Wang Han, Cui Li-Ying, Du Hua, Li Ben-Hong, Liu Ming-Sheng, Guan Yu-Zhou
Department of Neurology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2008 Dec;30(6):668-71.
To explore the value of anal sphincter electromyography (ASEMG), orthostatic hypotension (OH), and dizziness in diagnosing multiple system atrophy (MSA).
The characteristics of ASEMG and OH were compared among patients with dizziness (MSA and non-MSA), patients without OH (MSA and non-MSA), and patients with probable MSA (OH and non-OH).
Totally 476 patients underwent ASEMG examinations. Dizziness was the onset symptom in 69 patients. Between the MSA group and non-MSA group, the mean duration of dizziness [(14.6 +/- 2.1) vs. (12.8 +/- 2.0) ms, P < 0.01] and satellite potential occurrence rate [(22.7 +/- 11.8)% vs. (12.2 +/- 8.9)% , P < 0.01] were significantly different, while the OH rate (84.6% vs. 55.2% ) and the difference of the blood pressure between standing and supine positions were not significantly different. In 162 patients with symptom of dizziness, the mean duration of dizziness [(15.3 +/- 2.7) vs. (12.8 +/- 1.9) ms, P < 0.001], satellite potential occurrence rate [(25.4 +/- 12.8)% vs. (13.5 +/- 10.4)%, P < 0.001] , and difference of the diastolic blood pressure [(18.5 +/- 17.0) vs. (11.7 +/- 12.7) mmHg, P < 0.05] were significantly different between the MSA group and non-MSA group, while the normal rate of blood pressure at standing position (60% vs. 41.9%) and the difference of systolic blood pressure were not significantly different. In 146 patients with abnormal blood pressure at standing and supine positions, the mean duration of dizziness [(15.0 +/- 2.4) vs. (12.8 +/- 1.7) ms, P < 0.001] and satellite potential occurrence rate [(22.0 +/- 12.2)% vs. (10.6 +/- 8.5)%, P < 0.001] were significantly different between the MSA group (n = 61) and non-MSA group (n = 85). In 125 patients with probable MSA, the mean duration of dizziness [(15.5 +/- 2.4) vs. (15.9 +/- 2.2) ms, P > 0.05] and satellite potential occurrence rate [(24.3 +/- 12.6)% vs. (22.7 +/- 12.4)%, P > 0.05] were not significantly different between those with OH and those without OH. The rates of dizziness and the percentage of dizziness as the onset symptom were 93.2% and 52.3% in OH group and 44.4% and 8.3% in non-OH group.
ASEMG is better than OH in diagnosing patients with dizziness suspected as MSA. Neurogenic lesion can be found by ASEMG in patients without OH, which is helpful in the early diagnosis of MSA.
探讨肛门括约肌肌电图（ASEMG）、直立性低血压（OH）及头晕在多系统萎缩（MSA）诊断中的价值。
比较头晕患者（MSA和非MSA）、无OH患者（MSA和非MSA）以及可能患有MSA的患者（有OH和无OH）的ASEMG和OH特征。
共有476例患者接受了ASEMG检查。69例患者以头晕为首发症状。MSA组与非MSA组相比，头晕平均持续时间[（14.6±2.1）对（12.8±2.0）毫秒，P<0.01]和卫星电位发生率[（22.7±11.8）%对（12.2±8.9）%，P<0.01]有显著差异，而OH发生率（84.6%对55.2%）及站立位与仰卧位血压差值无显著差异。在162例有头晕症状的患者中，MSA组与非MSA组相比，头晕平均持续时间[（15.3±2.7）对（12.8±1.9）毫秒，P<0.001]、卫星电位发生率[（25.4±12.8）%对（13.5±10.4）%，P<0.001]及舒张压差值[（18.5±17.0）对（11.7±12.7）毫米汞柱，P<0.05]有显著差异，而站立位血压正常率（60%对41.9%）及收缩压差值无显著差异。在146例站立位和仰卧位血压异常的患者中，MSA组（n = 61）与非MSA组（n = 85）相比，头晕平均持续时间[（15.0±2.4）对（12.8±1.7）毫秒，P<0.001]和卫星电位发生率[（22.0±12.2）%对（10.6±8.5）%，P<0.001]有显著差异。在125例可能患有MSA的患者中，有OH者与无OH者相比，头晕平均持续时间[（15.5±2.4）对（15.9±2.2）毫秒，P>0.05]和卫星电位发生率[（
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