肌萎缩侧索硬化的针极肌电图诊断价值研究

Diagnostic value of needle electromyography in amyotrophic lateral sclerosis

摘要:

目的 探讨肌萎缩侧索硬化的针极肌电图（EMG）的诊断价值。方法 选取2014 年6 月—2017 年 6 月于海南医学院第二附属医院收治的33 例肌萎缩侧索硬化患者作为研究对象。比较患者不同神经重复电 刺激（RNS）复合肌肉动作电位波幅递减情况和不同部位针极EMG 特点，并比较呼吸障碍对患者针极EMG 的影响。结果 33 例患者中有16 例（48.48%）副神经RNS 低频递减阳性，幅度为15% ～ 46%。1 和3 Hz 的 递减阳性例数分别为9（27.27%）和16 例（48.48%），其中3 Hz 递减覆盖全部阳性结果。患者EMG 表现出 广泛神经源性损害，可见正锐波和纤颤电位，15 例患者出现束颤电位。有呼吸障碍组腹直肌针极EMG 自发 电位发生率高于无呼吸障碍组（P <0.05）。结论 肌萎缩侧索硬化患者存在副神经RNS 低频时复合肌肉动作 电位波幅递减现象，患者存在广泛神经源性损害，自发电位以正锐波和纤颤电位为主，且EMG 可帮助诊断呼 吸障碍。

Abstract:

Objective To investigate the diagnostic value of needle electromyography in amyotrophic lateral sclerosis. Methods Totally 33 patients with amyotrophic lateral sclerosis treated in our hospital from June 2014 to June 2017 were enrolled in this study. The amplitude of compound muscle action potential and EMG of different regions were compared in patients with different nerve stimulation (RNS), and the effects of respiratory disorders on EMG of patients were compared. Results Among the 33 patients, the RNS of accessory nerve decreased gradually at low frequencies in 16 patients (48.48%), ranging from 15% to 46%. The number of decreasing positive cases at 1 Hz and 3 Hz was 9 (27.27%) and 16 (48.48%), respectively, but decreasing cases with 3 Hz covered all positive results. EMG showed extensive neurogenic damage, positive sharp wave and fibrillation potential, and bundle fibrillation potential appeared in 15 patients. The incidence of EMG spontaneous potential of rectus abdominis needle pole in the group with respiratory disorder was higher than that in the group without respiratory disorder (P < 0.05). Conclusions The amplitude of compound muscle action potential will decrease gradually in patients with amyotrophic lateral sclerosis when there are low frequencies in the RNS of accessory nerve. There were extensive neurogenic damages in patients with amyotrophic lateral sclerosis. The main spontaneous potentials were positive sharp wave and fibrillation potential, and EMG can help to diagnose respiratory disorders.