肌萎缩侧索硬化感觉系统的神经电生理研究

Neuroelectrophysiological study of sensory system in amyotrophic lateral sclerosis

目的通过神经电生理技术,评价肌萎缩侧索硬化(ALS)患者感觉系统的功能状态。方法参照修订的El Escorial诊断标准,纳入临床确诊和拟诊肢体起病的ALS患者66例,根据临床有无感觉症状,分为有感觉症状组(sALS组,13例)和无感觉症状组(nsALS组,53例),并选择60例体检健康者为健康对照组。应用Keypoint 4肌电诱发电位仪,对受试者进行双侧上下肢感觉神经传导检查(SNCS)和皮肤交感反应(SSR)检测;借助Pathway疼痛和感觉评估系统进行双侧小腿前外侧及前臂掌侧面的接触性热痛诱发电位(CHEP)检测。结果(1)ALS患者SNCS异常率为0,SSR异常率为21.2%(14/66),CHEP异常率为27.3%(18/66);sALS组SSR和CHEP的异常率分别为30.8%(4/13)和38.5%(5/13),nsALS组SSR和CHEP的异常率分别为18.9%(10/53)和24.5%(13/53)。(2)与健康对照组相比,sALS组和nsALS组下肢SSR的潜伏期延长,上、下肢CHEP检测N波潜伏期延长、N-P波波幅减低(P<0.05)。与nsALS组相比,sALS组下肢CHEP检测N波的潜伏期延长、N-P波波幅减低(P<0.05)。结论ALS患者存在感觉系统小纤维损害。

Objective To evaluate the functional status of the sensory system in patients with amyotrophic lateral sclerosis(ALS)by neuroelectrophysiological techniques.Methods According to the revised El Escorial diagnostic criteria,66 patients with clinically confirmed and proposed limb-onset ALS were included and divided into the sensory symptom(sALS,n=13)group and without sensory symptom(nsALS,n=53)group according to the presence or absence of clinical sensory symptoms.Sixty healthy individuals were selected as the health control(HC)group.Sensory nerve conduction studies(SNCS)and skin sympathetic response(SSR)of bilateral upper and lower limbs were detected by Keypoint 4 electromyography evoked potential instrument.Pathway pain and sensation assessment system was used to conduct contact heat evoked potential(CHEP)detection of bilateral anterolateral leg and forearm volar side.Results(1)The abnormal rates of SNCS,SSR and CHEP in the ALS group were 0%,21.2%(14/66)and 27.3%(18/66),respectively.The abnormal rates of SSR and CHEP in the sALS group were 30.8%(4/13)and 38.5%(5/13).The abnormal rates of SSR and CHEP in the nsALS group were 18.9%(10/53)and 24.5%(13/53).(2)Compared with the HC group,the latency of SSR in lower limbs was prolonged in the sALS group and the nsALS group,the latency of N wave in CHEP of upper and lower limbs was prolonged,and the amplitude of N-P wave was decreased(P<0.05).Compared with the nsALS group,the sALS group showed prolonged N wave latency and reduced N-P wave amplitude for anterolateral calf stimulation by CHEP detection(P<0.05).Conclusion ALS patients have small fiber damage in the sensory system.