三重刺激技术在中国汉族人群中的正常参考值

目的 在健康志愿者中检验三重刺激技术(TST)的可靠性,并探讨其在中国汉族人群中的正常参考值.方法 对2010年4月至2011年2月来自北京大学第三医院神经科的100名健康志愿者进行了双侧小指展肌TST检测,结合经颅磁刺激和外周刺激,应用对冲技术,给予3个刺激,发生2次对冲.3个刺激分别为磁刺激皮质运动区、电刺激腕部、电刺激Erb点.TST检测的顺序是:经颅磁刺激→在腕部电刺激→在Erb点电刺激;TST对照的顺序:在Erb点电刺激→在腕部电刺激→在Erb点电刺激.结果以TST检测/TST对照波幅比率表示,采用配对样本t检验及单因素方差分析,同时比较不同性别、年龄、臂长以及左右侧之间的数值.结果 全部受试者的TST检测/TST对照波幅比率为85.0％±6.7％.受试者左、右侧TST数值以及不同性别、不同年龄组之间差异均无统计学意义.臂长61～70 cm的受试者(50名)和臂长71 ～ 80 cm的受试者(50名)TST数值分别为85.0％±2.6％和85.0％±8.7％,组间比较差异同样无统计学意义.结论 TST检测方法比较完善,不受年龄、侧别、性别、臂长的影响,可试用于锥体束功能的检测.

Triple stimulation technique: normative value of Chinese adults

Objective To validate the technique and to establish the reference values of triple stimulation technique(TST)in healthy Chinese adults.Methods One hundred healthy subjects were recruited to undergo TST from April 2010 to February 2011 in both abductor digiti minimi.The TST combines transcranial magnetic stimulation(TMS)of the motor cortex with peripheral collision studies.Three stimuli were given,leading to two collisions.A first magnetic stimulus was applied to the scalp overlying the motor cortex.After a delay,an electric stimulus was applied over the ulnar nerve at the wrist.The delay was chosen so that the action potentials descending from the cortex collided with the antidromic action potentials evoked at the wrist,with the collision site at the wrist and above.After another delay,another electrical stimulus was applied to Erb' s point.This delay was chosen so that ascending antidromic action potentials evoked by wrist stimulation collided at or distal to Erb' s point.At the same time,TST test curves were recorded.The TST test curve was compared with a TST control curve in which the first stimulus was applied to Erb' s point and the other two stimulus sites were the same as the test curve.Control stimuli were thus applied successively to Erb' s point,the wrist,Erb' s point.TST quantifies the number of conducting central motor neurons(expressed by the TST amplitude ratio).The values were compared among genders,age groups,arm length and sides respectively.Results The TST amplitude ratio(TSTteat/TSTcontrol)was 85.0％ ± 6.7％.There were no difference among genders,age groups,arm length and sides respectively.The TST amplitude ratio were 85.0％ ± 2.6％ and 85.0％ ± 8.7％,respectively in subjects with arm length 61-70 cm and 71-80 cm.Conclusion TST could be examined precisely and the normative value could be got.