肌萎缩侧索硬化症患者巴氏征的影响因素分析

Factors affecting Babinski sign in amyotrophic lateral sclerosis

目的探索肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)患者巴氏征的影响因素。方法纳入2015年至2020年就诊于西安交通大学第一附属医院神经内科、被诊断为ALS且资料齐全的262例患者。分别分析左、右侧巴氏征阳性与阴性患者组间临床特点的关系,以及有下肢无力主诉的患者其巴氏征与下肢受累特点间的关系。结果巴氏征阳性与更高诊断级别呈正相关(左侧相关系数0.297,P<0.001;右侧相关系数0.292,P<0.001);巴氏征阳性患者的ALSFRS-R(Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised)评分更低(左侧P=0.001,右侧P=0.001);同侧下肢有无力主诉者比例更高(左侧P=0.008,右侧P=0.038);且同侧上肢Hoffmann征阳性率更高(左侧P=0.004,右侧P=0.002)。在下肢有无力主诉的患者中,巴氏征阳性与同侧更好的足背屈肌力呈正相关(左侧相关系数0.207,P=0.021;右侧相关系数0.264,P=0.003);巴氏征阳性组患者的同侧胫骨前肌萎缩者比例更低(左侧P<0.001,右侧P=0.008);且巴氏征阳性与阴性组相比,同侧腓总神经复合肌肉动作电位(compound muscle action potential,CMAP)/胫神经CMAP比值不同(左侧P=0.008,右侧P=0.015),巴氏征阳性与该比值呈正相关(左侧相关系数0.246,P=0.007;右侧相关系数0.223,P=0.015)。结论巴氏征阳性患者通常诊断级别更高,临床受累更广泛。有下肢无力主诉的ALS患者,其小腿前群肌肉无力及萎缩程度较低时,巴氏征更容易被引出。

Objective To explore the factors affecting Babinski sign in amyotrophic lateral sclerosis(ALS).Methods We enrolled 262 patients diagnosed with ALS with adequate data in Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University from 2015 to 2020.The relationship between the clinical characteristics of patients with positive and negative Babinski sign was analyzed for both sides,respectively.Furthermore,for patients with left or right lower limb weakness complaint,the relationship between Babinski sign and the lower limb involvement characteristics was analyzed.Results Positive Babinski sign was positively correlated with higher diagnostic category(left correlation coefficient 0.297,P<0.001;right correlation coefficient 0.292,P<0.001).Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)score was lower in patients with positive Babinski sign(left P=0.001,right P=0.001);the proportion of complaints of ipsilateral lower limb weakness was higher(left P=0.008,right P=0.038);the positive rate of ipsilateral upper limb Hoffmann sign was higher(left P=0.004,right P=0.002).In patients with complaints of lower limb weakness,positive Babinski sign was positively correlated with better foot dorsiflexor muscle strength(left correlation coefficient 0.207,P=0.021;right correlation coefficient 0.264,P=0.003),and the proportion of ipsilateral tibialis anterior atrophy was lower in positive Babinski sign group(left P<0.001,right P=0.008);the ratio of ipsilateral common peroneal nerve compound muscle action potential(CMAP)/tibial nerve CMAP was different in positive Babinski sign and negative groups(left P=0.008,right P=0.015),which were positively correlated(left correlation coefficient 0.246,P=0.007;right correlation coefficient 0.223,P=0.015).Conclusion Patients with positive Babinski sign usually have a higher diagnostic category and more extensive clinical involvement.In ALS patients with complaints of lower limb weakness,Babinski sign is more likely to be elicited when the degree of weakness and atrophy of the anterior calf muscles is relatively low.