新斯的明试验与重复低频刺激对重症肌无力诊断意义的比较

Comparison About the Diagnosing Value of Neostigmine Test and Repeatedly Low-frequency Stimulation in Diagnosing MG

目的:探讨新斯的明试验与重复低频刺激在重症肌无力中诊断价值的比较。方法:选择59例疑诊为重症肌无力的患者,其中Ⅰ型28例,Ⅱ型10例,Ⅲ型14例,Ⅳ型4例(合并胸腺瘤3例),Ⅴ型3例。所有患者均行新斯的明药物试验(新斯的明注射液1 mg、阿托品注射液0.5 mg肌注),重复低频刺激检查,其中在重复低频刺激检查中分别以1 Hz、3 Hz、5 Hz进行刺激,选择的刺激神经有面神经、尺神经、腋神经。结果:所有的重症肌无力患者新斯的明试验均阳性,为100%(除1例剂量不足,增加剂量后呈阳性外)。重复低频刺激中,低频刺激波幅呈递减的占43%。结论:重症肌无力的诊断标准中,新斯的明试验是一种安全、可靠、敏感性极高的一种诊断手段,几乎所有类型的重症肌无力患者均呈阳性。重复低频刺激中,低频刺激波幅呈递减现象的Ⅰ型仅为3例(3/28),而其它类型的患者低频刺激波幅呈递减现象均高于Ⅰ型,在重复低频刺激波幅呈递减的神经中,以腋神经的阳性率最高。

Objective： To explore the value for clinical diagnosing MG between neostigmine test and repeatedly low - frequency stimulation. Methods： 59 cases with MG were selected , 28 patients with type Ⅰ, 10 patients with typeⅡ , 14 types with type Ⅲ , 4 patients with type IV, （3 patients with thymoma）, 3 patients with type V . Neostigmine test was used to all patients with MG （injection of neostigmine 1 mg and atropine 0.5 mg were inject into muscle）. To stimulate nerve repeatedly with low - frequency 1 Hz, 3 Hz, 5 Hz. Facial nerve, ulnar nerve and axiuary nerve ere selected to stimulate with MG . Results. （except one with inadequate dose, It was positive after increasing dose） The positive rate of neostigmine test is 100 %. In the patients with repeatedly low - frequency stimulation, the rate of stimulating amplitude reduced gradually was 43 %. Conclusion： In the diagnostic standards of MG, neostigmine test is a safe, reliable and highly sensitive diagnostic method. Almost all types of patients with MG were positive. In the patients with repeatedly low-frequency stimulation, the patients with gradually reducing amplitude were only three in typeⅠ （3/28）. The accidences in other types were higher than type Ⅰ. In the nerves that stimulating amplitude reduced gradually, the highest positive rate was axillary nerve.