应用多点刺激法运动单位数目估计评定平山病病情

A study of motor unit number estimation by multiple point stimulation in patients with Hirayamadisease ]

目的探讨多点刺激法运动单位数目估计（MUNE）在平山病病情判定中的意义。方法采用病例对照研究，记录35例健康人和69例平山病患者拇短展肌和小指展肌MUNE数值。结果（1）平山病组左侧拇短展肌MUNE为145．66±126．10，左侧小指展肌MUNE为102．20±112．67，右侧拇短展肌MUNE为149．72±117．80，右侧小指展肌MUNE为64．23±69．27，较对照组显著降低（P〈0．01）。（2）在临床尚未出现明显症状的肌肉也可见到MUNE明显下降，尤其在症状不显著侧（P〈0．05）。结论多点刺激法MUNE检测可客观监测疾病自然过程，早期了解病情及定量评价肌肉的失神经支配情况。

Objective To explore the significance of motor unit number estimation （MUNE） by using multiple point stimulating technique to evaluate patients with Hirayama disease （HD）. Methods Multiple point stimulating technique was used to estimate the motor unit number of abductor pollicis brevis and abductor digiti minimi in 35 normal subjects [ 14-33 years old, mean （20. 9 ±4. 0） years old, 33 men and 2 women] without nerve and muscle disease and 69 patients definitely diagnosed as HD [ 16-35 years old, mean （21.46 ±6. 61 ） years old, 67 men and 2 women]. The differences between the two groups were examined by Fisher＇s exact test and t test. Results There were 42 patients with atrophy and 27 patients with normal clinical manifestation of left hand. For right hand there were 54 patients with atrophy and 15 normal. For controls, the MUNE value of left abductor pollicis brevis was 226. 97 ± 30. 59, while that of right side was 228.31± 25.35. The MUNE value of left abductor digiti minimi was 237.43 ± 30. 78, while that of right side was 240. 20 ± 37.73. For HD patients, the MUNE of left abductor pollieis brevis and abductor digiti minimi was 145.66 ＋ 126. 10 （ t = 5.07, P 〈 O. 01 ） and 102. 20 ± 112. 67 （ t = 9.31, P 〈 0.01 ） respectively, while those of right hand was 149.72 ± 117.80 （ t = 5.31, P 〈 0. 01 ） and 64. 23 ＋ 69.27 （ t = 16. 76, P 〈 0. 01 ） respectively. MUNE of left abductor digiti minimi in 17 patients that was below 200 among 27 patients with normal clinical manifestation （ X2 = 9. 57,P = 0. 002）. MUNE of right abductor digiti minimi in 12 patients that was below 200 among 15 patients with normal clinical manifestation （ X2 = 4. 64, P = 0. 03 ）. Conclusions The differences of MUNE values by multiple point stimulating technique between the normal subjects and the HD patients is significant, which suggests this method is very useful to evaluate HD in the early state.