慢性酒精中毒性肌病的临床与神经电生理学研究

Clinical and Electrophysiological characteristics of chronic alcoholic myopathy

目的 探讨慢性酒精中毒性肌病的临床和电生理改变特点。方法 对 2 6例慢性酒精中毒性肌病、13例慢性酒精中毒性周围神经病、2 1例慢性酒精中毒性神经和肌肉混合损害患者 ,以及 2 0例正常受试者进行详细询问病史、查体 ,并记录酒精摄入量和测定相关神经电生理指标 ,包括肌电图、单纤维肌电图、肌纤维传导速度、周围神经传导速度和诱发电位。结果 (1)酒精中毒性肌病的主要临床表现为肢带肌的无力、肌肉疼痛和萎缩 ,肌病的症状和体征往往先于周围神经的损害。 (2 )与正常对照受试者比较 ,各组患者神经肌肉颤抖值均增大 (t检验 ,P<0 .0 5 ) ,纤维密度增加 (t检验 ,P<0 .0 5 ) ,周围神经病组患者的神经肌肉颤抖值和纤维密度改变尤为显著 (t检验 ,P<0 .0 1)。 (3)肌病组患者肌纤维传导速度明显减慢 (t检验 ,P<0 .0 5 ) ,其余两组患者无显著变化 (t检验 ,P>0 .0 5 )。结论 (1)酒精中毒性肌病临床主要表现为对称性肢带肌萎缩、肌力减退和肌肉疼痛。 (2 )肌电图提示肌源性改变 ,特别是肌纤维传导速度减慢 ,是诊断酒精中毒性肌肉病变的客观指征。

Objective To investigate the clinical and electrophysiological characteristics of chronic alcoholic myopathy. Methods A detailed medical record including individual life history,alcohol consumption,clinical symptoms and physical signs were collected in 26 patients with chronic alcoholic myopathy,13 patients with chronic alcoholic peripheral neuropathy,21 patients with chronic alcoholic neuromuscular damage and 20 normal subjects. An electrophysiological study including electromyography,nerve conduction velocity,evoked potential,single fiber electromyography and mulscle fiber conduction velocity were also performed in all patients. Results (1)The main clinical manifestations of the patients with chronic alcoholic myopathy were weakness,muscle pain and muscle atrophy,usually in the proximal parts of the limbs symmetrically. Symptoms resulted from injuried muscles were priority to that caused by peripheral nerve injury. (2)Comparing to the normal subjects,neuromuscular jitter and fiber density increased in all patients (t test,P< 0.05),the changes were most obvious among the patients with neuropathy (t test,P< 0.01). (3)Muscle fiber conduction velocity was significantly slowed in all patients with myopathy (t test,P< 0.05),but no significant change was found in the other two groups (t test,P> 0.05). Conclusion (1)The main clinical manifestations of chronic alcoholic myopathy are weakness,muscle pain and muscle atrophy,in the proximal parts of the limbs symmetrically.. (2)The myopathic patterns of electromyography,especially the slowed mulscle fiber conduction velocity,might be as the diagnostic indicates of chronic alcoholic myopathy.