA的线性相关有统计学意义(正中神经r^(2)=0.09,调整r^(2)=0.08,P=0.024;尺神经r^(2)=0.19,调整r^(2)=0.17,P=0.004);CSA≤10 mm2时,正中神经和尺神经CMAP波幅和CSA的相关性均无统计学意义。正中神经和尺神经腕部SCV、SNAP波幅和CSA的相关性亦无统计学意义。结论CSA更能反映运动神经的神经传导参数变化,且对运动神经传导速度的提示意义最大,提示其在有运动神经损害的脱髓鞘性周围神经病中的运用前景可能更为广泛。Objective To determine whether there is a correlation between the cross-sectional area(CSA)and the parameters as measured on nerve conduction studies.Methods Twenty-one patients with neuromuscular diseases in Beijing Tiantan Hospital from March 3,2022 to May 4,2023 underwent ultrasound measurement of the CSA of the median nerves and ulnar nerves at the wrist,elbow and the upper arm,followed by nerve conduction studies(NCS).A linear regression model was performed to compare NCS and CSA.Results A total of 180 sets of motor nerve conduction velocity(MCV)and CSA at the different sites including 102 sets of median nerve and 78 sets of ulnar nerve,220 sets of compound muscle action potential(CMAP)amplitude and CSA at the different sites including 104 sets of median nerve and 116 sets of ulnar nerve,60 sets of sensory nerve conduction velocity(SCV)and CSA and sensory nerve action potential(SNAP)amplitude and CSA at the wrist including 32 sets of median nerve and 28 sets of ulnar nerve were recorded.The linear correlation between MCV and CSA was statistically significant both in median nerve(r^(2)=0.10,adjusted r^(2)=0.09,P=0.001)and in ulnar nerve(r^(2)=0.18,adjusted r^(2)=0.17,P<0.001).When CSA>10 mm2,the linear correlation between CMAP amplitude and CSA was statistically significant both in median nerve(r^(2)=0.09,adjusted r^(2)=0.08,P=0.024)and ulnar nerve(r^(2)=0.19,adjusted r^(2)=0.17,P=0.004).The correlation between CMAP and CSA was not statistically significant when CSA≤10 mm2.And the correlations between SCV and CSA and between SNAP and CSA were not statistically significant.Conclusions CSA can better show the characteristics of changes in motor nerve conduction especially in motor conduction velocity.It is suggested that its application prospect in demyelinating peripheral neuropathy with motor nerve damage may be more extensive.

关 键 词：神经肌肉疾病 周围神经 超声检查 肌电描记术 神经传导 横截面积 

分 类 号：R746[医药卫生—神经病学与精神病学]