多系统萎缩患者交感神经皮肤反应特点分析

Characteristics of sympathetic skin response in patients with multiple system atrophy

目的观察多系统萎缩（MSA）患者交感神经皮肤反应（SSR）的特点，为MSA早期临床诊断提供依据。方法选取2013年7月至2015年8月海军总医院神经内科门诊及住院的MSA患者47例和健康对照（NC）32名，采用尼高力肌电诱发电位仪进行SSR检查，比较SSR潜伏期、SSR异常率及未引出率。结果MSA组与NC组之间上、下肢平均潜伏期分别相比差异有统计学意义[上肢：MSA组（1485±187）ms，NC组（1375±108）ms，P〈0．001，下肢：MSA组（2200±386）ms，NC组（1994±240）ms，P〈0．05]；性别、年龄对两组SSR潜伏期及其异常率、未引出率均无显著影响（P〉0．05）；病程〉2年的MSA患者上、下肢SSR潜伏期平均值[上肢：（1592±160）ms；下肢：（2268±254）ms]均大于病程≤2年[上肢：（1453±184）ms；下肢：（2190±442）ms]的MSA患者，但两亚组上肢潜伏期比较差异有统计学意义（P〈0．05），下肢潜伏期比较差异无统计学意义（P〉0．05）；病程〉2年的MSA患者SSR异常率（85．00％）、未引出率（75．00％）均高于病程≤2年（SSR异常率55．56％、未引出率22．22％）的MSA患者，且差异均有统计学意义（SSR异常率：P〈0．05，SSR未引出率：P〈0．001）；MSA—C亚组上、下肢SSR潜伏期与MSA—P亚组比较差异无统计学意义（P〉0．5）；MSA—C亚组SSR异常率（78．13％）大于MSA—P亚组，两亚组异常率差异具有统计学意义（P〈0．05），两亚组SSR未引出率差异无统计学意义（P〉0．05）。结论SSR是诊断MSA重要的辅助检查方法，SSR潜伏期、异常率和未引出率均随MSA病程延长而增加，MSA—C型患者较MSA—P型患者SSR异常率更高，双侧对称性SSR异常更支持MSA诊断。

Objective To provide evidence for early clinical diagnosis of multiple system atrophy （MSA）by studying the characteristics of sympathetic skin responses（SSR） in the patients with MSA. Methods A total of 47 MSA patients and 32 healthy individuals were enrolled as case group and normal control（NC） group, from in and out patients of Neurology Department of Navy General Hospital from July 2013 to August 2015. SSR was tested by Nicolet electromyography, the latency and abnormal and disappeared rate of SSR were compared. Results The SSR latency of upper limbs and lower limbs in MSA group had statistical significance compared respectively with the NCgroup （ upper limbs ： SSR latency was （ 1 485 ± 187 ） ms in MSA group, and （ 1 375 ± 108 ） ms in NC group,P 〈 0. 05 ; lower limbs ： SSR latency was （2 200 ± 386）ms in MSA group, and（1 994 ± 240）ms in NC group, P〈 0. 05）. Sex and age had no significant effect on the latency and the abnormal and disappeared rate of SSR in two groups （P 〉 0. 05 ）. The upper and lower limb SSR latency in MSA patients with disease duration more than 2 years（ SSR latency was （1 592 ± 160）ms in upper limb and （2 268 ± 254）ms in lower limb） were longer than those within 2 years （SSR latency was （1 453 ± 184）ms in upper limb and （2 190 ± 442）ms in lower limb）, but only the upper limbs had significantly statistical differences （P 〈 0. 05 ）. Both SSR abnormal rate and SSR disappeared rate in MSA patients whose disease duration were more than 2 years （SSR abnormal rate： 85.00%, SSR disappeared rate： 75.00% ） were higher than those with shorter disease duration （SSR abnormal rate： 55.56%, SSR disappeared rate： 22. 22% ）, and both were statistically significant （ SSR abnormal rate：P 〈 0. 05, SSR disappeared rate：P 〈 0. 001 ）. The upper and lower limb SSR latency of MSA- C subgroup had no statistical difference compared with MSA-P subgroup（ P 〉0. 05 ）. The SSR abnormal rate in MSA-C subgroup（78. 13% ） was higher than that of MSA-P subgroup（46. 76% ）, and were statistically significant （P 〈 0. 05 ）. The SSR disappeared rate in MSA-C subgroup has no statistical difference compared with the MSA-P subgroup（P 〉 0. 05）. Conclusions SSR is helpful to diagnose MSA. The latency and the abnormal and disappeared rate of SSR are significantly increased with the extension of MSA duration. The SSR abnormal rate in MSA-C patients is higher than that in MSA-P patients, and symmetrically abnormal SSR is more supporting the diagnosis of MSA.