上肢神经电刺激A波对急性吉兰--巴雷综合征的诊断价值

Diagnostic Value of Electric Nerve Stimulation A Waves in Upper Limb in Acute Guillain-Barré Syndrome

目的研究神经电生理F波检测时A波出现在急性吉兰-巴雷综合征（GBS）病程不同阶段中的特点,探索其对于GBS的诊断价值。方法回顾性分析62例GBS患者（GBS组）和26名健康对照者（对照组）的尺神经、正中神经、腓神经及胫神经在电生理F波检测时A波出现情况。对A波在GBS组与对照组上/下肢中的出现情况、以及不同病程的急性炎性脱髓鞘性多发神经根神经病（AIDP亚组）与轴索型GBS患者（轴索型亚组）的A波出现情况进行χ~2检验分析。结果 GBS组与对照组上肢A波出现情况的差异有统计学意义（P=0.002）;GBS病程及AIDP亚组对上肢A波出现的影响无统计学意义（P_（GBS）=0.781,P_（轴索型）=0.389）,而轴索型亚组病程对上肢A波出现的影响有统计学意义（P=0.028）;病程2周内,GBS分型对上肢A波出现的影响差异无统计学意义（P=0.065）,病程3~6周时,GBS分型对上肢A波出现的影响差异有统计学意义（P〈0.001）。AIDP患者中A波出现率低于F波异常率,但高于运动神经传导速度、远端运动潜伏期和复合肌肉动作电位波幅的异常率,且均差异有统计学意义（P〈0.005）;轴索型亚组患者中A波的出现率低于复合肌肉动作电位波幅和F波的异常率,高于运动神经传导速度和远端运动潜伏期的异常率,但仅复合肌肉动作电位波幅和A波间的出现率差异有统计学意义（P〈0.001）。结论上肢A波对于GBS早期诊断具有一定的参考价值,对AIDP和轴索型的诊断具有鉴别意义。

Aim To study the characteristics of A waves under the detection of F waves which occur at different stages of acute Guillain-Barré syndrome（GBS） and explore their diagnostic value of GBS.Methods The appearance of the A waves of ulnar,median,peroneal and tibial nerve on 62 GBS patients（GBS group） and 26 healthy subjects（the control group） was analyzed retrospectively.The appearance of A waves in upper and lower limb of the patients and healthy people,and the appearance of A waves in the acute inflammatory demyelinating polyradiculoneuropathy（AIDP subgroup） and axonal form（axonaltype subgroup） in different courses were analyzed by applying chi-square.Results There was statistical significance（P=0.002） in the different occurrence rate of A waves in upper limb between GBS and the control group.There was statistical significance（P=0.028） in different occurrence rate of A waves and different courses of axonal type subgroup,but there was not statistical significance（PGBS=0.781,Paxonal type=0.389） in GBS and AIDP subgroup.As for the GBS patients in course at weeks 0~2,there was not significance（P=0.065） in the difference of A waves in upper limb between AIDP and axonal GBS.But in the patients in course at weeks 3~6,the difference was of no statistical significance（P0.001）.As for AIDP patients,the occurrence rate of A waves was lower than that of F waves,but higher than that of MCV,DML and CMAP amplitude.And the difference was of statistical significance（P0.005）.As for axonal patients,the occurrence rate of A waves was lower than that of CMAP amplitude and F waves,but higher than that of MCV and DML.But the difference between CMAP amplitude and A waves was of statistical significance（P0.001）.Conclusion Upper A waves has certain reference value for the early diagnosis of GBS and plays an important role in identifying the AIDP and the axonal GBS.