运动传导异常与肌萎缩侧索硬化患者预后的关系  

Relationship between abnormal motor conduction and prognosis of patients with amyotrophic lateral sclerosis

作　　者：赵小泉 初红[1] 王艳[1] 卢祖能[1] Zhao Xiaoquan;Chu Hong;Wang Yan(Department of Neurology,Renmin Hospital of Wuhan University,Wuhan430060)

机构地区：[1]武汉大学人民医院神经内科,430060

出　　处：《卒中与神经疾病》2024年第4期382-386,共5页Stroke and Nervous Diseases

摘　　要：目的探讨运动神经传导异常与肌萎缩侧索硬化(Amyotrophic lateral sclerosis,ALS)患者预后的关系。方法回顾性分析2016年4月-2023年8月就诊于武汉大学人民医院神经内科、符合修订版El Escorial临床肯定和拟诊型诊断标准的ALS患者,纳入临床和电生理资料完整且通过诊室或电话随访获取了生存或机械通气时间的患者;通过Kaplan-Meier和Log rank检验对性别、年龄、起病部位、诊断级别、疾病进展率(Disease progression rate,DPR,通过ΔFS进行评估)、运动传导检测的远端运动潜伏期(Distal motor latency,DML)和复合肌肉动作电位波幅进行单因素分析。结果(1)符合纳入标准的ALS患者共90例,其中男51例、女39例,男/女比例1.31/1,首发症状在上肢的患者37例、下肢28例、四肢4例、延髓21例;(2)单因素分析显示,年龄(χ^(2)=7.106,P=0.008)、ΔFS(χ^(2)=7.586,P=0.006)和正中神经DML(χ^(2)=5.796,P=0.016)对ALS患者预后有显著影响;(3)多变量分析提示,年龄>54岁(HR=0.336,P=0.006)、ΔFS≥0.75/月(HR=0.185,P=0.000)和正中神经DML延长(HR=0.327,P=0.014)的患者预后较差;与正中神经DML较短的患者比较,正中神经DML延长的ALS患者生存期较短。结论无论起病部位,常规神经传导检测的正中神经DML延长与ALS患者的不良预后有关;正中神经DML这一简便、易获取的电生理参数可作为ALS患者的一项独立的预后指标,有助于患者的管理。Objective To evaluate the prognostic value of motor nerve conduction abnormalities in patients with amyotrophic lateral sclerosis(ALS).Methods Retrospective analysis was conducted on the patients who were referral to Department of Neurology,Renmin Hospital,Wuhan University from April 2016 to August 2023,and met the revised El Escorial criteria with clinical definite and probable ALS.Patients with complete clinical and electrophysiological data and whose survival or mechanical ventilation times were obtained through consultation or telephone follow-up were included.Univariated analysis using Kaplan-Meier and log rank test were performed to assess gender,age,site of onset,diagnostic certainty,disease progression rate(DPR,evaluated byΔFS),distal motor latency(DML)and amplitude of compound muscle action potentials by motor conduction studies.Results(1)There was a total of 90 ALS patients met the inclusion criteria,including 51 males and 39 females,with a male to female ratio of 1.31.There were 37 patients with initial symptoms in upper limbs,28 in lower limbs,4 in four extremities and 21 in spinal bulb.(2)Univariated analysis showed that the age(χ^(2)=7.106,P=0.008),ΔFS(χ^(2)=7.586,P=0.006)and median nerve DML(χ^(2)=5.796,P=0.016)had significant effects on the prognosis of ALS patients.(3)Multivariate analysis showed that the patients with age>54 years-old(HR=0.336,P=0.006),ΔFS≥0.75 point/month(HR=0.185,P=0.000)and prolonged median nerve DML(HR=0.327,P=0.014)had a poor prognosis.Compared with patients with shorter median nerve DML,those with prolonged DML had shorter survival time.Conclusion Regardless of the site of onset,the DML prolongation of median nerve measured by routine nerve conduction is associated with the poor prognosis of ALS patients.Median nerve DML,a simple and easily available electrophysiological parameter,can be used as an independent prognostic index of ALS patients,which is helpful to the management of patients.

关 键 词：肌萎缩侧索硬化 神经传导检测 预后 

分 类 号：R744.8[医药卫生—神经病学与精神病学]