肌萎缩侧索硬化患者的重复神经电刺激特点

摘要

Objective To investigate the characteristics of repetitive nerve stimulation (RNS ) in patients with amyotrophic lateral sclerosis (ALS ) and its application value in the diagnosis and differential diagnosis of ALS .Methods One hundred and one ALS patients were collected with detailed information in the neurology out‐patient or ward of Beijing Union Medical College Hospital from May 2008 to April 2009 .RNS examination was employed for all patients .Another 40 non‐ALS out‐patients with muscle atrophy and weakness were examined by RNS .The clinical data of all the patients were recorded .Electromyogram (EMG) and RNS were adopted among all the patients .The positive rate of RNS and the degree of amplitude decrease in low frequency stimulation in different nerves of ALS patients were analyzed .The effects of gender ,age ,course of disease ,the amplitude of the ulnar nerve and the clinical classification of the disease on the positive rate of RNS were analyzed .The positive rates of RNS in patients with ALS and non‐ALS muscular atrophy were compared . Results (1) The positive rates of low frequency RNS in patients with ALS and non‐ALS muscular atrophy were 53.5% and 7.5% respectively ,and the difference between the two groups was statistically significant (P<0.05) .No case of high‐frequency increments occurred .(2) The positive rates of low frequency RNS in different nerves were:axillary nerve (30.6% ) ,accessory nerve (25% ) ,radial nerve (15.5% ) ,ulnar nerve (7.8% ) , facial nerve (1% ) ,tibial nerve (0% ) ,respectively .(3) There was no correlation between positive rate of low frequency RNS in ALS patients and gender ,age ,disease duration (<1 year ,≥1 year) ,and the clinical disease classification (Light‐Medium‐Severe‐Critical) (P> 0.05 ,respectively) .The RNS‐positive rate of limb onset patients were higher than that of the bublar onset patients (P< 0.05) .Conclusions The positive rate of low frequency RNS in ALS patients is higher than that of the non‐ALS patients with muscular atrophy .RNS test is helpful for the diagnosis and differential diagnosis of ALS .The low frequency of RNS in ALS patients is not associated with gender ,age ,course of disease and clinical disease classification .%目的：探讨肌萎缩侧索硬化（ALS）患者重复神经电刺激（RNS）特点，及其在ALS诊断和鉴别诊断中的应用价值。方法收集2008‐05－2009‐04在北京协和医院神经科门诊或住院确诊或拟诊的A L S患者101例，另选择同期门诊就诊的非A L S肌肉萎缩患者40例为对照。记录患者的临床资料。所有患者行肌电图和RNS检查。比较ALS患者和非ALS肌萎缩患者RNS阳性率的差异。比较ALS患者不同神经RNS阳性率及递减幅度差异，并分析性别、年龄、病程、尺神经波幅、临床疾病分级对RNS阳性率的影响。结果（1）ALS患者和非ALS肌萎缩无力患者RNS检查低频递减阳性率分别为53.5％和7.5％，两组间比较差异有统计意义（P＜0.05），未出现高频递增患者。（2）所检测神经低频递减阳性率从高至低依次为腋神经（30.6％）＞副神经（25％）＞桡神经（15.5％）＞尺神经（7.8％）＞面神经（1.0％）＞胫神经（0％）。（3）ALS患者RNS检测低频递减阳性率与性别、年龄、病程、临床疾病分级无关（均P＞0.05），肢体起病者较球部起病者RNS低频递减阳性率高（P＜0.05）。结论 ALS患者RNS检测低频递减阳性率较非ALS肌无力萎缩患者高，RNS检测有助于ALS的诊断和鉴别诊断。ALS患者RNS检测低频递减阳性与性别、年龄、病程、临床疾病分级均无关。