运动神经元病神经传导与肌电图关系分析

Analysis of the Relationship between Nerve Conduction and Electromyography of Motor Neuron Disease

目的考察运动神经元病患者神经功能与肌电图间的关系。方法选择2011年6月至2013年12月在广州军区广州总医院确诊为运动神经元病患者19例,分别进行神经电图和肌电图检测,记录神经运动支及感觉支在不同分段中潜伏期、波幅及神经传导速度,并对正中神经及胫神经进行F波检测。记录不同肌肉静息电位、复合运动单位的平均波幅、平均时限、多相波比例和最大用力运动单位募集密度。结果与正常肌肉相比,呈神经源性改变肌肉的所支配神经运动支起始潜伏期延长程度,波幅降低程度程度均较高,所支配神经运动支传导速度减慢程度相对较低,差异有统计学意义(P<0.05);运动神经元病患者stim-rec1波幅及stim-rec2波幅降低程度在正常范围18.3%和25.1%时,对发现肌肉神经源性改变有较好的灵敏度(76.8%、80.0%)和特异度(72.5%、80.0%)。结论运动神经元病患者呈神经源性改变肌肉的所支配神经运动支有不同程度损害,主要表现为起始潜伏期延长及波幅降低,以波幅作为指标诊断支配肌肉神经源性改变有较好的临床应用价值。

Objective To reveal the electrophysiological indicators closely related to muscle neurogenic change by investigating the relationship between nerve function and electromyography of patients with motor neuron disease（ MND）,to provide certain experimental basis for the early,timely and accurate diagnosis of muscle neurogenic changes. Methods A total of 19 patients who were diagnosed with MND admitted to Guangzhou General Hospital of Guangzhou Military Command from Jun. 2011 to Dec. 2013 were included in this study. Electroneurography and electromyography were performed to record the changes of incubation period,amplitude and nerve conduction velocity in different segments of the motor and sensory nerve. F-wave of median nerve and tibial nerve was detected simultaneously,and the information including resting potential,average amplitude of compound motor unit,average time limit,polyphase wave ratio and the density of movement unit when heavy contraction in different muscles were recorded. Results Compared with normal muscle,the degree of initial incubation period extension and amplitude decrease degree of neurogenic changed muscle were higher,and the nerve conduction velocity declining was lower with statistically significant difference（ P〈0. 05）. And,when the reduction degree of amplitude reflected in stim-rec1 and stim-rec 2 of motor neuron patient was in the normal range 18. 3% to 25. 1%,it had good sensitivity（ 76. 8% and 80. 0%） and specificity（ 72. 5% and 80. 0%）. Conclusion The damages of different extents would occurr in motor nerves which were dominated by neurogenic changed muscle of patients with MND. The main performance is reflected in terms of the initial incubation period extension and amplitude reduction. Using amplitude as an index of muscle neurogenic diagnosis has good clinical application value.