不同中医证型腕管综合征患者的神经电生理特点

The characteristics of nerve electrophysiology in different TCM syndrome types of patients with carpal tunnel syndrome

目的研究不同中医证型腕管综合征(CTS)患者的神经电生理特点。方法选择2017年1～9月广东省佛山市中医院(以下简称"我院")收治的CTS患者80例为研究对象。根据患者中医证型不同将其分为寒湿阻络组(38例)与气阴两虚组(42例),另取同期于我院接受健康体检的正常人员40名记为对照组。采用英国Medelec Synerg肌电/诱发电位仪对三组人员进行常规神经电生理检测,分别测量三组正中神经的运动神经传导速度(MCV)、复合肌肉动作电位波幅(CMAP)、感觉神经传导速度(SNCV)及末端运动潜伏期(DML)、尺神经SNCV及DML情况。结果气阴两虚组MCV、CMAP水平均低于寒湿阻络组与对照组,而寒湿阻络组CMAP低于对照组,差异均有统计学意义(均P <0.05)。气阴两虚组指1至腕、指3至腕SNCV水平低于寒湿阻络组与对照组,且寒湿阻络组低于对照组(均P <0.05);而气阴两虚组DML高于寒湿阻络组与对照组,且寒湿阻络组高于对照组(均P <0.05)。三组尺神经SNCV、DML水平比较,差异无统计学意义(P> 0.05)。结论寒湿阻络型与气阴两虚型CTS患者的正中神经MCV、CMAP、SNCV以及DML水平存在明显差异,临床上可通过对上述指标进行检测,从而有利于对CTS患者的中医辨证分型。

Objective To study the characteristics of nerve electrophysiology in different TCM syndrome types of patients with carpal tunnel syndrome(CTS).Methods From January to September 2017,80 patients with CTS treated in Foshan Hospital of Traditional Chinese Medicine in Guangdong Province(“our hospital”for short)were selected as research objects.According to different TCM syndromes,the patients were divided into cold dampness blocking collaterals group(38 cases)and deficiency of qi and yin group(42 cases).In addition,40 normal persons who received physical examination in our hospital at the same time were taken as control group.British Medelec Synerg/evoked potentiometer was used to detect the conventional nerve electrophysiology of the three groups.The motor nerve conduction velocity(MCV),compound muscle action potential(CMAP),sensory nerve conduction velocity(SNCV)and distal motor latency(DML)and the SNCV,DML of ulnar nerve in the three groups were measured.Results The levels of MCV and CMAP in deficiency of qi and yin group were lower than those of cold dampness blocking collaterals group and control group,and the CMAP of cold dampness blocking collaterals group was lower than the control group,the differences were all statistically significant(all P<0.05).The levels of SNCV of finger 1 to wrist and finger 3 to wrist in deficiency of qi and yin group were lower than those of cold dampness blocking collaterals group and control group,and cold dampness blocking collaterals group was lower than control group(all P<0.05);the DML in deficiency of qi and yin group was higher than the cold dampness blocking collaterals group and control group,and cold dampness blocking collaterals group was higher than the control group(all P<0.05).The differences of SNCV and DML levels of ulnar nerve in the three groups were not statistically significant(P>0.05).Conclusion There is a significant difference in median nerve MCV,CMAP,SNCV and DML levels in CTS patients with cold dampness blocking collaterals type and deficiency of qi and yin type,the above indexes can be detected in clinic,which are beneficial for TCM syndrome differentiation of CTS patients.