不同阶段肌萎缩侧索硬化患者肌电图的研究

目的研究不同阶段肌萎缩侧索硬化(ALS)患者的定量肌电图(EMG)表现,寻找早期诊断ALS的敏感电生理指标。方法对60例ALS患者进行定量EMG检查,分析不同阶段运动单位动作电位(MUPs)多相参数、自发电位和大力收缩募集相变化,并与健康对照组进行比较。结果不同阶段ALS EMG表现不同,从最早期阶段到最后阶段可分为N0~N56个连续的电生理阶段。N2期MUPs的时限、波幅、面积、运动单位指数(SI)、多相波数值均较健康对照组显著升高(均P<0·001),N0、N4期MUPs部分多相参数数值明显升高(P<0·05);自发电位在病变的各个阶段均可见到,以N2~N5多见,分别为63·6%、83·0%、91·2%、100%。结论ALS患者早期阶段如出现自发电位,即为下运动神经元受累的特征表现;定量EMG检查中运动单位面积和波幅增大是其显著特点。

Study of electromyography in patients with amyotrophic lateral sclerosis of different stages

Objective To study the quantitative electromyography in patients with ALS of different stages and determine the sensitive parameters for early diagnosis.Methods Quantitative electromyography was performed in 371 muscles of 60 ALS patients and 275 control muscles. MUPs parameters, the presence of spontaneous activity and the recruitment order were measured. The electromyographic data were analyzed respectively and compared with the values obtained in the control group; Results There were obviously different electromyographic patterns in each stage. Six electrophysiological stages N_0-N_5 could be discerned from the early to the most advanced phase; Compared with those of the control group, the amplitude, area, duration, SI and polyphasia of MUPs all increased significantly in N_2 ( P< 0.001), and some parameters increased significantly in N_0, N_4 ( P< 0.05); Spontaneous activity could be detected in every stage.Conlusions The spontaneous activity in EMG could be found in the very early stage of ALS,which suggests lower motor neurons may be involved, if present, MUPs area and amplitude increasing in quantitative EMG are the significant feature of ALS.