神经电生理对不同临床分型的重症肌无力诊断价值研究

Diagnostic Value of Neural Electrophysiology in Myasthenia Gravis with Different Clinical Severity

目的探讨神经电生理对不同临床严重程度的重症肌无力诊断价值。方法回顾性分析2014年2月—2016年1月在我院神经内科住院治疗,符合入选标准且拟诊断为重症肌无力病人67例,采用丹麦Dantec keypoint四通道肌电图仪依次进行面神经、副神经、腋神经以及桡神经的低频重复神经刺激(RNS)和针电极肌电图(NEMG)检查,通过SPSS19.0统计软件分析重症肌无力病人不同神经RNS结果、不同MGFA分型以及肌源性受损的情况。结果面神经RNS总阳性率89.55%,高于副神经、腋神经以及桡神经的总阳性率(70.15%、35.82%、26.87%,P<0.05),副神经RNS总阳性率高于腋神经以及桡神经的总阳性率(P<0.05)。RNS总阳性率在MGFA临床分型Ⅳ型高于Ⅰ型、Ⅱ型以及Ⅲ型(P<0.05)。MGFA临床分型Ⅲ型的总阳性率高于Ⅰ型及Ⅱ型(P<0.05)。MGFA临床分型中肌源性受损组分布在Ⅱ型、Ⅲ型中,而无肌源性受损组Ⅰ型、Ⅱ型及Ⅲ型中,两组差异有统计学意义(P<0.05)。结论不同临床严重程度的重症肌无力病人,RNS的检测总阳性率随着病程的严重而升高,且有肌源性受损者分布在较重分型中,而无肌源性受损病人分布在较轻的分型中。

Objective To explore the diagnostic value of neural electrophysiology in myasthenia gravis with different clinical severity. Methods Sixty seven patients with myasthenia gravis from February 2014 to January 2016 in the department of neurology were ret rospectively analyzed.Using Danish Dantec keypoint four channel electromyograph,the low frequency repetitive electrical stimulation （RNS） and needle electrode electromyography （NEMG） of the facial nerve,axillary nerve,radial nerve,and sacral nerve were examined in turn.The different neural RNS results, neural RNS of different MGFA classification and the condition of damaged muscle in patients with myasthenia gravis were retrospectively analyzed through statistical software SPSS 19.0.Results The total positive rate of facial nerve RNS was significantly higher than that of accessory nerve, axillary nerve and radial nerve（ P 〈0.05）.The total positive rate of accessory nerve RNS was significantly higher than that of axillary nerve and radial nerve （ P 〈0.05）.RNS total positive rate in clinical classification Ⅳ MGFA type was significantly higher than type Ⅰ ,type H and type Ⅲ（P 〈0.05）.RNS total positive rate in clinical classification Ⅳ MGFA type was significantly higher than type Ⅰand type H （ P 〈0.05）.ln the clinical classification of MGFA, the mus culogenic lesions were distributed in type Ⅱ,type Ⅲ,and type Ⅳ.The non musculogenic lesions lesions were distributed in the type Ⅰ ,typeⅡ,and type Ⅲ .There was significant difference between two groups （P 〈0.05）.Conclusion The total positive rate of RNS in patients with myasthenia gravis with different clinical severity increased with the severity of the disease, and patients with musculo genie lesions were distributed in the serious classification,while patients with non musculogenic lesions were distributed in patients with less severe classification.