颏舌肌针极肌电图在检测肌萎缩侧索硬化中的应用

摘要

目的 探讨颏舌肌自发电位对肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的诊断价值.方法 回顾性分析2014年1月至2015年12月于首都医科大学附属北京天坛医院门诊就诊并确诊为ALS的79例患者的临床资料,按照患者有无球部症状将其分为无球部症状组(44例)和有球部症状组(35例),就其病程、颏舌肌自发电位、胸锁乳突肌自发电位、肌萎缩侧索硬化功能评分量表(ALS-FRS)评分进行分析,同时探讨颏舌肌自发电位的半定量评价与ALS-FRS评分之间的关系.结果 在ALS患者中,颏舌肌自发电位的阳性率为69.6％(55/79),其中有球部症状组为82.9％ (29/35),无球部症状组为59.1％(26/44),两组差异有统计学意义(x2=5.206,P＜0.05);而胸锁乳突肌自发电位阳性率较低,仅为13.9％(11/79),且在有、无球部症状两组间差异无统计学意义.颏舌肌纤颤电位的半定量评价与ALF-FRS评分间存在相关关系(r=-0.258,P＜0.05),而正锐波的半定量评价与ALS-FRS评分间无相关关系.结论 与胸锁乳突肌相比,ALS患者颏舌肌自发电位阳性率较高,且对球部亚临床患者有较高诊断价值.%Objective To investigate the diagnostic value of spontaneous activities in genioglossus of amyotrophic lateral sclerosis (ALS).Methods A retrospective analysis of 79 patients diagnosed with ALS from January 2014 to December 2015 in Beijing Tiantan Hospital Affiliated to Capital Medical University was made.The patients were divided into two groups according to the clinical examination:with (44 patients) or without bulbar symptoms (35 patients).The course of disease,spontaneous potentials and ALS-Functional Rating Scale (ALS-FRS) scores were discussed,together with the association between semi-quantitative evaluation of spontaneous potential of the genioglossus and ALS-FRS score.Results In ALS patients,the overall positive rate of glossal spontaneous potentials was 69.6％ (55/79),among which the positive rate was 82.9％ (29/35) in patients with bulbar symptoms and 59.1％ (26/44) in patients without bulbar symptoms,with statistically significant differences between the two groups (x2=5.206,P＜0.05).While the positive rate in sternocleidomastoid was only 13.9％ (11/79),and there was no statistically significant difference between patients with or without bulbar symptoms.Semi-quantitative evaluation of fibrillation potentials in genioglossus muscle was correlated with ALS-FRS score (r=-0.258,P＜0.05).Conclusion Compared with sternocleidomastoid muscle,genioglossus muscle has a higher positive rate of spontaneous potentials and a higher diagnostic value in patients with subclinical bulbar symptoms.