神经电生理检查在肌萎缩侧索硬化症中的应用

目的:观察神经电生理检查在肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)中的应用价值。方法:分别对28例临床确诊ALS、6例临床拟诊ALS、4例临床可能ALS患者进行4个区域的共8块肌肉肌电图(EMG)分析,四肢的磁运动诱发电位(MEP),上肢正中神经、尺神经、下肢胫神经F波检查,在双侧腓肠肌记录H波,四肢远端神经传导测定,包括运动传导速度(MCV)、感觉传导速度(SCV)、复合运动神经动作电位(CMAP)、感觉神经动作电位(SNAP)以及运动末梢潜伏期(DML)进行测定并分析,并与健康对照组30例进行比较。结果:临床确诊ALS的神经电生理测定各值异常均高于拟诊ALS和可能ALS(P<0.05),拟诊ALS和可能ALS组比较没有明显统计学差异。ALS组EMG异常率85%,MEP异常率72.4%,神经传导异常主要表现为CMAP降低36.2%,SCV基本正常,F波出波率下降33.3%,F波振幅增高26.3%,H波振幅增高26.3%。结论:EMG对ALS患者下运动神经元损害有定位诊断价值,EMG是ALS诊断的重要依据;MEP对ALS患者上运动神经元损害有诊断价值,但特异性不高;F波、H波对ALS患者上下神经元神经损害定位有补充诊断价值,神经传导测定用于ALS的鉴别诊断。

APPLICATION OF ELECTRONEUROPHYSIOLOGICAL EXAMINATION IN AMYOTROPHIC LATERAL SCLEROSIS

Objective：To explore the value applied of electroneurophysiological examination in amyotrophic lateral sclerosis（ALS）.Methods：The electromyography（EMG）data in four areas of 8 muscle were analized in 28 cases of ALS diagnosed clinically,6 cases of ALS suspected clinically and 4 cases of clinical possible ALS.The magnetic motor evoked potential（MEP）of limbs were routine performed.All patients underwent F wave examination in median nerve and ulnar nerve of upper limb,tibias nerve of lower limbs.H wave were recorded in bilateral gastrocnemius,distal nerve conduction measurement of limbs,including motor conduction velocity（MCV）,sensory conduction velocity（SCV）,composite motor nerve action potentia（lCMAP）,sensory nerve action potentia（lSNAP）and distal motor latency（DML）were measured and analyzed and compared with 30 cases of healthy control group.Result：The abnormal value of electroneurophysiological determination in patients diagnosed clinical were higher than that of ALS suspected and clinical possible ALS（P＆lt;0.05）.There were no statistical significance between patients with ALS suspected and clinical possible ALS.Abnormal rate of EMG was 85% in ALS group.Abnormal rate of MEP was 72.4%.Nerve conduction abnormalities mainly included CMAP went down 36%,SCV normal,F wave reduced 33.3%,the amplitude of F wave increased 26.3% and the amplitude of H increased 26.3%.Conclusion：EMG in lower motor neuron injury have localization diagnostic value in patients with ALS.EMG is important basis in diagnosis of ALS.MEP in upper motor neuron damage have diagnostic value in patients with ALS,but the specificity is not high;F wave,H wave in damage of neuron in patients with ALS have supplementary diagnostic value,nerve conduction measurement used in the differential diagnosis of ALS.