中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2013年
5期
308-312
,共5页
王亭亭%贾志荣%潘涛%柳竹%石昕%梁为
王亭亭%賈誌榮%潘濤%柳竹%石昕%樑為
왕정정%가지영%반도%류죽%석흔%량위
脊髓亚急性联合变性%电生理学%诱发电位,躯体感觉%上肢
脊髓亞急性聯閤變性%電生理學%誘髮電位,軀體感覺%上肢
척수아급성연합변성%전생이학%유발전위,구체감각%상지
Subacute combined degeneration%Electrophysiology%Evoked potentials,somatosensory%Upper extremity
目的 分析亚急性联合变性(subacute combined degeneration,SCD)的躯体感觉诱发电位(somatosensory evoked potential,SEP)上肢各波潜伏期及各波峰间期改变特点,探讨SCD的上肢SEP特点及上肢SEP对SCD中枢病变的诊断价值.方法 回顾性分析34例临床确诊的SCD患者临床资料、躯体感觉诱发电位、脊髓MRI的检查结果并观察其特点.对比SCD组与健康对照组的SEP各波潜伏期的差异,将SCD组的SEP结果按照周围段及中枢段进行分析.结果 与健康对照组相比,SCD组上肢N9[(10.80±1.07) ms与(10.23 ±0.64) ms,t=3.223]、P14[17.28±2.56) ms与(14.62 ±0.84) ms,t =6.643]、N9 ～ P14[(6.48 ±2.27) ms与(4.40 ±0.58) ms,t =5.951]及下肢N9[(12.11 ±0.83) ms与(10.93 ±0.56) ms,=5.690]、P30[(36.96 ±5.56) ms与(30.37±2.20)ms,t=7,217]及P38[(46.94 ±5.83) ms与(39.80±2.54) ms,t =7.353]各潜伏期均较健康对照组延长,差异均具有统计学意义(均P ＜0.01).SCD组P14 ～ N20间期较健康对照组延长,差异无统计学意义.SCD组SEP异常率为80.9％(110/136),上肢异常率为85.3％(58/68),下肢异常率为76.5％(52/68).上肢N9 ～ P14间期异常率最高,为72.1％ (49/68).在N9正常的神经中,中枢传导时间中N9 ～ P14节段的异常率(64.9％,24/37)最高.SCD组N9正常的神经和健康对照组比较,N9 ～ P14延长,差异具有统计学意义[(5.98±1.90) ms与(4.40 ±0.58) ms,t=5.267,P＜0.01].结论 SCD不仅可累及感觉神经周围段传导通路,还可累及脑干和大脑半球的中枢段感觉神经传导通路.在SCD患者上肢SEP中,N9 ～ P14异常率较高,中枢病变以颈髓到脑干的感觉传导通路受损更明显.SEP上肢中枢传导时间的测定,可提供SCD中枢受损的客观依据.
目的 分析亞急性聯閤變性(subacute combined degeneration,SCD)的軀體感覺誘髮電位(somatosensory evoked potential,SEP)上肢各波潛伏期及各波峰間期改變特點,探討SCD的上肢SEP特點及上肢SEP對SCD中樞病變的診斷價值.方法 迴顧性分析34例臨床確診的SCD患者臨床資料、軀體感覺誘髮電位、脊髓MRI的檢查結果併觀察其特點.對比SCD組與健康對照組的SEP各波潛伏期的差異,將SCD組的SEP結果按照週圍段及中樞段進行分析.結果 與健康對照組相比,SCD組上肢N9[(10.80±1.07) ms與(10.23 ±0.64) ms,t=3.223]、P14[17.28±2.56) ms與(14.62 ±0.84) ms,t =6.643]、N9 ～ P14[(6.48 ±2.27) ms與(4.40 ±0.58) ms,t =5.951]及下肢N9[(12.11 ±0.83) ms與(10.93 ±0.56) ms,=5.690]、P30[(36.96 ±5.56) ms與(30.37±2.20)ms,t=7,217]及P38[(46.94 ±5.83) ms與(39.80±2.54) ms,t =7.353]各潛伏期均較健康對照組延長,差異均具有統計學意義(均P ＜0.01).SCD組P14 ～ N20間期較健康對照組延長,差異無統計學意義.SCD組SEP異常率為80.9％(110/136),上肢異常率為85.3％(58/68),下肢異常率為76.5％(52/68).上肢N9 ～ P14間期異常率最高,為72.1％ (49/68).在N9正常的神經中,中樞傳導時間中N9 ～ P14節段的異常率(64.9％,24/37)最高.SCD組N9正常的神經和健康對照組比較,N9 ～ P14延長,差異具有統計學意義[(5.98±1.90) ms與(4.40 ±0.58) ms,t=5.267,P＜0.01].結論 SCD不僅可纍及感覺神經週圍段傳導通路,還可纍及腦榦和大腦半毬的中樞段感覺神經傳導通路.在SCD患者上肢SEP中,N9 ～ P14異常率較高,中樞病變以頸髓到腦榦的感覺傳導通路受損更明顯.SEP上肢中樞傳導時間的測定,可提供SCD中樞受損的客觀依據.
목적 분석아급성연합변성(subacute combined degeneration,SCD)적구체감각유발전위(somatosensory evoked potential,SEP)상지각파잠복기급각파봉간기개변특점,탐토SCD적상지SEP특점급상지SEP대SCD중추병변적진단개치.방법 회고성분석34례림상학진적SCD환자림상자료、구체감각유발전위、척수MRI적검사결과병관찰기특점.대비SCD조여건강대조조적SEP각파잠복기적차이,장SCD조적SEP결과안조주위단급중추단진행분석.결과 여건강대조조상비,SCD조상지N9[(10.80±1.07) ms여(10.23 ±0.64) ms,t=3.223]、P14[17.28±2.56) ms여(14.62 ±0.84) ms,t =6.643]、N9 ～ P14[(6.48 ±2.27) ms여(4.40 ±0.58) ms,t =5.951]급하지N9[(12.11 ±0.83) ms여(10.93 ±0.56) ms,=5.690]、P30[(36.96 ±5.56) ms여(30.37±2.20)ms,t=7,217]급P38[(46.94 ±5.83) ms여(39.80±2.54) ms,t =7.353]각잠복기균교건강대조조연장,차이균구유통계학의의(균P ＜0.01).SCD조P14 ～ N20간기교건강대조조연장,차이무통계학의의.SCD조SEP이상솔위80.9％(110/136),상지이상솔위85.3％(58/68),하지이상솔위76.5％(52/68).상지N9 ～ P14간기이상솔최고,위72.1％ (49/68).재N9정상적신경중,중추전도시간중N9 ～ P14절단적이상솔(64.9％,24/37)최고.SCD조N9정상적신경화건강대조조비교,N9 ～ P14연장,차이구유통계학의의[(5.98±1.90) ms여(4.40 ±0.58) ms,t=5.267,P＜0.01].결론 SCD불부가루급감각신경주위단전도통로,환가루급뇌간화대뇌반구적중추단감각신경전도통로.재SCD환자상지SEP중,N9 ～ P14이상솔교고,중추병변이경수도뇌간적감각전도통로수손경명현.SEP상지중추전도시간적측정,가제공SCD중추수손적객관의거.
Objective To analyze the features of the latency and interval in somatosensory evoked potentials (SEP) of the upper limbs in subacute combined degeneration(SCD),and evaluate the SEP of the upper limbs in the diagnosis of SCD.Methods Thirty-four defined SCD patients and 22 healthy controls were included in this study.The patients underwent the SEP test and the magnetic resonance imaging(MRI)of spinal cord.The SEP results of the patients were compared with those of the controls.The results of the SEP,which were divided into the peripheral part and central part to be evaluated,were also compared with the related results of the SEP and MRI.Results Compared with the controls,the N9 ((10.80 ± 1.07) ms vs (10.23 ± 0.64) ms,t =3.223),P14 ((17.28 ± 2.56) ms vs (14.62 ± 0.84) ms,t =6.643),N9-P14 ((6.48±2.27) ms vs(4.40-0.58) ms,t =5.951) in the upper limbs and N9((12.11 ±0.83) ms vs (10.93±0.56) ms,t=5.690),P30((36.96±5.56) ms vs(30.37±2.20) ms,t=7.217),P38 ((46.94 ±5.83) ms vs(39.80 ±2.54) ms,t =7.353) in the lower limbs of SCD patients were prolonged (all P ＜0.01),however,the P14-N20 was prolonged without statistical significance.The abnormality of SEP was 80.9％ (110/136),in which the abnormality of the upper limbs was 85.3％ (58/68)while that of the lower limbs was 76.5％ (52/68).N9-P14 had the highest abnormality rate which was 72.1％ (49/68).The patients with SCD with normal N9 had prolonged N9-P14 ((5.98 ± 1.90) ms vs(4.40 ± 0.58) ms,t =5.267,P ＜ 0.01).Conclusions Subacute combined degeneration can involve not only the peripheral part of the somatosensory pathway but also the central part including the brainstem and brain.In the SEP of upper limbs,N9-P14 has the highest abnormality rate which suggests that the part from cervical spinal cord to the brainstem may be the most vulnerable in SCD.The test of SEP in the upper limbs may provide evidence for the damage in the central part in SCD.
