CAJ | 학술논문

目的探讨三重刺激技术(TST)检测多灶性运动神经病(MMN)近端神经传导阻滞的作用.方法受检测者来自2010年4月至2011年4月北京大学第三医院神经科门诊和病房.对12例MMN患者、30名健康志愿者、30例肘管综合征患者、30例肌萎缩侧索硬化患者进行双侧小指展肌TST检测和常规神经传导研究,根据TST波幅比和复合肌肉动作电位波幅变化判断神经传导阻滞.结果健康志愿者TST波幅比率为93.0％±2.7％；MMN患者神经传导测定显示神经远端存在传导阻滞(CB)47处,TST波幅比异常42.3％±7.1％,提示神经近端存在传导阻滞,与人组时(7例)比较,确诊级别的例数(12例)差异有统计学意义(x2 =6.31,P＜0.05 );ALS患者TST波幅比异常30.5％ ±4.8％(t=2.43,P＜0.05),提示锥体束损害；肘管综合征患者TST波幅比率92.2％±2.6％,在正常范围内(t =0.68,P＞0.05),肘上、下传导速度减慢(23.6±3.5) m/s(=2.00,P＜0.05).结论三重刺激技术可以用于检测神经近端的传导阻滞,有利于MMN的诊断.
목적 탐토삼중자격기술(TST)검측다조성운동신경병(MMN)근단신경전도조체적작용.방법 수검측자래자2010년4월지2011년4월북경대학제삼의원신경과문진화병방.대12례MMN환자、30명건강지원자、30례주관종합정환자、30례기위축측색경화환자진행쌍측소지전기TST검측화상규신경전도연구,근거TST파폭비화복합기육동작전위파폭변화판단신경전도조체.결과 건강지원자TST파폭비솔위93.0％±2.7％；MMN환자신경전도측정현시신경원단존재전도조체(CB)47처,TST파폭비이상42.3％±7.1％,제시신경근단존재전도조체,여인조시(7례)비교,학진급별적례수(12례)차이유통계학의의(x2 =6.31,P＜0.05 );ALS환자TST파폭비이상30.5％ ±4.8％(t=2.43,P＜0.05),제시추체속손해；주관종합정환자TST파폭비솔92.2％±2.6％,재정상범위내(t =0.68,P＞0.05),주상、하전도속도감만(23.6±3.5) m/s(=2.00,P＜0.05).결론 삼중자격기술가이용우검측신경근단적전도조체,유리우MMN적진단.
Objective To detect the conduction block (CB) between nerve root and Erb's point by triple stimulation technique (TST) in patients with multifocal motor neuropathy (MMN).Methods The subjects were recruited from Peking University Third Hospital during the period of April 2010 to April 2011.Twelve MMN patients,30 healthy subjects,30 patients with cubital tunnel syndrome and 30 patients with amyotrophic lateral sclerosis (ALS) underwent TST along with clinical assessments and nerve conduction studies.TST combined transcranial magnetic stimulation (TMS) of motor cortex with peripheral collision studies.The results were expressed by the TST amplitude ratio.And the conduction block was judged by TST amplitude ratio or the amplitude ratio of compound muscle action potential (CMAP).Results The TST amplitude ratio of healthy volunteers was 93.0％ ±2.7％.And it was 42.3％ ±7.1％ in patients with MMN indicating a proximal CB.There were 47 CBs in distal segments by routine nerve conduction study.Compared with the baseline levels,the patients with definite MMN increased (x2 =6.31,P ＜ 0.05 ).The TST amplitude ratio(30.5％ ± 4.8％ )of those with ALS indicated the lesion of pyramid tract (t =2.43,P ＜ 0.05).And the TST amplitude ratio ( 92.2 ％ ± 2.6％ ) of those with cubital tunnel syndrome was normal( t =0.68,P ＞ 0.05 )while the nerve conduction velocity of cubital tunnel syndrome patients (below elbow-above elbow) was slower( (23.6 ± 3.5) m/s) ( t =2.00,P ＜ 0.05).Conclusion TST may be used to detect proximal CB and facilitate the diagnosis of MMN.