肌电图对颈髓髓内肿瘤和炎性脱髓鞘病的鉴别诊断研究

The value of electromyography in differentiating intramedullary tumor from inflammatory demyelinating disease of cervical region

目的 探讨肌电图（EMG）对颈髓髓内肿瘤和炎性脱髓鞘病的鉴别诊断价值.方法 选择2008年3月至2013年6月解放军总医院收治的颈椎MRI呈现异常信号,拟诊髓内肿瘤或炎性脱髓鞘病的住院患者为研究对象,于手术等治疗前行电生理检查,结合手术病理结果进行分析,对预后进行随访观察,并比较EMG诊断以及依据病史、症状和体征对髓内肿瘤诊断效能的差异.结果 共纳入55例颈髓内病变患者,22例最终诊断为髓内肿瘤,其中15例（68.18％）EMG出现神经源性损害;33例最终诊断为炎性脱髓鞘病,其中仅1例（3.03％） EMG出现神经源性损害.两者EMG异常率比较,差异有统计学意义（P =0.000）.出现神经源性损害的肌肉对应的脊髓节段均在影像所见病灶范围内.采用病史、症状和体征进行的临床诊断方法对髓内肿瘤诊断的敏感度为59.09％,特异度为75.76％;采用EMG诊断的敏感度为68.18％,特异度为96.97％.结论 EMG对颈髓髓内肿瘤及炎性脱髓鞘病具有较好的鉴别诊断价值,在髓内肿瘤诊断中EMG诊断优于临床诊断.

Objective To investigate the value of needle electromyography （EMG） in differentiating intramedullary tumor from inflammatory demyelinating disease of cervical region.Methods Patients hospitalized in the Chinese PLA General Hospital from March 2008 to June 2013 with abnormalities on MRI of cervical vertebra and preliminary diagnosed as intramedullary tumor or inflammatory demyelinating disease of cervical region were enrolled in the study.Electrophysiological examination was performed before any treatment.Pathological findings were analyzed and prognosis was evaluated in all the subjects.Results A total of fifty-five patients were enrolled in the study with 33 cases of inflammatory demyelinating disease and 22 cases of intramedullary tumor defined by the postoperative pathological findings.In all the 33 cases with demyelinating disease,only one case （3.03%） presented as neurogenic damage by needle EMG.While in all the 22 cases with intramedullary tumor,needle EMG revealed neurogenic damage in 15 cases （68.18%） and the spinal segments of muscles with neurogenic damage were all within the spinal lesions demonstrated by MRI.The diagnostic sensitivity of EMG for intramedullary tumor was 68.18% and the diagnostic specificity was 96.97%,while the diagnostic sensitivity and specificity for intramedullary tumor by the medical history,symptoms and signs were 59.09% and 75.76% respectively.Conclusion Needle EMG might play an important role in distinguishing intramedullary tumor from inflammatory demyelinating disease of cervical spinal cord.