摘要
目的分析肌萎缩侧索硬化(ALS)患者针极肌电图(EMG)特点,并探讨ALS患者第10胸段椎旁肌EMG各参数与病程、疾病进展速率、用力肺活量(FVC)和肌萎缩侧索硬化功能评分(ALSFRS—R)的关系。方法收集解放军总医院神经内科2012年3月至2013年6月确诊ALS患者112例,每例均行一侧胸锁乳突肌和(或)舌肌、上下肢肌及第10胸段椎旁肌EMG检测,测定自发电位、运动单位电位(MUP)时限、波幅及募集相参数。结果每例患者肌电图均呈广泛神经源性损害,均可见纤颤电位和(或)正锐波,二者同时出现最多见;8例出现束颤电位(FPs),其中5例与纤颤电位和正锐波同时出现;1例发现复合性重复放电(CRDs)。MUP时限延长、波幅增高,募集相为单纯相比率高达72.32%,高波幅募集相比率为35.71%。Logistic回归分析发现FVC降低与ALSFRS-R下降及第10胸段椎旁肌募集相峰值波幅呈正相关(OR值分别为1.157和2.363)。结论ALS患者自发电位主要以纤颤电位、正锐波最为多见,FPs出现率较低,偶可见CRDs。ALSFRS—R及第10胸段椎旁肌募集相峰值波幅对判断病情严重程度特别是呼吸功能障碍具有一定临床意义。
Objective To analyze the features of needle electromyography (EMG) in patients with amyotrophic lateral sclerosis ( ALS ), and explore the correlation between EMG parameters of the tenth thoracic paraspinal muscle and disease duration, rate of disease progression, forced vital capacity (FVC) and revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R). Methods Standard EMG was recorded from unilateral sternocleidomastoid muscle and/or tongue muscles, upper and lower limbs muscles and the tenth thoracic paraspinal muscle in 112 patients with definite ALS between March 2012 and June 2013 in the Department of Neurology at Chinese PLA General Hospital. Parameters studies included spontaneous potentials, duration and amplitude of motor unit potentials ( MUP ), pattern of recruitment. Results EMG revealed diffuse neurogenic changes in each case. Fibrillation potential or positive sharp waves were found in some muscles in all of patients, and both of them were found in most of the cases. Fasciculation potentials (FPs) were found in 8 patients and accompanied with fibrillation potential and positive sharp waves in 5 of them. Complex repetitive discharges (CRDs) were found in only 1 patient. Duration and amplitude of MUP was prolonged and increased in ALS patients, and the rate of high amplitude and decreased recruitment pattern were 35.71% and 72. 32%, respectively. Logistic regression analysis revealed an association of the FVC loss with the drop of ALSFRS-R and peak amplitude of the tenth thoracic paraspinal muscle. Conclusions The abnormal spontaneous activity with high frequency are fibrillation potentials and/or positive sharp waves. However, FPs is observed in a small number of patients and CRDs is rarely seen in ALS. The ALSFRS-R and peak amplitude of thetenth thoracic paraspinal muscle may be of certain clinical value in estimating the severity of disease especially the respiratory dysfunction in ALS patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第33期2616-2619,共4页
National Medical Journal of China