肌萎缩侧索硬化病人胸段棘旁肌、胸锁乳突肌、舌肌肌电图联合检测分析

Analysis of combined tests of thoracic paraspinal muscles and sternocleidomastoid muscles and tongue muscles with electromyography for patients suffering ALS

目的探讨胸段棘旁肌、胸锁乳突肌、舌肌肌电图联合检测在肌萎缩侧索硬化(ALS)诊断中的价值。方法对30例临床确诊的ALS患者的胸段棘旁肌、胸锁乳突肌、舌肌及3肢体肌的肌电图进行分析。同时将性别、年龄相匹配的30名健康者作为对照,行胸段棘旁肌、胸锁乳突肌自发电位检测。结果30例ALS患者中,28例(93%)胸段棘旁肌肌电图可见正锐波和纤颤电位。胸锁乳突肌肌电图异常27例(90%),以运动单位时限增宽、波幅增高为特点。舌肌肌电图12例(40%)可见正锐波和纤颤电位。健康对照组胸段棘旁肌、胸锁乳突肌均无异常。结论胸段棘旁肌肌电图和胸锁乳突肌肌电图在诊断ALS疾病中的敏感性是相同的。对ALS患者除行常规3肢体肌的肌电图检测外,应加做胸段棘旁肌和胸锁乳突肌,以提高ALS早期诊断的阳性率和准确性。舌肌肌电图检测阳性率低于胸段棘旁肌和胸锁乳突肌,且容易出血、检查痛苦,患者不易接收,不应作为常规检测。

Objective: To evaluate combined tests of thoracic paraspinal muscles and sternocleidomastoid muscle and tongue muscles with electromyography as diagnostic aids in amyotrophic lateral sclerosis (ALS). Methods: Thoracic paraspinal muscles, sternocleidomastoid muscles, tongue muscles and three-limb muscles were analysed with electromyography in 30 patients who had been identified as having ALS. Age and sex matched. 30 normal subjects were also detected in thoracic paraspinal muscles and sternocleidomastoid muscle for finding fib and psw [fibrillation potentials (fib) and positive sharp waves (psw)] serving as controls. Results: In ALS group, fib and psw were found in thoracic paraspinal muscles in 28 of 30 ALS patients (93%), abnormal in sternocleidomastoid muscle in 27 of 30 ALS patients (90%), characterized by having long-duration and high-amplitude. Fib and psw were found in tongue muscles in 12 of 30 ALS patients (40%). Normal subjects were not found abnormal in thoracic paraspinal muscles and sternocleidomastoid muscle. Conclusions: Electromyography for thoracic paraspinal muscles and sternoeleidomastoid muscle should present the same sensitive tool for diagnosis of ALS. To ALS patients, except for the test of regular three-limb muscles, we suggest that tests of thoracic paraspinal muscles and sternocleidomastoid muscle be added with electromyography so as to raise the positive rate and accuracy in early ALS diagnosis. The positive rate of tongue muscles with electromyography is lower than that of thoracic paraspinal muscles and sternocleidomastoid muscles. Because of probably causing bleeding and pain which patients cannot easily accept, the test of tongue muscles shouldn′t be used as a means of regular test.