束颤电位在肌萎缩侧索硬化诊断中的作用

Role of fasciculation potentials in the diagnosis of amyotrophic lateral sclerosis

目的探讨束颤电位在肌萎缩侧索硬化诊断中的作用。方法对2009年8月至2010年8月就诊于北京大学第二三医院神经科的60例肌萎缩侧索硬化患者进行常规肌电图检测，包括针极肌电图、神经传导速度等，其中肌电图静息状态下束颤电位的检测条件为：患者保持所检测肌肉放松，检测者取同心圆针电极进行检测，记录条件：带通20Hz至10kHz，扫描速度为5ms／D，灵敏度在0．05～0．5mV／D的范围内调节，每块肌肉观察1～5min，记录束颤电位的波幅、时限和相位数。结果胸锁乳突肌中，束颤电位的出现率高于纤颤电位和正锐波（36．7％比13．3％，X2=8．71，P〈0．05），病程18个月以上患者束颤电位波幅和时限高于发病8个月以下患者[（1．8±0．9）mV，（1．0±0．6）mV；（15．2±4．1）InS，（11．2±3．0）ms；q=3．43，3．51，P〈0．05），如果把束颤电位列入急性失神经表现，肌萎缩侧索硬化确诊级别患者可以增加（80％比60％；X＾2=5．71，P=0．02）。结论束颤电位对于肌萎缩侧索硬化的廿期诊断可能有重要意义，在疾病的不同时期，束颤电位形态不同。

Objective To explore the role of fascieulation potentials in the diagnosis of amyotrophic lateral sclerosis （ALS）. Methods A total of 60 ALS patients were recruited from August 2009 to August 2010 at our hospital. Standard examinations of electromyography and nerve conduction were performed. And faseieulation potentials were measured in the resting muscles with a band pass of 20 Hz - 10 kHz, a sensitivity of 0. 05 -0. 5 mV/D and a sweep speed of 5 ms/D. Each muscle was observed for 1 -5 minutes. The amplitude, duration and phase of faseieulation potentials were recorded. Results The occurrence rate of fasciculation potential in sternoeleidomastoid was more than that of fibrillation and positive sharp wave in ALS patients （ 36. 7% vs 13.3%, X2 = 8.71, P 〈 0. 05 ）. The amplitude and duration of fascieulation potentials in ALS patients with a duration of over 18 months were higher than that of those with a duration of under 8 months [（1.8±0.9） mY, （1.0±0.6） mV; （15.2±4.1） ms, （11.2±3.0） ms; q = 3.43, 3.51 , P 〈 0.05 ） 1. The patients with definite ALS might increase if faseiculation potentials were X2 considered as spontaneous potential （ 80% vs 60% ; = 5.71, P = 0. 02 ）. Conclusion With different morphologies at different disease stages, faseieulation potentials may be useful in the earlier diagnosis of amyotrophie lateral sclerosis.