斜方肌肌电图在肌萎缩侧索硬化早期诊断中的应用

Evaluation of upper trapezius electromyography in the early diagnosis of amyotrophic lateral sclerosis

目的探讨斜方肌肌电图在检测肌萎缩侧索硬化（ALS）延髓部下运动神经元损害中的价值。方法对100例ALS患者、80例颈椎病患者和100名健康志愿者进行斜方肌肌电图检测，ALS组和颈椎病组同时进行胸锁乳突肌、第一骨间肌、腹直肌、胫前肌肌电图检测，比较3组肌电图的差异。颈椎病组中43例患者进行手术前后斜方肌肌电图比较。结果ALS组中，病程≤8个月的患者斜方肌肌电图自发电位的出现率高于病程〉8个月者[分别为21／30（70％）和28／70（40％），χ2=7．56，P=0．004]；斜方肌肌电图与胸锁乳突肌肌电图异常率比较差异无统计学意义。ALS组[波幅（1086．9±152．6）μV，时限（17．2±6．5）ms，多相波23．6％±3．4％]与对照组[波幅（606．7±82．7）μV，时限（11．6±1．8）ms，多相波12．8％±2．2％；g=9．27、4．57、4．12，均P〈0．01]、ALS组与颈椎病组[术前，波幅（615．7±90．3）μV，时限（12．1±2．0）ms，多相波13．5％±2．4％]间运动单位动作电位（MUAP）各参数比较，差异有统计学意义（q=8．32、4．25、4．23，均P〈0．01）。颈椎病患者手术前后斜方肌肌电图MUAP各参数无明显变化，5例术后发现少量自发电位。结论斜方肌肌电图可作为检测ALS延髓部下运动神经元损害的辅助手段，特别是早期可见自发电位增多。

Objective To evaluate the application of upper trapezius muscle electromyography （EMG） in the diagnosis of lower motor neuron damage in bulbar region in amyotrophic lateral sclerosis （ALS）. Methods Standard EMG was recorded over upper trapezius muscle in 100 patients with ALS, 80 patients with cervical spondylotic myelopathy （CSM） and 100 normal controls. In groups of ALS and CSM, EMG was also recorded over sternocleidomastoid, rectus abdominis, first dorsal intercostals muscle and tibialis anterior muscles. Among those CSM patients, 43 patients had operations and the EMG on their trapezius muscle was examined at pre-operation and at 3 months post-operation. The parameters of EMG were analyzed between the groups. Results In ALS patients, spontaneous activity in upper trapezius EMG was detected more frequently in patients with disease duration equal to or less than 8 months than the others （21/30（70%） vs 28/70（40% ）, X2 = 7.56, P = 0. 004）. There was no difference in neurogenic EMG changes including abnormal spontaneous potentials and motor unit action potentials （MUAP） between trapezius and sternocleidomastoid in patients with ALS. Significant differences in MUAP were noted between ALSpatients（（1086.9 ± 152.6） μV, （17.2 ±6.5） ms, 23.6% ±3.4%） and controls （（606.7 ± 82.7）μV,（11.6±l. 8） ms,12. 8% ±2.2% ;q =9.27, 4.57, 4. 12, allP〈0.01）, and between patients with ALS and patients with CSM （（615.7±90.3） μV,（12.1 ±2.0） ms, 13.5% ±2.4%,q =8.32, 4. 25, 4. 23, all P 〈 0. 01 ）. Few spontaneous activities in trapezius EMG were detected in post-operation CSM patients. Conclusion EMG in upper trapezius can assist in assessment of clinical and subclinical involvement of bulbar lower motor neurons in patients with ALS, especially at earlier stage.