中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2013年
2期
191-193
,共3页
韦朝霞%莫绮娴%祁风%刘祖佑%余科
韋朝霞%莫綺嫻%祁風%劉祖祐%餘科
위조하%막기한%기풍%류조우%여과
重症肌无力%重复神经刺激%疲劳试验%低频%诊断
重癥肌無力%重複神經刺激%疲勞試驗%低頻%診斷
중증기무력%중복신경자격%피로시험%저빈%진단
Myasthenia gravis%Repetitive nerve stimulation%Exercise test%Low-frequency%Diagnosis
目的 观察重复神经电刺激(RNS)及疲劳试验对全身型重症肌无力(MG)的诊断应用价值,探讨提高RNS诊断阳性率的方法. 方法 广州医学院荔湾医院神经内科自2008年1月至2012年6月45例收治的全身型MG患者45例,首先在休息状态下对每位患者的口轮匝肌、肘肌、三角肌和小指展肌分别用低频(1 Hz、3 Hz、5 Hz)和高频(10 Hz、20 Hz、30 Hz)超强电流进行RNS检查;之后肌肉强直收缩,疲劳后再以同样电流进行RNS检查,观察阳性率的变化. 结果 疲劳试验前4块肌肉综合统计低频刺激下RNS阳性率[60.0％(27/45)],高于高频刺激下RNS阳性率[17.78％(8/45)],差异有统计学意义(x2=16.878,P=0.000);与疲劳试验前比较,疲劳试验后肘肌、三角肌的RNS阳性率增加,差异有统计学意义(P＜0.05)；口轮匝肌、小指展肌的RNS阳性率无明显变化,差异无统计学意义(P＞0.05)；4块肌肉综合统计低频刺激下RNS阳性率增高,差异有统计学意义(P＜0.05). 结论 (1)重复神经电低频刺激在MG疾病诊断中具有重要的价值,低频刺激阳性率高,具诊断价值；(2)不同肌肉的阳性率不同,同时做4块肌肉可明显提高RNS的阳性率及灵敏度；(3)疲劳试验可显著提高三角肌、肘肌和低频刺激下4块肌肉综合统计的RNS阳性率,从而提高诊断的灵敏度.
目的 觀察重複神經電刺激(RNS)及疲勞試驗對全身型重癥肌無力(MG)的診斷應用價值,探討提高RNS診斷暘性率的方法. 方法 廣州醫學院荔灣醫院神經內科自2008年1月至2012年6月45例收治的全身型MG患者45例,首先在休息狀態下對每位患者的口輪匝肌、肘肌、三角肌和小指展肌分彆用低頻(1 Hz、3 Hz、5 Hz)和高頻(10 Hz、20 Hz、30 Hz)超彊電流進行RNS檢查;之後肌肉彊直收縮,疲勞後再以同樣電流進行RNS檢查,觀察暘性率的變化. 結果 疲勞試驗前4塊肌肉綜閤統計低頻刺激下RNS暘性率[60.0％(27/45)],高于高頻刺激下RNS暘性率[17.78％(8/45)],差異有統計學意義(x2=16.878,P=0.000);與疲勞試驗前比較,疲勞試驗後肘肌、三角肌的RNS暘性率增加,差異有統計學意義(P＜0.05)；口輪匝肌、小指展肌的RNS暘性率無明顯變化,差異無統計學意義(P＞0.05)；4塊肌肉綜閤統計低頻刺激下RNS暘性率增高,差異有統計學意義(P＜0.05). 結論 (1)重複神經電低頻刺激在MG疾病診斷中具有重要的價值,低頻刺激暘性率高,具診斷價值；(2)不同肌肉的暘性率不同,同時做4塊肌肉可明顯提高RNS的暘性率及靈敏度；(3)疲勞試驗可顯著提高三角肌、肘肌和低頻刺激下4塊肌肉綜閤統計的RNS暘性率,從而提高診斷的靈敏度.
목적 관찰중복신경전자격(RNS)급피로시험대전신형중증기무력(MG)적진단응용개치,탐토제고RNS진단양성솔적방법. 방법 엄주의학원려만의원신경내과자2008년1월지2012년6월45례수치적전신형MG환자45례,수선재휴식상태하대매위환자적구륜잡기、주기、삼각기화소지전기분별용저빈(1 Hz、3 Hz、5 Hz)화고빈(10 Hz、20 Hz、30 Hz)초강전류진행RNS검사;지후기육강직수축,피로후재이동양전류진행RNS검사,관찰양성솔적변화. 결과 피로시험전4괴기육종합통계저빈자격하RNS양성솔[60.0％(27/45)],고우고빈자격하RNS양성솔[17.78％(8/45)],차이유통계학의의(x2=16.878,P=0.000);여피로시험전비교,피로시험후주기、삼각기적RNS양성솔증가,차이유통계학의의(P＜0.05)；구륜잡기、소지전기적RNS양성솔무명현변화,차이무통계학의의(P＞0.05)；4괴기육종합통계저빈자격하RNS양성솔증고,차이유통계학의의(P＜0.05). 결론 (1)중복신경전저빈자격재MG질병진단중구유중요적개치,저빈자격양성솔고,구진단개치；(2)불동기육적양성솔불동,동시주4괴기육가명현제고RNS적양성솔급령민도；(3)피로시험가현저제고삼각기、주기화저빈자격하4괴기육종합통계적RNS양성솔,종이제고진단적령민도.
Objective To evaluate the diagnostic utility of repetitive nerve stimulation (RNS)and the effect of exercise test in RNS,as well as to find the way to improve the diagnostic sensitivity of RNS in myasthenia gravis (MG).Methods A total of 45 patients with generalized MG,admitted to our hospital from January 2008 to June 2012,were chosen in our study; they,firstly,underwent RNS test in orbiculatis otis,anconeus,deltoid and musculus abductor digiti minimi with low frequency (1,3 and 5Hz) and high frequency (10,20 and 30 Hz) supramaximal current,and then,till the muscle tetanic contraction (fatigue),RNS test at the same frequency was performed again; the diagnostic sensitivity of RNS in MG was compared.Results Before exercise test,the comprehensive positive rate of the four muscles on low-frequency RNS test was 60.0％ (27/45),which was significantly higher than that on high-frequency RNS test (17.78％,8/45) (x2=16.878,P=0.000).As compared with that before exercise test,the RNS positive rate of anconeus and deltoid after exercise was significantly higher (P＜0.05),while no significant difference was noted on orbicularis otis and abductor digiti minimi between before exercise test and after exercise test (P＞0.05).Increased comprehensive positive rate of four muscles in low-frequency RNS test was showed as compared with that in high-frequency RNS test (P＜0.05).Conclusion RNS has important diagnosis value in MG,and low-frequency RNS enjoys high positive rate; different muscles have different positive rate of RNS,and RNS for the four muscles at the same time can obviously increase the positive rate and detection sensitivity; exercise test can significantly improve the diagnostic sensitivity of RNS in anconeus and deltoid,as well as the comprehensive positive rate of four muscles in low-frequency RNS test.
