肌萎缩侧索硬化与腕管综合征的正中神经运动传导及F波比较

The study of median nerve motor conduction and F wave in amyotrophic lateral sclerosis and carpal tunnel syndrome

目的通过对肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)、腕管综合征(carpal tunnel syndrome,CTS)及健康对照组正中神经的神经传导及F波指标的对比分析,探讨无创鉴别ALS和CTS的电生理指标。方法回顾性分析作者医院2019年1月至2020年10月收治的ALS患者(n=45)及CTS患者(n=53),并选择同期健康体检者(n=58)作为健康对照,对三组正中神经的神经传导及F波指标进行分析,并对ALS组临床资料(包括ALS的病程、起病部位、病情进展方式、近或远端起病方式等)与正中神经F波指标进行相关性分析。结果远端运动潜伏期(distal motor latency,DML)、复合肌肉动作电位(compound muscle action potential,CMAP)、感觉神经传导速度(sensory nerve conduction velocity,SCV)三组间差异有统计学意义(均P<0.05),且三组间两两比较差异均有统计学意义(均P<0.05)。F波出波率(F-wave persistent,FP)、重复F波百分比(the percentage of repeated F waves,RFP)、巨大F波(giant F waves,GF)出现与不出现受试者比值、重复巨大F波(repeated giant F waves,RGF)出现与不出现受试者比值在三组间差异有统计学意义(均P<0.05)。与CTS组比较,ALS组正中神经DML〔(4.51±0.91)ms比(4.02±0.76)ms,P<0.05〕更短、CMAP波幅下降更明显〔(10.76±3.98)mV比(5.15±3.86)mV,P<0.05〕、SCV更快〔(42.54±12.07)m/s比(58.81±6.21)m/s,P<0.05〕、F波最短潜伏期与M波潜伏期差(difference between F-wave minimal latency and M-wave latency,Fmin-M)更长〔(20.05±3.44)ms比(22.05±2.47)ms,P<0.05〕、FP降低〔95.0(80.0,100.0)%比50.0(25.0,85.0)%,U=2046.50,P<0.05〕、RFP更高〔0(0,10.0)%比15.0(0,27.5)%,U=885.00,P<0.05〕、GF出现与不出现受试者比值〔3/50比14/31,χ^(2)=98.00,P<0.05〕及RGF出现与不出现受试者比值更高〔0/53比7/38,χ^(2)=98.00,P<0.05〕。ALS组FP与病程(r=-0.49,P=0.003)、病情进展方式(r=-0.43,P=0.020)及起病部位(r=-0.50,P=0.003)呈负相关,RFP与病情进展方式(r=-0.42,P=0.022)及起病部位(r=-0.45,P=0.008)呈负相关。结论正中神经感觉传导相对保留而CMAP波幅降低是ALS鉴别于CTS的重要电生理特点。出现正中神经RGF是ALS与CTS鉴别的重要指标;ALS在腕以远和腕以近均有运动传导障碍,不能将远端运动潜伏期延长作为鉴别ALS与CTS的指标。

Objective This research analyzed median nerve conduction and F wave variables in amyotrophic lateral sclerosis(ALS),carpal tunnel syndrome(CTS)and normal control group.The potential aim is to find the non-invasive and effective parameters to identify ALS and CTS.Methods A retrospective analysis was conducted on ALS patients(n=45)and CTS patients(n=53)admitted to authors hospital from January 2019 to October 2020,and healthy individuals during the same period(n=58)were selected as healthy control group.The nerve conduction and F-wave data of the median nerve in the three groups were analyzed.Correlation analysis was conducted between clinical data of ALS group(including the duration of ALS,site of onset,mode of disease progression,and proximal or distal onset)and F-wave data of the median nerve.Results There were significant differences in distal motor latency(DML),compound muscle action potential(CMAP),and sensory nerve conduction velocity(SCV)between the three groups(all P<0.05),and post hoc analysis(all P<0.05).The F-wave persistence(FP),the percentage of repeated F waves(RFP),the ratio of the appearance and absence of giant F waves(GF),and the ratio of the appearance and absence of repeated giant F waves(RGF)showed statistically significant differences among the three groups(all P<0.05).Compared with the CTS group,the median nerve DML in the ALS group[(4.51±0.91)ms vs.(4.02±0.76)ms,P<0.05]was shorter,CMAP amplitude decreased more significantly[(10.76±3.98)mV vs.(5.15±3.86)mV,P<0.05],SCV was faster[(42.54±12.07)m/s vs.(58.81±6.21)m/s,P<0.05],and the difference between the minimal F-wave latency and M-wave latency(Fmin-M)was longer[(20.05±3.44)ms vs.(22.05±2.47)ms P<0.05],FP decreased[95.0(80.0,100.0)%vs.50.0(25.0,85.0)%,U=2046.50,P<0.05],RFP was higher[0(0,10.0)%vs.15(0,27.5)%,U=885.00,P<0.05],GF occurrence ratio[3/50 vs.14/31,χ^(2)=98.00,P<0.05]and RGF occurrence ratio was higher[0/53 vs.7/38,χ^(2)=98.00,P<0.05].The F-wave persistence in the ALS group was negatively correlated with the duration of the disease(r=-0.49,P=0.003),mode of disease progression(r=-0.43,P=0.020),and region of onset(r=-0.50,P=0.003).RFP was negatively correlated with mode of disease progression(r=-0.42,P=0.022)and region of onset(r=-0.45,P=0.008).Conclusions The relativelg spared median nerve sensory conduction and the decrease in CMAP amplitude are important electrophysiological characteristics for distinguishing ALS from CTS;The appearance of RGF in the median nerve of ALS is an important indicator for distinguishing it from CTS.ALS has motor conduction disorders both far and near the wrist,and prolonged distal motor latency cannot be used as an indicator to distinguish ALS from CTS.