运动单位数量估计方法与定量运动单位电位分析在 ALS 诊断中的应用。
The utility of motor unit number estimation methods versus quantitative motor unit potential analysis in diagnosis of ALS.
机构信息
Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
出版信息
Clin Neurophysiol. 2018 Mar;129(3):646-653. doi: 10.1016/j.clinph.2018.01.002. Epub 2018 Jan 17.
OBJECTIVE
To compare the diagnostic utility of motor unit number estimation (MUNE) methods to motor unit potential (MUP) analysis in amyotrophic lateral sclerosis (ALS).
METHODS
Twenty-five patients (1 definite, 11 probable, 9 possible ALS and 4 progressive muscular atrophy) and 22 healthy controls were prospectively included. Quantitative MUP analysis and three MUNE methods; Multiple Point Stimulation MUNE (MPS), Motor Unit Number Index (MUNIX) and MScanFit MUNE (MScan) were done in abductor pollicis brevis muscle. The sensitivities were compared by McNemar chi-square test. MUNE, MUP and revised ALS Functional Rating Scale (ALSFRS-R) parameters were correlated by regression analysis.
RESULTS
The sensitivities of MPS (76%) and MScan (68%) were higher than MUP duration (36%) and amplitude (40%) in detecting motor unit loss (p < 0.05). MUNE methods increased the categorical probability from possible to probable ALS in 4 patients (16%). There was only significant correlation between ALSFRS-R and MScan (r = 0.443, p = 0.027) among the electrophysiological tests. MUNE methods did not correlate to MUP parameters.
CONCLUSIONS
MUNE methods are more sensitive in showing abnormality than MUP analysis.
SIGNIFICANCE
MUNE methods, in particular MScan, may have the potential to be implemented in the clinical practice for diagnosis and follow-up of neuromuscular disorders particularly ALS.
目的
比较运动单位数量估计（MUNE）方法与运动单位电位（MUP）分析在肌萎缩侧索硬化症（ALS）中的诊断效用。
方法
前瞻性纳入 25 例患者（1 例确诊，11 例疑似，9 例可能 ALS 和 4 例进行性肌萎缩）和 22 例健康对照者。定量 MUP 分析和 3 种 MUNE 方法：多点刺激 MUNE（MPS）、运动单位数量指数（MUNIX）和 MScanFit MUNE（MScan），均在拇短展肌中进行。采用 McNemar 卡方检验比较敏感性。通过回归分析比较 MUNE、MUP 和改良 ALS 功能评定量表（ALSFRS-R）参数。
结果
MPS（76%）和 MScan（68%）的敏感性高于 MUP 持续时间（36%）和幅度（40%）（p<0.05），可用于检测运动单位丧失。3 种 MUNE 方法使 4 例（16%）患者的分类概率从可能变为疑似 ALS。在电生理测试中，仅 ALSFRS-R 与 MScan 之间存在显著相关性（r=0.443，p=0.027）。MUNE 方法与 MUP 参数无相关性。
结论
MUNE 方法比 MUP 分析更能敏感地显示异常。
意义
MUNE 方法，特别是 MScan，可能有潜力在神经肌肉疾病（尤其是 ALS）的临床实践中用于诊断和随访。
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