肌萎缩侧索硬化患者神经传导分析

目的分析肌萎缩侧索硬化(ALS)患者的神经传导特点,并探讨神经传导与不同起病部位之间的关系。方法收集于2012年1月至2014年12月期间我院门诊或病房收治的ALS患者47例和体检的健康对照组40例,均测定其运动及感觉神经传导、F波。结果ALS患者运动神经传导检测表现为潜伏期(DML)延长,复合肌肉动作电位(CMAP)波幅下降,传导速度(MCV)减慢,其中以CMAP波幅下降为主。可见"分裂手"和"分裂足"现象。部分病人的症状、体征或电生理出现感觉神经受累证据。部分病人的F波出波率异常。结论诊断ALS需对临床和神经电生理进行综合分析,不能仅凭其中一项而轻易排除诊断。临床医生,特别是基层医院医生,要全面细致地完善辅助检查结果,减少漏诊和误诊的发生。

Analysis of nerve conduction in patients with amyotrophic lateral sclerosis

Objective To analyze the characteristics of nerve conduction in patients with amyotrophic lateral sclerosis (ALS) and to investigate the correlation between nerve conduction and different sites of onset.Methods Analysis was performed on 47 cases who were outpatients or inpatients with ALS in our hospital from January 2012 to December 2014 and 40 healthy controls who had been physically examined. Motor and sensory nerve conduction and F-wave were determined for the participants.Results The patients with ALS showed increased distal motor latency, reduced compound muscle action potential (CMAP) amplitude, and decreased motor conduction velocity, among which CMAP amplitude reduction was the main manifestation. The "split hand" and "split foot" phenomena were observed. It was revealed by clinical manifestations, physical signs, or electrophysiological examinations that sensory nerve conduction was involved in some of the patients. The rate of F-wave appearance was abnormal in some patients.Conclusions The diagnosis of ALS is based on comprehensive analysis of clinical and neuroelectrophysiological examination results and cannot be hastily excluded by only one result among the methods. Clinicians, especially those from primary hospitals, must thoughtfully and carefully evaluate the results of accessory examinations to reduce missed diagnosis and misdiagnosis.