重复神经电刺激在重症肌无力中的临床应用研究

目的　探讨重复神经电刺激 (RNS)对重症肌无力 (MG)的临床应用价值。方法　对 3 0例MG患者的面神经、副神经、腋神经、尺神经分别用低频 (3Hz、5Hz)和高频 (10Hz、15Hz、2 0Hz)超强电流进行RNS检查 ,共检查 12 0条神经。所检神经对应的肌肉疲劳后 ,再以上述频率和电流重复进行RNS检查。结果　低频刺激阳性为 5 6.67% (17/ 3 0 ) ,高频刺激阳性为 2 6.67% (8/ 3 0 ) ,两者比较差异有高度显著性 (P <0 .0 0 1)。 10 0 %RNS阳性患者在低频刺激时即可获得阳性结果。疲劳前的RNS阳性率为 5 6.67% (17/ 3 0 ) ,疲劳后为 83 .3 3 % (2 5 / 3 0 ) ,两者比较差异有显著性 (P <0 .0 5 )。疲劳后按 4块肌肉统计RNS阳性率为 86.67% (2 6/ 3 0 ) ,而按 3块肌肉统计阳性率为 60 .0 0 % (18/ 3 0 ) ,两者比较差异有显著性 (P <0 .0 5 )。结论　低频RNS检查在MG疾病诊断中具有重要的价值 ,对MG患者的临床分型和指导治疗具有重要意义 ,受检神经所支配的肌肉疲劳后和增加检查的神经数目能提高RNS阳性率。

Repetitive nerve stimulation in diagnosis of myasthenia gravis

Objective To investigate the cl in ical effects of repetitive nerve stimulation (RNS) in diagnosis of myasthenia gr avis (MG). Methods The facial nerves, accessory nerves, axillary nerves and ulnar nerve in 30 patients with MG were examined by RNS with ultra-current of low frequency (3Hz, 5Hz) and high frequency (10Hz, 15 Hz, 20Hz), altogether 120 nerves were tested. After the correspondent muscles to the tested nerves fatigued, the RNS test was repeated with the mentioned above frequency and current one by one. Results The p ositive rate of low frequency stimulation was 56.67% (17/30), and the positive r ate of high frequency was 26.67% (8/30), there was statistically significant dif ference in comparison to this two group (P<0.001). All the positive RNS can be obtained in low frequency stimulation. The positive RNS before fatigue test w as 86.67% (26/30), and the positive rate after fatigue was 83.33%(25/30), there was statistically significant difference between in comparison to this two (P <0.05). The positive rate of RNS in testing 4 nerves was 86.67% (26/30), and i n testing 3 nerves was 60.00% (18/30), there was statistically significant diff erence in comparison to this two (P<0.05). Conclusion Low frequency RNS test is of great value in diagnosis of MG, and can guide to the clinical typing and treatment. The fatigue test and increasing the number of the tested nerves can increase the RNS positive rate.