咬肌单纤维肌电图在重症肌无力和炎性肌病中的应用研究

发布时间：2018-03-27 12:56

本文选题：咬肌　切入点：单纤维肌电图　出处：《郑州大学》2015年博士论文

【摘要】：背景和目的:单纤维肌电图(single fiber electromyography,SFEMG)借助的是一种特殊的针电极,通过其侧面小的记录面积来识别和记录单个肌纤维的动作电位,SFEMG作为一种具有较高敏感性的诊断方法,现已广泛应用于临床,尤其是对重症肌无力(myasthenia gravis,MG)的临床识别诊断有着非常重要的临床意义。本文就咬肌的单纤维肌电图对重症肌无力、炎性肌病的诊断价值以及治疗对其结果的影响进行了一系列前瞻性研究,以期更好的指导临床实践。方法:第一部分:随机选取自愿参与研究的郑州大学第五附属医院健康职工48例,在同一天同一时段,由专业肌电图技师对48名受试者先后完成SSFEMG和VSFEMG检查,两次测试时间间隔至少大于5分钟。每人均在咬肌和拇短展肌上测试jitter值及FD值。第二部分:对30例MG患者均在入院后同一天同一时段依次进行临床QMG评分、咬肌低频RNS检查和SFEMG检查。第三部分:对23例炎性肌病患者行肌酶谱检测,肱二头肌、股四头肌、胫前肌、拇短展肌的常规肌电图(EMG)检查,运动、感觉神经传导速度检查,咬肌的单纤维肌电图检测以及肌肉病理检查。结果:第一部分:推荐中国人群咬肌的jitter正常参考值为33μs和22μs,此结果与国外同类研究推荐结果基本一致;jitter、FD正常值会随着年龄的增加而增加,咬肌的单纤维肌电图的jitter、FD值与性别无关;拇短展肌jitter值、FD值与年龄成正相关,与性别无关;拇短展肌的jitter值和FD值的正常上限值均较咬肌的高。第二部分:结果显示MG组与正常对照组受试者咬肌的MCD值,颤抖增宽的电位对比例,阻滞电位对比例均显著高于对照组,OMG与GMG组相比较,OMG型患者的发病年龄显著低于GMG型患者;RNS的方法对于GMG的检测阳性率高于OMG;SFEMG的诊断技术的总体敏感性为90.0%,高于RNS的60.0%;30名MG患者通过包括了胆碱酯酶抑制剂、激素治疗、霉酚酸酯免疫抑制剂、咪唑硫嘌呤免疫抑制剂、静脉注射免疫球蛋白、胸腺切除术、血浆交换等治疗后,利用美国QMG方法对治疗前后病情变化进行相对计分,无效组和好转组患者的病情变化与jitter值变化两者之间无线性相关关系,而显效组和痊愈组中两者之间均有线性相关,呈正相关关系,痊愈组比显效组的相关性更大,病情好转的程度越高,jitter值的变化与病情的变化相关性越大,在病情改善明显的患者应用jitter值更能客观的评价治疗效果。第三部分:结果显示肱二头肌、胫前肌在插入电位异常率、纤颤电位、正锐波、平均时限缩短指标均高于拇短展肌;不伴有间质性肺病的患者组的肱二头肌和股四头肌测定结果异常率在纤颤电位、正锐波、平均时限缩短指标中均显著高于4例伴发有间质性肺病的患者;对23名患者的咬肌进行单纤维肌电图检测均显示异常,其中肌纤维密度(FD)值异常升高的最明显,异常值占96%,jitter值检测结果也较正常值升高,异常值占78%,但FD值异常率偏低;分析比较单纤维肌电图检测FD值与血清肌酶谱检测CK值相关性显示,两者之间存在显著正相关。结论:咬肌可以作为单纤维肌电图理想的受试肌肉;在病情改善明显的重症肌无力患者,咬肌的jitter值更能客观的评价治疗效果。在炎性肌病处于恢复期阶段,肌酸激酶检测正常时,SFEMG的检测技术更加有价值。
[Abstract]:Background and objective: single fiber electromyography (single fiber electromyography, SFEMG) with is a kind of special needle electrode, action potentials recorded by the side of the small area to identify and record the individual muscle fibers, SFEMG as a diagnostic method with high sensitivity, has been widely used in clinical, especially for myasthenia gravis (myasthenia gravis, MG) have very important clinical significance in clinical diagnosis. The identification of single fiber electromyography masseter muscle of myasthenia gravis, influence of inflammatory myopathy diagnosis and treatment of the results of the research a series of forward-looking, in order to guide clinical practice better. Methods: the first part: random from the Fifth Affiliated Hospital of Zhengzhou University volunteered to participate in the study of the health workers in 48 cases, on the same day at the same time, by professional technicians EMG of 48 subjects completed SSFEMG and VS FEMG examination, two test time interval of at least 5 minutes. Each value of the test value of jitter and FD were in the masseter muscle and abductor pollicis brevis. The second part: 30 cases of MG patients were admitted to hospital after the same period in clinical QMG score, masseter muscle low frequency RNS examination and SFEMG examination. The third part: the biceps in 23 cases of inflammatory myopathy patients with myocardial enzyme detection, unit four quadriceps, tibialis anterior muscle, EMG of the abductor pollicis brevis (EMG) examination, movement, sensory nerve conduction velocity, masseter single fiber electromyography and muscle biopsy. Results: the first part: the value of 33. S and 22 s normal reference population jitter recommended China masseter muscle, the results are consistent with other similar studies recommended results; jitter increases with age in normal value FD, single fiber electromyography masseter muscle jitter, FD value has nothing to do with sex; the abductor pollicis brevis jitter, F The value of D was positively correlated with age, regardless of gender; the abductor pollicis brevis jitter value and FD value of the upper limit of normal value than the masseter muscle. The second part: the results showed that the high MG group and normal control subjects of masseter muscle MCD value, shaking potential broadening in proportion, block potential contrast cases OMG was significantly higher than the control group, compared with GMG group, the age of onset of OMG patients was significantly lower than that in patients with type GMG; RNS method is higher than that of OMG for the positive detection rate of GMG; overall sensitivity of diagnosis technology of SFEMG was 90%, higher than 60% RNS; 30 MG patients by including a cholinesterase inhibitor, hormone treatment of immunosuppressant mycophenolate mofetil, azathioprine immunosuppression, intravenous immunoglobulin, thymectomy, plasma exchange treatment, using the QMG method to change the relative score before and after the treatment condition, invalid group and improved group of patients. No linear correlation between jitter value and the change, while the effective group and cure group had linear correlation between the two. The positive correlation between the cured group markedly more correlation than the group, the higher the better the degree of correlation varied with the jitter value of the larger, significant improvement in the patients with jitter value the disease can objectively evaluate the therapeutic effect. The third part: the results show that the biceps brachii, anterior tibial muscle insertion potential in the abnormal rate of fibrillation potentials and positive sharp wave, the average duration index was higher than the abductor pollicis brevis; without between the biceps and femoral head four muscle group of patients with interstitial lung disease were abnormal rate the fibrillation potentials and positive sharp wave, the average duration index was significantly higher than that of 4 patients with interstitial lung disease patients; in 23 patients the masseter muscles were single fiber electromyography showed abnormalities, including muscle fiber density Degree (FD) increased the most obvious anomalies, abnormal value accounted for 96%, the value of jitter detection results than the normal value increased, the abnormal value accounted for 78%, but the value of FD abnormal rate is low; analysis and comparison of single fiber electromyography FD values showed a correlation with serum muscle enzyme spectrum detection CK, there was a significant positive correlation between the two. Conclusion: the masseter muscle can be used as the ideal test of single fiber electromyography muscle; significantly improved in patients with myasthenia gravis disease, the masseter muscle jitter value objectively. Can the treatment effect on inflammatory myopathy in the recovery stage, normal creatine kinase detection, SFEMG detection technology is more valuable.

【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R746.1;R741.044

【相似文献】