肌电图在临床诊断中的应用现状和价值分析

发布时间：2018-06-10 00:42

本文选题：神经肌肉疾病 + 临床神经电生理　；参考：《北京协和医学院》2012年博士论文

【摘要】：背景近年国内神经电生理的临床诊断和研究水平不断进步,但各地区电生理技术发展不平衡。当前,神经电生理检测在我国临床诊断中是否真正发挥了其应有的作用?又有何不足之处?明确肌电图临床应用现状,获得基线资料,对于进一步促进肌电图规范化应用具有重要意义。北京协和医院作为国内电生理领域的核心单位之一,可以作为国内肌电图技术应用较好的代表,对其应用现状进行分析,具有一定的意义。目的通过对北京协和医院肌电图患者临床与电生理资料的回顾性分析,获得肌电图应用现状的基线资料,分析我院目前电生理对临床诊断的价值,并对临床症状、体征和电生理之间的相关性进行探讨。方法回顾性收集我院2008-2010年所有行常规肌电图(routine electromyography, rtEMG)、神经传导测定(nerve conduction study, NCS)、重复神经电刺激(repetitive nerve stimulation, RNS)患者的临床和电生理资料,建立数据库,并与1993-2003年资料进行比较。调查内容包括一般情况、临床情况、相关既往史、相关辅助检查、诊断结果、电生理结果、临床与电生理关系,对肌电图检测的现状进行描述性统计,并就临床和电生理的相关性以及应用价值进行统计分析。结果1)不同年度行肌电图检查例数及阳性率分别为：1993-1995年3097例,阳性率62.8%；2001-2003年6455例,阳性率60.7%；2008-2010年10161例,阳性率48.9%。2)2008-2010年间,具有不同首发症状的患者EMG阳性率不同,分别为：运动功能障碍68.1%,同时具有运动和感觉障碍67.2%,单纯感觉症状49%,其他难以归类的症状31.9%,无症状30.7%；同时合并感觉症状与客观查体感觉障碍者肌电图阳性率(69.3%)与仅存在感觉症状者的阳性率(38.5%)存在明显差异(P0.05)。3)在所有行针电极EMG的患者中,39.5%为神经源性损害,7.9%为肌源性损害,1.5%同时合并神经源性和肌源性损害。肌电图表现为广泛神经源性损害者546例(占神经源性损害的14.7%),包括运动神经元病/肌萎缩侧索硬化400例(73.3%)、脊肌萎缩症10例、肯尼迪病7例、平山病9例、神经根神经病19例、腓骨肌萎缩症9例、多灶性运动神经病3例、其他疾病7例、不能确诊者82例。肌电图表现为上下肢周围神经源性损害者704例,包括糖尿病周围神经病246例、急性炎症性脱髓鞘性多发性神经病43例、腓骨肌萎缩症43例、结缔组织病相关周围神经病36例、POEMS综合征22例,慢性炎性脱髓鞘性多发神经病16例,副肿瘤综合征7例,其他29例,不能确诊者262例。4)4688例肌电图与临床初步诊断一致,其中1339例(28.5%)肌电图无异常。2822例肌电图与初步诊断不一致,其中2010例(71.2%)肌电图无异常；在肌电图阳性的812例患者中,250例可解释原有临床症状并改变了原有诊断,411例肌电图虽阳性,但与临床所诊治疾病无关,151例预期肌电图阴性,却得到了可以解释病情的阳性结果。结论：1)近年来肌电图检测的病例总数明显增加,但阳性率下降。2)不同首发症状、体征对应肌电图检测的阳性率不同,其中感觉症状阳性率最低,对仅有感觉障碍主诉者进行肌电图检测、筛查,是造成肌电图阳性率下降的原因之一。3)尽管肌电图检测对临床诊断起到了重要的支持作用,但存在过度使用现象。4)同一肌电图结果,可对应于多种临床疾病,同一疾病也可有多种电生理表现,37.6%的病例临床诊断和肌电图诊断无关,因此肌电图结果的解释必须结合临床。
[Abstract]:Background the clinical diagnosis and research level of neurophysiology in China has been progressing in recent years, but the development of electrophysiological technology in various regions is not balanced. The standardized application of the step electromyography is of great significance. As one of the core units in the field of electrophysiology in China, Peking Union Medical College Hospital can be used as a better representative of the domestic electromyography technology, and it is of certain significance to the analysis of its application status.
Objective through the retrospective analysis of clinical and electrophysiological data of electromyography patients in Peking Union Medical College Hospital, the baseline data of electromyographic application were obtained, and the value of electrophysiology in clinical diagnosis in our hospital was analyzed, and the correlation between clinical symptoms, signs and electrophysiology was discussed.
Methods the clinical and electrophysiological materials of patients with routine electromyography (rtEMG), nerve conduction study (NCS), repeated neuroelectrical stimulation (repetitive nerve stimulation, RNS) were collected in our hospital for 2008-2010 years, and a database was established and compared with the data of 1993-2003 years. It includes general situation, clinical situation, related past history, related auxiliary examination, diagnosis results, electrophysiological results, clinical and electrophysiological relationships, descriptive statistics of the current status of electromyography detection, and statistical analysis of clinical and electrophysiological correlation and application value.
Results 1) the number and positive rate of electromyography examination in different years were 3097 cases in 1993-1995 years, the positive rate was 62.8%, 6455 cases in 2001-2003 years, the positive rate was 60.7%, 2008-2010 years 10161 cases, positive rate 48.9%.2), and the positive rate of EMG with different initial symptoms was different, respectively: motor dysfunction 68.1%, and transportation at the same time Dynamic and sensory disorders 67.2%, simple sensory symptoms 49%, other difficult to classify symptoms 31.9%, asymptomatic 30.7%, and the positive rate of electromyography (69.3%) with sensory symptoms (69.3%) and only the presence of sensory symptoms (38.5%) had significant difference (P0.05).3) in all the patients with EMG of the needle electrode, 39.5% were God 7.9% of the myogenic damage, 1.5% combined with neurogenic and myogenic damage, 546 cases (14.7% of neurogenic damage), 400 cases of motor neuron disease / amyotrophic lateral sclerosis (73.3%), 10 cases of spinal muscular atrophy, 7 Kennedy's disease, 9 cases of Pingshan disease, and neuropathic neuropathy. 19 cases, 9 cases of fibula muscular dystrophy, 3 cases of multifocal motor neuropathy, 7 cases of other diseases, 82 cases of undiagnosed, 704 cases of electromyography, 704 cases of peripheral neurogenic damage of upper and lower limbs, 246 cases of diabetic peripheral neuropathy, 43 cases of acute inflammatory demyelinating polyneuropathy, 43 cases of fibula muscular atrophy, and connective tissue disease related gods. 36 cases of disease, 22 cases of POEMS syndrome, 16 cases of chronic inflammatory demyelinating polyneuropathy, 7 cases of paraneoplastic syndrome, 29 cases of other 29 cases and 262 cases of undiagnosed.4) 4688 cases of electromyography and clinical preliminary diagnosis, of which 1339 cases (28.5%) electromyography without abnormal.2822 cases were not consistent with the preliminary diagnosis, 2010 cases (71.2%) electromyography was not abnormality. Of the 812 patients with positive electromyography, 250 were able to explain the original clinical symptoms and changed the original diagnosis. 411 cases were positive in electromyography, but were not related to the clinical diagnosis and treatment of the disease. 151 cases were negative in anticipation of electromyography, but the positive results could be explained.
Conclusions: 1) in recent years, the total number of electromyographic cases increased obviously, but the positive rate decreased.2). The positive rate of electromyography was different in different initial symptoms and physical signs. The positive rate of sensory symptoms was the lowest. The electromyography examination of the only subjects who had only sensory disorders, screening, was one of the reasons for the decrease of electromyography positive rate,.3) Electromyography (EMG) plays an important role in clinical diagnosis, but there is an over use phenomenon.4). The same EMG results can correspond to a variety of clinical diseases, and the same disease can also have a variety of electrophysiological manifestations. 37.6% of the cases are not related to clinical diagnosis and electromyography diagnosis, because the interpretation of this EMG must be combined with clinical.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R741.044

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