CAJ | 학술논문

目的前瞻性研究尺神经与正中神经复合肌肉动作电位(CMAP)波幅比值在运动神经元病变中的诊断价值.方法 2009年5月至2012年2月因无力、不灵活、肉跳、肌萎缩就诊于我科的患者,均进行四肢常规神经传导检测(表面电极刺激和记录)和针电极肌电图检测,检测者固定.对连续入组且符合诊断标准的确诊型肌萎缩侧索硬化(ALS)和平山病患者,主要分析在其腕部刺激尺神经、正中神经,分别于小指展肌(ADM)、拇短展肌(APB)记录的CMAP,并计算二者的波幅比值,即ADM/APB；吉兰-巴雷综合征(GBS)、其他多发性神经病(PN)患者作为病例对照,34名健康志愿者作为健康对照.结果 (1) ALS 78例、平山病25例、GBS 51例、其他PN 140例,年龄(岁)分别为54.7±11.6、17.6±2.2、41.3±18.4、57.1±14.3;健康对照组为45.7±16.3.(2)ADM/APB在ALS为2.28 ±2.87(0.12 ～22.38),平山病0.66±0.36(0.05 ～ 1.34),GBS 1.42±1.33 (0.25 ～ 9.85),其他PN 1.36±1.48(0.08 ～ 14.44),健康对照1.07±0.28(0.61 ～1.64,F=6.872,P=0.000).(3)接受者操作特征曲线下面积在ALS为0.830(标准误=0.039),在平山病为0.691(标准误=0.039,P=0.000)；ADM/APB为2.0时,诊断ALS的敏感度和特异度分别为36.7％和93.3％;ADM/APB为0.7时,诊断平山病的敏感度和特异度分别为53.6％和89.0％.结论尺神经与正中神经的CMAP波幅比值在ALS增大、平山病减小,可能为相对特异的电生理指标；建议以比值大于2.0、小于0.7分别作为ALS、平山病的电生理诊断参数.
목적 전첨성연구척신경여정중신경복합기육동작전위(CMAP)파폭비치재운동신경원병변중적진단개치.방법 2009년5월지2012년2월인무력、불령활、육도、기위축취진우아과적환자,균진행사지상규신경전도검측(표면전겁자격화기록)화침전겁기전도검측,검측자고정.대련속입조차부합진단표준적학진형기위축측색경화(ALS)화평산병환자,주요분석재기완부자격척신경、정중신경,분별우소지전기(ADM)、무단전기(APB)기록적CMAP,병계산이자적파폭비치,즉ADM/APB；길란-파뢰종합정(GBS)、기타다발성신경병(PN)환자작위병례대조,34명건강지원자작위건강대조.결과 (1) ALS 78례、평산병25례、GBS 51례、기타PN 140례,년령(세)분별위54.7±11.6、17.6±2.2、41.3±18.4、57.1±14.3;건강대조조위45.7±16.3.(2)ADM/APB재ALS위2.28 ±2.87(0.12 ～22.38),평산병0.66±0.36(0.05 ～ 1.34),GBS 1.42±1.33 (0.25 ～ 9.85),기타PN 1.36±1.48(0.08 ～ 14.44),건강대조1.07±0.28(0.61 ～1.64,F=6.872,P=0.000).(3)접수자조작특정곡선하면적재ALS위0.830(표준오=0.039),재평산병위0.691(표준오=0.039,P=0.000)；ADM/APB위2.0시,진단ALS적민감도화특이도분별위36.7％화93.3％;ADM/APB위0.7시,진단평산병적민감도화특이도분별위53.6％화89.0％.결론 척신경여정중신경적CMAP파폭비치재ALS증대、평산병감소,가능위상대특이적전생리지표；건의이비치대우2.0、소우0.7분별작위ALS、평산병적전생리진단삼수.
Objective To investigate prospectively the diagnostic significance of ulnar/median nerve amplitude ratio in motor neuron disorders.Methods Patients referral to our department between May 2009 and February 2012,due to muscle weakness,inflexible,cramps and atrophy,were consecutively enrolled.Conventional nerve conduction studies of 4 extremities (using surface electrodes) and needle electromyography were performed in all patients with fixed examiner.The compound muscle action potentials (CMAP) were recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) with stimulation of ulnar and median nerve at wrist,respectively.Moreover,the ratio of CMAP amplitude between ADM and APB (ADM/APB) was calculated in the patients who met the diagnostic criteria for definite amyotrophic lateral sclerosis (ALS) and Hirayama disease (HD).The patients with Guillain-Barré syndrome (GBS) and other popyneuropathies (PN) were served as case-controls,and 34 healthy volunteers (aged (45.7 ± 16.3) years) as normal-controls.Results (1) There were 78 cases with ALS,25 HD,51 GBS and 140 other PN,with the mean age(years) of 54.7 ± 11.6,17.6 ± 2.2,41.3 ± 18.4 and 57.1 ± 14.3,respectively.(2) ADM/APB in the ALS subgroup was 2.28 ±2.87 (0.12-22.38),HD0.66±0.36 (0.05-1.34),GBS 1.42 ± 1.33 (0.25-9.85),other PN 1.36 ± 1.48 (0.08-14.44) and normal-controls 1.07 ± 0.28 (0.61-1.64,F =6.872,P =0.000),respectively.(3) The areas under receiver operator characteristic curve in patients with ALS was 0.830 (s-x =0.039) and HD 0.691 (sx =0.039,P =0.000) ; the diagnostic sensitivity and specificity for ALS patients were 36.7％ and 93.3％,respectively,with cutoff value of ADM/APB =2; and the diagnostic sensitivity and specificity for HD patients were 53.6％ and 89.0％,respectively,with cutoff value of ADM/APB =0.7.Conclusions The ulnar/median CMAP amplitude ratio increases in ALS,but decreases in HD,which may be served as a relatively specific electrophysiological index.ADM/APB amplitude ratio ＞ 2.0 is suggested to be a diagnostic parameter for ALS and ＜ 0.7 for HD.