肯尼迪病患者F波特点分析

The characteristics of F-waves in patients with Kennedy＆#39;s disease

目的 总结分析肯尼迪病患者F波的变化特点.方法 对2013年8月至2014年7月就诊于北京协和医院神经科的32例肯尼迪病患者和30名男性健康志愿者进行正中神经、尺神经、胫神经和腓神经运动的神经传导检测和F波检测.使用100次刺激获得F波.比较肯尼迪病患者和健康受试者所检神经F波参数的差异.分析的F波参数包括F波最短潜伏期、F波出现率、平均和最大F波波幅、巨大F波出现率和出现巨大F波受试者比例.结果 肯尼迪病患者所检神经的平均F波波幅[正中神经：375.0（298.3）μV与297.0（145.0）μV,Z=-3.378,P＜0.01;尺神经：397.5（295.0） μV与293.0（101.8） μV,Z=-3.968,P＜0.01;胫神经：374.5（227.3） μV与294.0（160.5）μV,Z=-3.144,P=0.002;腓神经：346.5（292.8）μV与146.5（69.3） μV,Z=-6.864,P＜0.01]和最大F波波幅[正中神经：1 291.0（952.0） μV与846.5（523.0） μV,Z=-4.823,P＜0.01;尺神经：1 663.5（1 374.0）μV与760.5（341.8） μV,Z=-6.813,P＜0.01;胫神经：（1 054.1±451.6） μV与（652.5±172.5） μV,t=5.380,P＜0.01;腓神经：（840.4±494.1）μV与（370.2±202.0） μV,扛6.475,P＜0.01]及巨大F波出现率[正中神经：0.0％（7.2％）与0.0％（0.0％）,Z=-5.149,P＜0.01;尺神经：3.1％（10.5％）与0.0％（0.0％）,Z=-7.026,P＜0.01;胫神经：0.0％（3.3％）与0.0％（0.0％）,Z=-4.651,P＜0.01;腓神经：3.3％（28.2％）与0.0％（0.0％）,Z=-5.532,P＜0.01]和出现巨大F波受试者比例[正中神经：78.1％（25/32）与10.0％（3/30）,x2=29.016,P＜0.01;尺神经：87.5％（28/32）与10.0％（3/30）,x2=37.200,P＜0.01;胫神经：62.5％（20/32）与6.7％（2/30）,x2=21.085,P ＜0.01;腓神经：68.8％（22/32）与10.0％（3/30）,x2=22.209,P＜0.01]均高于健康受试者,差异有统计学意义.肯尼迪病患者所检神经的F波出现率显著低于健康受试者[正中神经：52.5％（36.3％）与98.0％ （7.0％）,Z=9.010,P＜O.01;尺神经：71.0％（28.3％）与100.0％（1.0％）,Z=9.455,P＜0.01;胫神经：100.0％（2.0％）与100.0％（0.0％）,Z=4.255,P＜0.01;腓神经：33.1％±23.9％与46.9％±27.2％,t=-2.848,P=0.007].肯尼迪病患者的巨大F波可出现于多条神经并倾向于对称分布.肯尼迪病患者巨大F波的出现率与疾病的病程无明显相关性（r =0.162,P =0.418）.结论 肯尼迪病患者的F波特点为F波出现率降低、F波波幅增高和巨大F波增多,且巨大F波可出现于多条神经并倾向对称分布于左、右侧相同神经,符合肯尼迪病患者慢性无选择性前角运动神经元丢失的病理改变.

Objective To investigate the characteristics of F-waves in patients with Kennedy＇s disease.Methods Thirty two patients with Kennedy＇s disease and 30 male healthy volunteers,who visited the Department of Neurology,Peking Union Medical College Hospital between August 2013 and July 2014,were recruited consecutively for this study.Motor nerve conduction study and F-wave examination were performed on the median,ulnar,tibial and peroneal nerves of all participants.A series of 100 electrical stimuli were employed to obtain F-waves.The F-wave parameters in all tested nerves were compared between patients with Kennedy＇s disease and normal controls including F-wave minimum latency,F-wave persistence,mean and maximum F-wave amplitude,the frequency of giant F-waves.Results The mean Fwave amplitude （median nerve：patients with Kennedy＇s disease 375.0 （298.3） μV,healthy volunteers 297.0（145.0） μV,Z =-3.378,P 〈0.01;ulnar nerve：patients with Kennedy＇s disease 397.5（295.0） μV,healthy volunteers 293.0 （101.8） μV,Z =-3.968,P 〈 0.01;tibial nerve：patients with Kennedy＇s disease 374.5 （227.3） μV,healthy volunteers 294.0 （160.5） μV,Z =-3.144,P =0.002;peroneal nerve：patients with Kennedy＇s disease 346.5 （292.8） μV,healthy volunteers 146.5 （69.3） μV,Z =-6.864,P 〈 0.01）,maximum F-wave amplitudes （median nerve：patients with Kennedy＇s disease 1 291.0 （952.0） μV,healthy volunteers 846.5 （523.0） μV,Z =-4.823,P 〈 0.01;ulnar nerve：patients with Kennedy＇s disease 1 663.5 （1 374.0） μV,healthy volunteers 760.5 （341.8） μV,Z =-6.813,P 〈 0.01;tibial nerve：patients with Kennedy＇s disease （1 054.1 ± 451.6） μV,healthy volunteers （652.5-± 172.5） μV,t =5.380,P 〈 0.01;peroneal nerve：patients with Kennedy＇s disease （840.4 ± 494.1） μV,healthy volunteers （370.2 ± 202.0） μV,t =6.475,P 〈 0.01）,frequency of giant F-waves （median nerve：patients with Kennedy＇s disease 0.0% （7.2%）,healthy volunteers 0.0% （0.0%）,Z =-5.149,P 〈 0.01;ulnar nerve：patients with Kennedy＇s disease 3.1% （10.5%）,healthy volunteers 0.0% （0.0%）,Z =-7.026,P 〈0.01;tibial nerve：patients with Kennedy＇s disease 0.0% （3.3%）,healthy volunteers 0.0% （0.0%）,Z =-4.651,P 〈0.01;peroneal nerve：patients with Kennedy＇s disease 3.3% （28.2%）,healthy volunteers 0.0% （0.0%）,Z =-5.532,P 〈0.01）,and frequencies of patients with giant F-waves （median nerve：patients with Kennedy＇s disease 78.1% （25/32）,healthy volunteers 10.0% （3/30）,x2 =29.016,P 〈 0.01;ulnar nerve：patients with Kennedy＇s disease 87.5% （28/32）,healthy volunteers 10.0% （3/30）,x2 =37.200,P 〈 0.01;tibial nerve：patients with Kennedy＇s disease 62.5% （20/32）,healthy volunteers 6.7% （2/30）,x2 =21.085,P 〈 0.01;peroneal nerve：patients with Kennedy＇s disease 68.8 % （22/32）,healthy volunteers 10.0% （3/30）,x2 =22.209,P 〈 0.01） in all nerves examined were significantly higher in patients with Kennedy＇s disease than in the normal controls.The F-wave persistence in all nerves examined was significantly lower than in the normal controls （median nerve：patients with Kennedy＇s disease 52.5% （36.3%）,healthy volunteers 98.0% （7.0%）,Z =9.010,P 〈 0.01;ulnar nerve：patients with Kennedy＇s disease 71.0% （28.3%）,healthy volunteers 100.0% （1.0%）,Z =9.455,P 〈 0.01;tibial nerve：patients with Kennedy＇s disease 100.0% （2.0%）,healthy volunteers 100.0% （0.0%）,Z =4.255,P 〈 0.01;peroneal nerve：patients with Kennedy＇s disease 33.1% ± 23.9%,healthy volunteers 46.9% ± 27.2%,t =-2.848,P =0.007）.Giant F-waves were detected in multiple nerves and often appeared symmetrically on the same nerves between the left and right sides in patients with Kennedy＇s disease.No significant correlations were found between the pooled frequency of giant F-waves and disease duration in patients with Kennedy＇s disease（r =0.162,P =0.418）.Conclusions The results showed increased F-wave amplitudes,increased number of giant F-waves,especially giant F-waves detected in multiple nerves or appearing symmetrically combined with low persistence,consistent with the pathologic features of chronic and unselected loss of anterior horn cells in patients with Kennedy＇s disease.