CAJ | 학술논문

背景:运动神经元病的最早及好发部位为颈膨大,随病情发展,最早累及禽近的上部颈段及延髓区,三叉神经-颈反射受累较早.目的:建立三叉神经-颈反射的肌电检测方法,分析三叉神经-颈反射对运动神经元病球部损害的诊断价值.设计:病例-对照观察.单位:北京大学第三医院神经内科电生理检查室.对象:北京大学第三医院2002/2005就诊的运动神经元病患者主要为肌萎缩性侧索硬化症30例及健康志愿者70例.运动神经元病患者符合西班牙El Escorial会议诊断标准.方法:受检测者取仰卧位,头部轻度抬高.使你锁乳突肌轻度收缩.刺激一侧眶下神经,于双侧胸锁乳突记录峰潜伏期和波幅.所用检测仪器为Keypoint肌电图仪.所用电极均为Ag/Agcl表面电极.主要观察指标:正/负波潜伏(P20/N30),波幅比率的平方根,即A值.结果:刺激对照者一侧的眶下神经,可于双侧胸锁乳突肌引出正/负波.运动神经元病组7例正常(23.3%),8例未引出(26.7%),11例潜伏期延长(36.7%),4例双侧反射超常不对称(13.3%).运动神经元病组三叉神经-颈反射正波/负波的峰潜伏期(P20/N30)明显高于正常对照组,差异有显著性.波幅比的平方根(峰值与刺激前波幅比值的平方根即A值)明显低于正常对照组,差异有显著性.结论:三叉神经-颈反射能够可靠测定,可作为颈-球区病变的一种辅助检查手段,有助于运动神经元病的早期诊断.
배경:운동신경원병적최조급호발부위위경팽대,수병정발전,최조루급금근적상부경단급연수구,삼차신경-경반사수루교조.목적:건립삼차신경-경반사적기전검측방법,분석삼차신경-경반사대운동신경원병구부손해적진단개치.설계:병례-대조관찰.단위:북경대학제삼의원신경내과전생리검사실.대상:북경대학제삼의원2002/2005취진적운동신경원병환자주요위기위축성측색경화증30례급건강지원자70례.운동신경원병환자부합서반아El Escorial회의진단표준.방법:수검측자취앙와위,두부경도태고.사니쇄유돌기경도수축.자격일측광하신경,우쌍측흉쇄유돌기록봉잠복기화파폭.소용검측의기위Keypoint기전도의.소용전겁균위Ag/Agcl표면전겁.주요관찰지표:정/부파잠복(P20/N30),파폭비솔적평방근,즉A치.결과:자격대조자일측적광하신경,가우쌍측흉쇄유돌기인출정/부파.운동신경원병조7례정상(23.3%),8례미인출(26.7%),11례잠복기연장(36.7%),4례쌍측반사초상불대칭(13.3%).운동신경원병조삼차신경-경반사정파/부파적봉잠복기(P20/N30)명현고우정상대조조,차이유현저성.파폭비적평방근(봉치여자격전파폭비치적평방근즉A치)명현저우정상대조조,차이유현저성.결론:삼차신경-경반사능구가고측정,가작위경-구구병변적일충보조검사수단,유조우운동신경원병적조기진단.
BACKGROUND: Cervical intumescence is the earliest and easy attacking part of motor neuron disease (MND). With the development of patients'condition, cervical part and medulla oblongata region were involved early,and the trigemino-cervical reflex (TCR) was involved earliest.OBJECTIVE: To establish electromyography of TCR and analyze the value in the diagnosis of MND of the TCR.DESIGN: Case-control study.SETTING: Room of Electrophysiologic Study, Department of Neurology,Third Hospital, Peking University.PARTICIPANTS: Thirty MND patients,mainly amyotrophic lateral sclerosis (ALS) patients and 70 healthy volunteers who were examined at Third Hospital, Peking University from 2002 to 2005. MND patients accorded with the diagnostic standard of Spain El Escorial conference.METHODS: The subjects held the heads slightly raised when lying supine to make the sternocleidomastoid muscles contracted slightly. Electrical stimulation was applied to the infraorbital nerves and latency and amplitude of wave were recorded from the bilateral sternocleidomastoid muscles. The detecting instrument was Keypoint electromyography (EMG).The surface EMG activity was recorded via Ag/AgCl.MAIN OUTCOME MEASURES: Latency of positive wave/ negative wave (P20/N30); square root of the ratio of the amplitudes, that is, value A.RESULTS: Stimulation of the infraorbital nerve on one side of controlled people produced bilateral positive and negative waves. In the MND group,7 patients showed normal (23.3%), 8 patients showed absence of wave (26.7%), 11 patients were delayed in latency (36.7%), and extreme asymmetry of reflection of the two sides was found in 4 patients (13.3%).In the MND group, the latency of positive and negative waves of TCR (P20/N30) was markedly longer than that in the normal control group,and the difference was significant. Square root of the ratio between the amplitudes after and before stimulation (square root of the ratio between peak to peak value and amplitude of wave before stimulation, that was,value A) was lower remarkably than that in the normal control group, and the difference was significant.CONCLUSION: The TCR can be reliably measured. It may help examine the cervical-bulbar lesion and diagnosing motor neuron disease in an early period.