运动神经根传导时间在神经根型颈椎病中的应用研究

Application of motor root conduction time in cervical spondylotic radiculopathy

目的比较正常人和神经根型颈椎病(CSR)患者的运动神经根传导时间(MRCT)、F波潜伏期之间的差异,探讨MRCT的诊断价值。方法根据公认的CSR诊断标准,第一步纳入CSR A组106例,正常对照A组45人。CSR A组共检测正中神经和尺神经各212根。正常对照A组检测双侧正中神经和尺神经各90根。记录F波潜伏期、M波潜伏期、计算MRCT,进行ROC曲线分析,获取MRCT最佳临界值。第二步再纳入CSR B组151例,正常对照B组44人。CSR B组共检测正中神经和尺神经各302根,正常对照B组检测双侧正中神经和尺神经各88根。利用第一步获取的临界值进行验证MRCT灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、Kappa一致性分析,评估MRCT对CSR的诊断价值。结果正常对照组正中神经MRCT为1.50(1.25,1.65)ms,尺神经MRCT为1.40(1.20,1.50)ms。ROC曲线分析结果显示,正中神经、尺神经MRCT ROC曲线下面积、约登指数、95%CI、灵敏度、特异度均高于F波潜伏期。正中神经和尺神经MRCT的ROC曲线下面积均大于0.7(均P<0.01),正中神经、尺神经MRCT均可作为独立的检测指标。MRCT与现有CSR诊断标准进行Kappa一致性分析结果显示具有较好的一致性(Kappa值0.491,标准误0.038)。MRCT灵敏度88.13%,特异度63.69%,阳性预测值86.45%,阴性预测值60.11%,阳性似然比2.21,阴性似然比0.20,95%CI:正中神经0.711~0.811,尺神经0.703~0.801。结论MRCT在CSR诊断中具有较好的灵敏度、特异度,其诊断价值优于F波潜伏期,可应用于CSR诊断筛查。

Objective To compare the differences between motor root conduction time(MRCT)and F wave latency of normal people and patients with cervical spondylotic radiculopathy(CSR),explore the diagnostic value of MRCT.Methods According to the accepted diagnostic criteria of cervical spondylotic radiculopathy(CSR),in the first step,106 cases in CSR group A and 45 cases in normal control group A were enrolled.A total of 212 median nerves and ulnar nerves were detected in the CSR A group.The normal control A group detected 90 bilateral median nerves and ulnar nerves.The F-wave latency and M-wave latency were recorded,MRCT was calculated,the ROC curve was analyzed to obtain the optimal cut-off value of MRCT.In the second step,151 cases in CSR group B and 44 cases in normal control group B were enrolled.A total of 302 median nerves and ulnar nerves were detected in CSR group B,and 88 bilateral median nerves and ulnar nerves were detected in normal control group B.The optimalcut-off value obtained in the first step was used to verify the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,and Kappa consistency analysis of MRCT,and then evaluate the diagnostic value of MRCT for CSR.Results In the normal control group,the reference value of median nerve MRCT was 1.50(1.25,1.65)ms,the ulnar nerve MRCT was 1.40(1.20,1.50)ms.ROC curve analysis results showed that the median nerve and ulnar nerve MRCT area under ROC curve,Youden index,95%confidence interval,sensitivity and specificity were higher than those of F wave latency.The area under ROC curve of median nerve and ulnar nerve MRCT was above 0.7(all P<0.01),both the median nerve and the ulnar nerve MRCT could be used as independent detection indicators.The results of kappa consistency analysis showed good consistency between MRCT and the existing CSR diagnostic standards(Kappa value0.491,standard error 0.038).The sensitivity of MRCT was 88.13%,specificity was 63.69%,positive predictive value was 86.45%,negative predictive value was 60.11%,positive likelihood ratio was 2.21,negative likelihood ratio was 0.20,95%CI:median nerve was 0.711-0.811,ulnar nerve was 0.703-0.801.Conclusion MRCT has good sensitivity and specificity in the diagnosis of CSR,and its diagnostic value is superior to wave F wave latency,which can be applied in the diagnosis and screening of CSR.