神经生理指数对肌萎缩侧索硬化患者生存情况的评估价值

The value of neurophysiological index in evaluating the survival of patients with amyotrophic lateral sclerosis

目的探讨肌电图检测神经生理指数对肌萎缩侧索硬化症(ALS)患者生存情况的评估作用。方法收集龙岩市第二医院神经内科2018年1月至2021年1月期间收治的40例ALS患者为ALS组,其中男23例,女17例,年龄28~72岁。另选取同期健康体检的志愿者40例为对照组,其中男20例,女20例,年龄28~72岁。两组均接受肌电图检测,比较两组正中、尺、胫、腓总神经运动末端潜伏期(DML)、复合肌肉动作电位(CMAP)波幅、F波出现频率及神经生理指数(NI),NI=(CMAP波幅/DML)×F波出现频率。根据ALS组患者预后情况分为死亡组及生存组,比较两组各神经NI及改良肌萎缩侧索硬化功能评分(ALSFRS-R)。采用受试者工作特征曲线分析NI、ALSFRS-R及二者联合对ALS患者生存情况的预测价值。结果40例ALS患者经肌电图检测双侧神经,正中神经DML和运动传导速度异常率最高,尺神经CMAP和F波异常率最高。针极肌电图检测280块肌肉,共出现神经源性损害182块(65.0%,182/280块)。ALS组各神经NI均低于对照组(P<0.001)。ALS组CMAP波幅、F波出现率低于对照组,DML长于对照组(P<0.001)。40例ALS组患者随访2年,死亡14例,生存26例,死亡组NI、ALSFRS-R评分均低于生存组(P<0.001)。NI联合ALSFRS-R评分对ALS患者生存情况的预测价值较高,曲线下面积、灵敏度、特异度分别为0.984、92.30%、92.86%。结论神经生理指数是一种客观的电生理指标,对预测ALS患者生存情况具有重要意义。

Objective To explore the value of neurophysiological index in evaluating the survival of patients with amyotrophic lateral sclerosis(ALS).Methods A total of 40 ALS patients admitted to the Department of Neurology of Longyan Second Hospital from January 2018 to January 2021 were enrolled in the ALS group,including 23 males and 17 females,aged 28-72 years.Another 40 healthy volunteers in the same period were selected as the control group,including 20 males and 20 females,aged 28-72 years old.The subjects in both groups were examined by EMG,and the distal motor latency(DML),complex muscle action potential(CMAP)amplitude,F-wave frequency and neurophysiological index(NI)of the median,ulnar,tibial,and common peroneal nerves were compared between the two groups,NI=(CMAP amplitude/DML)×F-wave frequency.According to the prognosis of ALS patients,they were divided into death group and survival group,and the NI and revised ALS functional rating scale(ALSFRS-R)in the two groups were compared.The predictive value of NI,ALSFRS-R,and their combination in predicting the survival of ALS patients was analyzed using receiver operating characteristic curve.Results The abnormal rate of DML and motor conduction velocity of median nerve was the highest,and the abnormal rate of CMAP and F-wave of ulnar nerve was the highest in 40 ALS patients.280 muscles were detected by needle electromyography,with a total of 182 muscles(65.0%,182/280 muscles)showing neurogenic damage.The NI of each nerve in the ALS group was lower than that in the control group(P<0.001).The amplitude of CMAP and F-wave occurrence rate in the ALS group were lower than that in the control group,while the DML was longer than that in the control group(P<0.001).40 patients with ALS were followed up for 2 years,with 14 deaths and 26 survivors.NI and ALSFRS-R scores in the death group were lower than those in the survival group(P<0.001).NI combined with ALSFRS-R score had higher predictive value for survival of ALS patients,and area under curve,sensitivity and specificity were 0.984,92.30%and 92.86%,respectively.Conclusion Neurophysiological index is an objective electrophysiological index,which is of great significance for predicting the survival of ALS patients.