眼眶冰试验和休息试验对重症肌无力的诊断价值

The ice test and rest test for diagnosis of myasthenic ptosis

目的评价眼眶冰试验、休息试验对重症肌无力(myasthenia gravis,MG)性上睑下垂的诊断价值。方法对228例出现上睑下垂症状的患者相继进行疲劳、冰、休息及新斯的明试验,比较各项试验对MG性上睑下垂患者诊断的敏感性与特异性。结果①所有试验均能引起MG性上睑下垂患者睑裂显著性变化,其中以20min冰试验睑裂变化幅度最大,Md=3mm,[P25,P75]∶[2mm,4.75mm];②若分别以睑裂变化幅度≥2mm及≥3mm为阳性标准,对于MG性上睑下垂患者,20min冰试验的敏感性(79.1%、60.5%)最高,休息、新斯的明试验的特异性(100%、100%)最高;③配对比较显示,对于MG性上睑下垂患者,2min、20min冰试验比休息试验致睑裂变化幅度大(P=0.000、P=0.000),20min冰试验比2min冰试验、新斯的明试验致睑裂变化幅度大(P=0.000、P=0.002);④非MG性上睑下垂患者对上述试验(特别是20min冰试验)有一定的假阳性反应,若提高阳性标准至≥3mm可以减少假阳性反应。结论由于冰试验的敏感性高,休息试验的特异性高,两项试验均具有快捷、安全、价廉、无创的优势,对于MG性上睑下垂有辅助诊断价值。

Objective TO evaluate the value of non-invasive ice test and rest test for diagnosis of myasthenic ptosis. Methods Palpebral fissures of 228 cases with ptosis, including 181 cases with myasthenic ptosis and 47 cases with non-myasthenic ptosis, were measured before and immediately after 1 min fatigue test, 2 min rest test, 2 min and 20 rain ice test and 30 min neostigmine test at 20℃-25℃ on the same day. The sensitivity and specificity of all tests to the diagnosis of myasthenic ptosis were compared. Results （1）For all tests, there were significant palpebral fissure changes in patients with myasthenic ptosis, and the greatest eyelid change was observed at 20 min ice test, Md = 3. 31 mm, [ P25, P75 ] ： [2 mm, 4. 75 mm] ; （2）As for myasthenic ptosis, if eyelid change 32 mm or ≥3mm was considered as a positive standard separately, the highest sensitivity was noted at 20 min ice test （79.1% , 60.5% ）, the highest specificity were noted at rest test and neostigmine test （ 100%, 100% ） ; （3）Paired comparison showed that 2 min and 20 min ice test improved eyelid elevation greater than rest test（ P = 0. 000, P = 0.000） , 20 min ice test improved it greater than 2 min ice test and neostigmine test （P = 0. 000 ,P = 0.002 ） ; （4） Some false-positive reactions occasionally occurred in non-myasthenic ptosis at above tests, especially at 20 min ice test. But if the positive standard was increased from ≥2 mm to ≥3 mm, the false-positive reactions were declined. Conclusions The high sensitivity of ice test and high specificity of rest test, as well as their rapid, simple, safe, cheap and woundless characteristics make them both benefit to the diagnosis of myasthenic ptosis.