神经电生理检查在运动神经元病中的应用比较研究

THE COMPARATIVE STUDY ON ELECTRONEUROPHYSIOLOGICAL EXAMINATION IN MOTOR NEURON DISEASE(MND)

目的:研究神经电生理检查在运动神经元病(MND)中的应用比较。方法:分别对50例MND患者进行4个区域的共8块肌肉肌电图(EMG)分析,四肢的磁运动诱发电位(MEP),上肢正中神经、尺神经、胫神经F波检查,在双侧腓肠肌记录H波,四肢神经传导速度(NCV)被测定,并与健康对照组30例进行比较。结果:MND组中EMG失神经电位65.0%,轻力时限增宽62.5%,振幅增高52.8%,大力单纯或单混相60.0%;MEP中枢运动传导时间(CMCT)延长71.5%;F波出波率下降24.7%,F波增高26.0%;H波增高25.0%;复合运动神经动作电位(CMAP)降低27.3%,运动神经传导(MCV)减慢2.5%,感觉神经传导(SCV)减慢0.6%,感觉神经动作电位(SNAP)降低2.0%。结论:EMG对MND患者下运动神经元损害有定位诊断价值;MEP对MND患者上运动神经元损害有诊断价值;F波、H波对MND患者上下神经元神经损害定位有补充诊断价值,可作为损伤程度的评价标准;NCV测定帮助鉴别诊断。

Objectives： To research application of electroneurophysiological examination in motor neuron disease （ MND ） . Methods： In eight muscles of four areas for 50 patients with MND electromyogram （ EMG ） was analyzed, magnetic motor evoked potential （ MEP ） of four limbs, F wave of median nerve, ulnar nerve, tibial nerve of upper limbs were examined, H wave of bilateral gastrocnemius was recorded, nerve conduction velocity （ NCV ） of four limbs were determined, and compared with healthy control group （n=30） Results： In patients with MND,nerve potential of EMG lost 65.0%, time broadened lightly 62.5%, amplitude increased 52.8%, 60.0% pure or mixed phase; Central motor conduction time （CMCT） of MEP extended 71.5%; F wave rate fell 24.7%, F wave rised 26.0%, H wave rised 25.0%, Composite motor nerve action potential（ CMAP ）decreased 27.3%, motor nerve conduction（ MCV ）slowed 2.5%, sensory nerve conduction（ SCV ） slowed 0.6%, sensory nerve action potential （ SNAP ） decreased 2.0%. Conclusion： EMG is of localization diagnostic value in MND patients with lower motor neuron damage MEP on upper motor neuron damage in patients with MND has diagnostic value. F wave and H wave in lower and upper neuron damage of patients with MND have supplementary diagnostic value, can be used as a damage degree evaluation standard. Determination of Ncv help the differential diagnosis.