Zhang S, Liu X X, Fan D S
Department of neurology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Yi Xue Za Zhi. 2019 Nov 19;99(43):3413-3416. doi: 10.3760/cma.j.issn.0376-2491.2019.43.012.
To investigate the application value of motor unit number index (MUNIX) for diagnosis and assessment progress in patients with amyotrophic lateral sclerosis (ALS). Sixty healthy controls and 60 ALS patients in the clinic were enrolled from May 2017 to December 2018. The bilateral deltoid, abductor digiti minimi, quadriceps femoris and tibialis anterior muscles of the subjects were detected by MUNIX method, and the negative peak amplitude of compound muscle action potential (CMAP) of ulnar nerve, femoral nerve, peroneal nerve, axillary nerve in bilateral was collected. MUNIX and motor unit size index (MUSIX) of muscles were compared between ALS group and control group. The difference between the MUNIX abnormal rate of muscles and abnormal rate of the corresponding CMAP negative peak amplitude in ALS patients was further compared. Meanwhile, the correlation between the disease course of ALS patients and MUNIX and MUSIX was analyzed. Compared with the control group, the MUNIX values of the deltoid, abductor digiti minimi, quadriceps femoris and tibialis anterior decreased significantly (97±24 vs 183±38, 48±17 vs 191±39, 54±15 vs 159±22, 49±16 vs 147±25, all <0.05). MUSIX values increased ((175±32) μV vs (47±15) μV, (189±34) μV vs (54±16) μV, (170±30) μV vs (49±13) μV, (190± 36) μV vs (48± 14) μV, all <0.05)). In ALS patients, the abnormal rate of MUNIX was respectively 81%, 87%, 75% and 89%. The negative peak amplitude abnormal rate of corresponding neuralCMAP was 35%, 40%, 31% and 36%, respectively, with a significant difference (<0.05). There was a negative correlation between MUNIX value and the course of disease in ALS patients (<0.05), and a positive correlation between MUSIX value and the course of disease (<0.05). The MUNIX technique exhibits the features of quantifying the proximal upper and lower limb muscles and assessing the loss of motor units in motor neuron degeneration.
探讨运动单位数量指数（MUNIX）在肌萎缩侧索硬化症（ALS）患者诊断及评估病情进展中的应用价值。选取2017年5月至2018年12月门诊收治的60例健康对照者和60例ALS患者。采用MUNIX法检测受试者双侧三角肌、小指展肌、股四头肌及胫前肌，并采集双侧尺神经、股神经、腓总神经、腋神经复合肌肉动作电位（CMAP）的负峰波幅。比较ALS组与对照组肌肉的MUNIX及运动单位大小指数（MUSIX）。进一步比较ALS患者肌肉MUNIX异常率与相应CMAP负峰波幅异常率的差异。同时分析ALS患者病程与MUNIX、MUSIX的相关性。与对照组比较，ALS组三角肌、小指展肌、股四头肌及胫前肌的MUNIX值显著降低（97±24 vs 183±38、48±17 vs 191±39、54±15 vs 159±22、49±16 vs 147±25，均P<0.05）。MUSIX值升高（（175±32）μV vs（47±15）μV、（189±34）μV vs（54±16）μV、（170±30）μV vs（49±13）μV、（190±36）μV vs（48±14）μV，均P<0.05）。ALS患者中，三角肌、小指展肌、股四头肌及胫前肌的MUNIX异常率分别为81%、87%、75%和89%。相应神经CMAP负峰波幅异常率分别为35%、40%、31%和36%，差异有统计学意义（P<0.05）。ALS患者MUNIX值与病程呈负相关（P<0.05），MUSIX值与病程呈正相关（P<0.05）。MUNIX技术具有量化近端上下肢肌肉及评估运动神经元变性中运动单位丢失的特点。
