分裂手现象对肌萎缩侧索硬化和肌萎缩型颈椎病的鉴别诊断价值

Value of split hand in the differential diagnosis of amyotrophic lateral sclerosis and cervical spondyiotic amyotrophy

目的探讨分裂手现象对肌萎缩侧索硬化和肌萎缩型颈椎病的鉴别诊断价值。方法对2013年5月至2017年6月于北京积水潭医院神经科及脊柱科门诊就诊或住院收治的患者进行分析，其中肌萎缩侧索硬化（ALS）患者62例，肌萎缩型颈椎病（CSA）患者57例，选取健康对照者65名，均于小指展肌和拇短展肌记录其复合肌肉动作电位（CMAP）波幅，并计算波幅比，即小指展肌／拇短展肌。结果ALS组的小指展肌／拇短展肌（1．93±1．97）大于健康对照组（0．92±0．22），差异有统计学意义（P〈0．05）；CSA组的小指展肌／拇短展肌（0．74±0．32）小于健康对照组（0．92±0．22），差异有统计学意义（P〈0．05）；ALS组的小指展肌／拇短展肌（1．93±1．97）大于CSA组（0．74±0．32），差异有统计学意义（P〈0．05）；ALS组的ROC曲线下面积为0．843，临界值为1．077，敏感度为75．8％，特异度为83．1％（P〈0．05）；CSA组ROC曲线下面积为0．737，临界值为0．739，敏感度为64．9％，特异度为87．1％（P〈0．05）。结论小指展肌／拇短展肌对ALS和CSA的鉴别有一定的临床指导价值。

Objective To investigate the value of split hand in the differential diagnosis of amyotrophic lateral sclerosis （ALS） and cervical spondylotic amyotrophy （CSA）. Methods A total of 62 ALS patients, 57 CSA patients and 65 normal controls who visited the Neurology and Spine Department of Beijing Jishuitan Hospital from May 2013 to June 2017 were enrolled into this study. The amplitudes of compound muscle action potentials （CMAP） were recorded from abductor digiti minimi （ADM） and abductor pollicis brevis （APB）. Moreover, the ratio of CMAP amplitude between ADM and APB （ADM/ APB） was calculated. Results The ADM/APB of the ALS group （ 1.93 ± 1.97 ） was significantly higher than that of the normal control group （ 0. 92 ± 0. 22 ） （ P 〈 0. 05 ） ; the ADM/APB of the CSA group （ 0. 74 ± 0. 32） was significantly lower than that of the normal control group （ 0. 92 ± 0. 22 ） （ P 〈 0. 05 ） ; the ADM/ APB of the ALS group （ 1.93 ± 1.97 ） was significantly higher than that of the CSA group （ 0. 74 ± 0. 32 ） （P 〈 0.05 ）;the areas under receiver operator characteristic curve in patients with ALS was 0. 843, the diagnostic sensitivity and specificity for ALS were 75.8% and 83.1% with the cutoff value of ADM/APB = 1. 077 ; the areas under receiver operator characteristic curve in patients with CSA was 0. 737, the diagnostic sensitivity and specificity for CSA were 64. 9% and 87. 1% with the cutoff value of ADM/APB = 0. 739. Conclusion The ADM/APB has certain clinical value for the differentiation of ALS and CSA.