重症肌无力患者单纤维肌电图与低频重复电刺激测定的对比研究

通过对４６例确诊的重症肌无力（ＭＧ）患者进行低频重复电刺激（ＬＦＲＮＳ）和单纤维肌电图（ＳＦＥＭＧ）的对比研究，部分病例还作了常规同心针极肌电图（ＣＮＥＭＧ）检查。发现ＬＦＲＮＳ阳性率为５７％。受检的三组肌肉中三角肌阳性率最高（４８％）。ＳＦＥＭＧ阳性率为９１％，其中轻型（改良Ｏｓｓｅｒｍａｎ分型中Ⅰ、Ⅱ＿Ａ型）为８８％，重型（Ⅱ＿Ｂ、Ⅲ、Ⅳ和Ｖ型）为１００％。两种检查阳性率有显著性差异（Ｐ＜０．０１）。ＳＦＥＭＧ是目前诊断ＭＧ最为敏感的电生理方法。轻型ＭＧ临床未表现肌无力的肌肉中也存在着潜在的神经肌肉传递障碍。Ｊｉｔｔｅｒ阻滞率是反映ＭＧ病情严重程度的良好指标。ＣＮＥＭＧ有助于排除和发现临床上症状相似的其它疾病或其它疾病同时伴发ＭＧ者。     

常规肌电图和单纤维肌电图在盆底疾病中的应用

本文三组患者均检查耻骨直肠肌，肛门内外括约肌共１０９８块肌肉，检测６７８８０个运动单位。结果表明：常规肌电图和单纤维肌电图在便秘组、肿瘤术后组和脊髓病变组异常率分别为：８２．２％和９４．７％；６６．７％和７９．２％；９８．４％和１００％。并初步探讨其对盆底疾病的诊断价值。     

腰椎间盘突出症肌电图,CT与手术结果对照研究

目的：探讨腰椎间盘突出症患者的肌电图（ＥＭＧ）和ＣＴ与手术探查结果之间的下位关系。列角诊为腰椎间盘突出症患者术前进行ＥＭＧ、ＣＴ检查,然后实施手术探查。结果：ＥＭＧ检查结果与手术发现结果的符合率为８３．３％,ＣＴ检查结果与手术结果的答合率为９３．３％。ＥＭＧ检查与ＣＴ扫描之间的符合率无显著性差异（Ｐ〉０．０５）。结论：ＥＭＧ是从神经电生理角度反映神经根受压的功能状态,ＣＴ则是从形态学上反映腰椎间盘     

急性高碳酸血症对膈肌功能的影响

本文用电刺激犬膈神经（ＰＮＳ）、记录经膈压（Ｐｄｉ）－刺激频率（Ｆ）曲线、分析自主呼吸膈肌肌电频谱（ＥＭＧｄｉ）的方法，研究急性ＣＯ２潴留对膈肌功能的影响，并探讨ｐＨ值在其中的作用。发现：１．急性ＣＯ２潴留使Ｐｄｉ进行性下降、Ｐｄｉ－Ｆ曲线右移，ＥＭＧｄｉ频谱改变；２．维持正常的ｐＨ值可减轻Ｐｄｉ、ＥＭＧｄｉ的改变。提示急性ＣＯ２潴留严重损害膈肌功能，ｐＨ的变化于其中起重要作用。     

神经肌电图对踝管综合征的诊断

报告２０例踝管综合征进行神经电生理检测，结果局部嵌压指标为：１．常规肌电图检查在足底肌中有阳性发现。２．足母展肌至踝上的传导时间大于６．０ｍｓ且较健侧延长０．５ｍｓ以上。３．踝管传导时间大于０．７ｍｓ，且传导速度＜４０．０ｍ／ｓ。４．ＥＭＡＰ衰减率大于１０％。以上４项中任何一项阳性指标存在即可诊断为本病。就本病而言，神经肌电图的检查提示较其它检查更有价值     

周围神经外伤609例肌电图与神经电图分析

对６０９例周围神经外伤肌电图与神经电图进行分析。损伤神经支配的２４１１块肌肉，肌电图为神经源性损害占９８．８％，运动神经传导速度减慢占９７．６％。其中８８例臂丛神经损伤，其Ｆ波传导速度减慢（４１．３～４５．９ｍ／ｓ），结合肌电图改变而确定诊断；坐骨神经损伤９例，其Ｈ反射传导速度减慢（３５．０～～４７．６ｍ／ｓ）与Ｈ／Ｍ降低（１１．７～１５．９％）结合肌电图改变可确定诊断。     

辅酶Q10对兔膈肌疲劳的作用

实验以膈肌肌电图（ＥＭＧｄｉ）及膈肌诱发电位为指标，观察辅助酶Ｑ１０对兔膈肌作用，发现：（１）复制膈肌疲劳（ＤＩＦ）后静脉注射ＣｏＱ１０ｍｇ／ｋｇ，对ＤＩＦ有治疗作用，（２）提前１静脉注射ＣｏＱ１０１０ｍｇ／ｋｇ预处理，对电致作膈肌有保护作用。     

52例周围神经损害SLSEP测定的意义

目的探讨周围神经损害患者进行短潜伏期体感诱发电位（ＳＬＳＥＰ）测定的意义。方法对５２例周围神经损害患者常规进行ＳＬＳＥＰ检查，并同时作肌电图（ＥＭＧ）、运动神经传导速度（ＭＣＶ）、感觉神经传导速度（ＳＣＶ），结果均以３０名健康人所测作对照。结果ＳＬＳＥＰ、ＥＭＧ、ＭＣＶ和ＳＣＶ的异常率分别为９２％、８３％、７５％和８１％。结论ＳＬＳＥＰ对周围神经受损程度、部位的判断有独到之处，但还应结合临床表现、ＥＭＧ、ＭＣＶ、ＳＣＶ等因素加以分析判断。     

一家系遗传性运动感觉性神经病的神经电生理检查

本文报告１家３代遗传性运动感觉性神经病（ＨＭＳＮ）１２例患者及１例无症状者的脑干听觉诱发电位（ＢＡＥＰ）、体感诱发电位（ＭＥＰ）、磁刺激运动诱发电位（ＭＥＰ）、视觉诱发电位（ＶＥＰ）及肌电图（ＥＭＣ）和神经传导速度（ＮＣＶ），结果表明：ＢＡＥＰ、ＳＥＰ、ＭＥＰ、ＶＥＰ、ＥＭＧ和ＮＣＶ的异常率分别为９２％、９０％、９２％、７７％、９４％、９５％。     

无症状心肌缺血和心绞痛患者血浆中内皮素、降钙素基因相关肽和P物质含量的变化

本文测定了无症状心肌缺血（ＳＭＩ）组（１４例）、心绞痛组（１１例）和对照组（７例）运动试验前后血浆内皮素（ＥＴ）、降钙素基因相关肽（ＣＧＲＰ）和Ｐ物质（ＳＰ）的含量，探讨了这３种肽类物质在ＳＭＩ和心绞痛发生中作用的差异。结果显示：运动前３组之间血浆ＥＴ含量比较无显著性差异，运动后３组组血浆ＥＴ含量分别为７７．７０±１８．４４，１１１．３３±２４．８２，９４．３８±１２．５９ｎｇ／Ｌ心绞痛组显著高于ＳＭＩ组（Ｐ＜０．０１）．运动前３组之间和运动后３组之间血浆ＣＧＲＰ含量比较均无显著性差异。运动前３组之间血浆ＳＰ含量比较无显著性差异，运动后３组血浆ＳＰ含量分别为２．２５±０．２１、２．４６±０．２０、２．１８±０．１２ｎｍｏｌ／Ｌ，心绞痛组明显高于ＳＭＩ组（Ｐ＜０．０５）和对照组（Ｐ＜０．０１）．结果提示：血浆ＥＴ、ＳＰ含量升高可能参与了心绞痛的发生，而心肌缺血时无症状可能与血浆ＥＴ、ＳＰ未升高有关。     

Facioscapulohumeral muscular dystrophy. A quantitative electromyographic study

BACKGROUND: Quantitative electromyography (EMG) using different needle techniques has not been performed or reported on a relatively large group of patients with facioscapulohumeral muscular dystrophy (FSHD). Purpose: To establish statistically: (1) correlations between clinical features of patients (age, disease duration and degree of weakness) and quantitative needle EMG/SFEMG,; (2) correlations between different EMG parameters in the patient group, and (3) quantitative EMG differences comparing patients with a healthy control group. METHODS: Nerve conduction studies, and needle EMG (motorunit analysis, MacroEMG, SFEMG) were performed on Mm. triceps brachii and Mm. tibialis anterior according to standard techniques on 20 patients with FSHD. RESULTS: Nerve conduction studies were normal. In Mm. triceps brachii and, to a lesser extent, Mm. tibialis anterior motorunit analysis and MacroEMG showed myopathic changes, that correlated with patient clinical parameters. In Mm. triceps brachii (but not in Mm. tibialis anterior) EMG results were statistically different in patients compared to control group data. The most sensitive indicators of a myopathy were MUP duration (motorunit analysis) and MUP area (MacroEMG). In the Mm. triceps brachii SFEMG revealed correlations between worsening pooled MCD data and patient clinical parameters. Pooled MCD results did not correlate with other MUP parameters. SFEMG showed abnormal jitter only in 2 patients with the longest disease duration. CONCLUSION: Quantitative EMG results are compatible with a mild, slowly progressive myopathy. The most sensitive indicators of early muscle disease were MUP duration (motorunit analysis) and MUP area (MacroEMG) that would not be detected on "routine" EMG SFEMG showed subtle, progressive worsening of neuromuscular junction physiology. However, quantitative EMG and SFEMG showed that muscle fiber degeneration and loss followed a course independent of muscle fiber regeneration and reinnervation.     

慢性脊髓性肌萎缩的电生理改变及肌活检

目的:探讨慢性脊髓性肌萎缩(SMA)患者的肌电图及肌活检的诊断价值。方法:对38例SMA病人进行肌电图和肌活检检查。结果:肌电图除3例正常外,其余表现为神经原性损害;光镜提示神经原性萎缩。结论:提示肌电图在SMA的确诊有重要价值。     

Rigid spine syndrome (vacuolar variant). A quantitative electromyograhic study

BACKGROUND: Quantitative electromyography (EMG) using different needle techniques was performed as part of a complete systems review on 9 patients diagnosed with the vacuolar variant of rigid spine syndrome (RSS). Purpose: To establish statistically: (1) correlations between clinical features (patient age, disease duration, degree of weakness) and quantitative EMG; (2) correlation between different EMG parameters; (3) differences in quantitative EMG comparing patients with a healthy control group; and (4) correlate EMG with muscle pathology findings. METHODS: Nerve conduction studies and needle EMG (motorunit analysis, MacroEMG, SFEMG) were performed on Mm. triceps brachii and tibialis anterior according to standard techniques on 9 RSS patients. RESULTS: Nerve conduction studies were normal. Overall, clinical parameters did not correlate well with motorunit analysis and MacroEMG results. Motorunit analysis and MacroEMG results were significantly different comparing patients with controls. Motorunit analysis and MacroEMG correlated well with muscle biopsy findings. SFEMG results were within normal limits. CONCLUSION: Comprehensive EMG study results were compatible with a benign myopathic process. Results were consistent amongst patients within the study group, but differed significantly from the control group. Stable neuromuscular junction physiology did not accurately reflect evidence of muscle fiber degeneration and regeneration observed on muscle biopsies.     

A comparative study of single fiber electromyography and repetitive nerve stimulation in consecutive patients with myasthenia gravis

AIM: To compare the diagnostic yield of single fiber electromyography (SFEMG) and repetitive nerve stimulation (RNS) in consecutive patients with myasthenia gravis (MG). METHODS: Consecutive 33 patients with MG diagnosed on the basis of clinical features, positive neostigmine test and/or acetylcholine receptor antibody assay were categorized into stage 1 (3), 2A (10), 2B (12) and 2C (8 patients). Low rate repetitive nerve stimulation (3Hz) was performed in distal muscles (abductor digiti minimi, anconeus, flexor carpi ulnaris, tibialis anterior) and proximal muscles (deltoid, serratus anterior, trapezius and nasalis). Decrement exceeding 10% was considered abnormal. Single fiber EMG was performed in extensor digitorum communis (EDC), recording 20 potential pairs. The abnormality was defined as mean jitter exceeding 40 micros or 10% of potential pairs having block or jitter exceeding 54 micros. The abnormality in RNS and SFEMG was compared and correlated with severity of MG. RESULTS: RNS study was carried out in 33 and SFEMG in 30 patients. In 2 patients SFEMG was not possible due to lack of cooperation and in one due to severe weakness. The RNS study was normal in 6 (2 in stage 1, 3 in 2A and 1 in 2B) patients and in all of them SFEMG was abnormal. The abnormality in RNS and SFEMG correlated with severity of MG. CONCLUSION: SFEMG is indicated in the patients with MG in whom RNS test is negative.     

甲状腺机能亢进伴发重症肌无力患者电生理研究

目的：探讨甲状腺机能亢进（甲亢）伴发重症肌无力（MG）患者的电生理检测特点，和与慢性甲状腺机能亢进性肌病（CTM）的关系。方法：对7例甲亢伴发MG患者进行神经传导速度（NCV）、重复电刺激（RNS）、针极肌电图（EMG）和单纤维肌电图（SFEMG）检测。结果：7例NCV均正常，RNS5例异常。EMG2例发现有肌病的表现，SFEMG均出现jitter增宽。结论：甲亢病人可伴发MG，还可能同时伴发CTM，进行RNS、EMG、SFEMG检测是有必要的。     

单纤维肌电图(SFEMG)的研究进展

单纤维肌电图(single fiber electromyogram,SFEMG)研究的主要内容是骨骼肌同一运动单位相邻两条肌纤维在重复兴奋过程中,电位对时间间隔的变异,即颤抖(jitter)。两根肌纤维的放电间在2—20mS之间,而人体骨骼正常jitter值一般为5-55uS,因此在引导、测量、分析方面难度较大。随着科学技术的发展,SFEMG已在生理学科的研究和临床医学诊断等领域中占有重要地位。本文阐述了单纤维肌电图jitter的产生、引导、测量、分析的方法及应用价值。     

肌电图、神经电图在格林—巴利综合征中的应用

目的:探讨肌电图(EMG)、神经电图在格林-巴利综合征(GBS)中的特点。方法:对31例GBS患者进行运动神经124条、感觉神经93条及128块肌肉进行EMG;运动神经传导速度(MCV);远端潜伏期;F波的出现率、潜伏期、波形;感觉神经传导速度(SCV)及一过性离散(TD)测定。结果:每例均有3条以上神经受累;远端潜伏期延长58％;MCV减慢70％;SCV减慢50％;F波异常率73％;TD异常55％。EMG出现自发电位占32％。结论:GBS为广泛的周围神经远端,近端损害,感觉运动均受累,存在以脱髓鞘为主伴有轴索变性的特点。EMG、神经电图的无创性,简便及可重复性使其成为GBS极为重要的诊断手段。     

单纤维肌电图、重频电刺激在运动神经元病中的研究

本文对48例MND患者进行SFEMG研究,对其中43名MND患者进行RNS测定,研究发现:MND患者SFEMG阳性率为73％,在RNS检测中,部分MND患者有类重症肌无力现象的表现,即低频刺激时波幅递减,高频刺激波幅的递增反应。提示MND存在神经肌肉接头功能障碍,且以突触前损害可能性大。     

Recovery of the human biceps electromyogram after heavy eccentric,concentric or isometric exercise

Summary Five men performed submaximal isometric, concentric or eccentric contractions until exhaustion with the left arm elbow flexors at respectively 50%, 40% and 40% of the prefatigued maximal voluntary contraction force (MVC). Subsequently, and at regular intervals, the surface electromyogram (EMG) during 30-s isometric test contractions at 40% of the prefatigued MVC and the muscle performance parameters (MVC and the endurance time of an isometric endurance test at 40% prefatigued MVC) were recorded. Large differences in the surface EMG response were found after isometric or concentric exercise on the one hand and eccentric exercise on the other. Eccentric exercise evoked in two of the three EMG parameters [the EMG amplitude (root mean square) and the rate of shift of the EMG mean power frequency (MPF)] the greatest (P<0.001) and longest lasting (up to 7 days) response. The EMG response after isometric or concentric exercise was smaller and of shorter duration (1–2 days). The third EMG parameter, the initial MPF, had already returned to its prefatigued value at the time of the first measurement, 0.75 h after exercise. The responses of EMG amplitude and of rate of MPF shift were similar to the responses observed in the muscle performance parameters (MVC and the endurance time). Complaints of muscle soreness were most frequent and severe after the eccentric contractions. Thus, eccentric exercise evoked the greatest and longest lasting response both in the surface EMG signal and in the muscle performance parameters.     

有源电极用于表面肌电信号的检测

表面肌电信号的研究对康复医学、运动医学和临床诊断等具有重要意义，信号的正确检测是定量分析表面肌电信号的前提。本文探讨了如何减小表面肌电信号检测中可能遇到的噪声及电极单元的设计要点，并采用仪用放大器AD620设计了双极性的有源电极用于信号检测。实验表明，采用有源电极可以提高信噪比，减小噪声，有效地提取出表面肌电信号。