肌萎缩侧索硬化症患者腹直肌去神经支配与通气功能障碍之间的关联

Association Between Rectus Abdominis Denervation and Ventilation Dysfunction in Patients with Amyotrophic Lateral Sclerosis.

作者信息

Zhang Hua-Gang, Zhang Shuo, Xu Ying-Sheng, Zhang Nan, Fan Dong-Sheng

机构信息

Department of Neurology, Peking University Third Hospital, Beijing 100191, China.

出版信息

Chin Med J (Engl). 2016 Sep 5;129(17):2063-6. doi: 10.4103/0366-6999.189070.

DOI:10.4103/0366-6999.189070

PMID:27569232

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5009589/

Abstract

BACKGROUND

Spontaneous potentials in electromyography (EMG) of paraspinal muscles are associated with diaphragm denervation and, therefore, poor respiratory function in amyotrophic lateral sclerosis (ALS) is understandable. EMG changes in the rectus abdominis (RA) display an effect similar to those in paraspinal muscles with respect to the function of lower motor neurons in the thoracic spinal cord. The RA denervation was examined to determine its association with ventilation dysfunction in ALS.

METHODS

We collected the clinical data of 128 patients with sporadic ALS in Department of Neurology of Peking University Third Hospital from 2009 to 2013. EMG, Revised ALS Functional Rating Scale (ALSFRS-R) and forced vital capacity (FVC) were performed in all patients and the differences in the EMG changes in RA between those with and without FVC ≥ 80% were analysed.

RESULTS

The mean FVC value was 83.4% ± 17.1% (range: 45%-131%) of the predicted value. A total of 79 patients displayed FVC ≥80%, and 49 patients displayed FVC <80%. Compared with the patients displaying a normal FVC (60/79, 75.9%), spontaneous activity in RA was significantly different among those patients displaying an FVC <80% (47/49, 95.9%). In addition, spontaneous potentials in RA were more frequently detected in patients exhibiting dyspnea (32/33, 97.0%) than in patients without dyspnea (75/95, 78.9%).

CONCLUSION

Spontaneous potentials in RA are associated with ventilation dysfunction and dyspnea in ALS patients.

摘要

背景

椎旁肌肌电图（EMG）中的自发电位与膈肌失神经支配有关，因此，肌萎缩侧索硬化症（ALS）患者呼吸功能不佳是可以理解的。腹直肌（RA）的肌电图变化在胸段脊髓下运动神经元功能方面显示出与椎旁肌类似的效应。对RA失神经支配进行检查以确定其与ALS患者通气功能障碍的关系。

方法

我们收集了2009年至2013年北京大学第三医院神经内科128例散发性ALS患者的临床资料。对所有患者进行肌电图、修订的ALS功能评定量表（ALSFRS-R）和用力肺活量（FVC）检查，并分析FVC≥80%和FVC<80%的患者之间RA肌电图变化的差异。

结果

FVC的平均数值为预测值的83.4%±17.1%（范围：45%-131%）。共有79例患者FVC≥80%，49例患者FVC<80%。与FVC正常的患者（60/79，75.9%）相比，FVC<80%的患者（47/49，95.9%）中RA的自发电活动有显著差异。此外，有呼吸困难的患者（32/33，97.0%）比无呼吸困难的患者（75/95，78.9%）更频繁地检测到RA中的自发电位。