肌萎缩侧索硬化患者早期选择性损害快速传导运动神经元的电生理研究

An electrophysiological study on selected damage of fast motor neuron in the early stage of patients with amyotrophic lateral sclerosis

目的分析早期肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)患者正中神经F波最小潜伏期(Fwave minimal latency,Fmin)和运动末端潜伏期(distal motor latency,DML)改变及其与复合肌肉动作电位(compound muscle action potentials,CMAP)负波波幅和负波面积的相关性,寻找 ALS早期选择性损害快速传导运动神经元的证据。方法纳入确诊和很可能的ALS(改良EI Escorial标准)患者42例,选择性别构成、年龄及身高与之匹配的健康自愿受试者46名为对照组。采用电生理检测手段检测所有对象正中神经DML、Fmin、CMAP负波波幅和负波面积等指标,比较两组间以上指标的差异,并通过Pearson相关性分析方法分析ALS患者DML、Fmin、Fmax与CMAP负波波幅、负波面积的相关性。结果与对照组比较,ASL组正中神经Fmin延长(P< 0.01),DML虽有延长趋势但差异无统计学意义(P> 0.05),正中神经负波波幅及负波面积较对照组下降(P< 0.01)。ALS患者正中神经CMAP负波波幅、负波面积均与DML(r=-0.433,P= 0.005;r=-0.320,P= 0.041),及Fmin(r=-0.669,P< 0.001;r=-0.597,P< 0.001)呈线性负相关,与Fmax(r=-0.283,P=0.072;r=-0.220,P= 0.166)无相关性。结论早期ALS患者Fmin与CMAP波幅、负波面积呈负相关,提示快传导的大运动神经元在 ALS早期优先受累。

Objective To analyze the changes of F-wavc minimum latencies(Fmin),distal motor latencies(DML) in the early stage of patients with amyotrophic lateral sclerosis(ALS) and the correlation between Fmin,DML and the compound muscle action potentials(CMAP),negative area of CMAP,to seek the evidence supporting preferential vulnerability of the fastest motor neuron in the early stage of ALS.Methods For this study we enrolled 42 patients who met the revised EI criteria for definite and probable diagnosis ALS and selected 46 healthy volunteers with matching sex composition,age and height as the control group.Standard clectrophysiology studies were performed in all the participants and DML,Fmin,Fmax,CMAP negative amplitude and negative wave area in the median nerve were collected.We compared differences of the above indicators between the two groups and used Pearson correlation analysis to measure the correlation between DML,Fmin,Fmax and CMAP negative amplitude,negative wave area in the median nerve.Results Compared with the control group,Fmin was longer(P0.01) in the ALS group.Although DML tent to be a prolonged in the ALS group,but no statistically significant difference was found.CMAP negative amplitude in the ALS group decreased significantly when compared with the control group(P0.01),so did the negative wave area of CMAP(P0.01).The median nerve CMAP negative amplitude and negative wave area in the ALS group were negatively correlated with DML after height adjustment(r=-0.433,P=0.005;r=-0.320,P =0.041),so did the same pattern to the Fmin(r =-0.669,P0.001;r=-0.597,P0.001),but no correlation was found with the Fmax(r=-0.283,P= 0.072;r=-0.220,P = 0.166).Conclusions In early ALS patients,the significantly negative correlation between Fmin and CMAP negative amplitude,negative wave area revealed preferential vulnerability of the fastest motor neurons in the early stage of ALS.