Pavey Nathan, Hannaford Andrew, Higashihara Mana, van den Bos Mehdi, Kiernan Matthew C, Menon Parvathi, Vucic Steve
Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia.
Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Clin Neurophysiol. 2023 Dec;156:175-182. doi: 10.1016/j.clinph.2023.09.018. Epub 2023 Oct 26.
Utility of the split hand index (SI) in amyotrophic lateral sclerosis (ALS) has been reported when using the compound muscle action potential (CMAP) amplitude method (SI). A motor unit number index (MUNIX) based SI method (SI) was purported to exhibit higher sensitivity. The present study assessed the clinical utility of SI, derived by CMAP amplitude, MUNIX and MScan-MUNE (SI) methods, in ALS.
Sixty-two consecutive patients with neuromuscular symptoms (36 ALS and 26 ALS-mimics) were prospectively recruited. The SI was derived by dividing the product of the CMAP amplitude, MUNIX and MScan-MUNE values recorded over first dorsal interosseous and abductor pollicis brevis by values recorded over abductor digit minimi.
SI, SI and SI were significantly reduced in ALS, with SI (area under curve (AUC) = 0.801) and SI (AUC = 0.805) exhibiting greater diagnostic utility than SI (AUC = 0.713). SI and SI exhibited significant correlations with clinical measures of functional disability and weakness of intrinsic hand muscles.
SI differentiated ALS from mimic disorders, with SI and SI exhibiting greater utility.
The split hand index represents could serve as a potential diagnostic biomarker in ALS.
当采用复合肌肉动作电位（CMAP）波幅法（SI）时，已报道了劈手指数（SI）在肌萎缩侧索硬化症（ALS）中的应用价值。一种基于运动单位数量指数（MUNIX）的SI法（SI）据称具有更高的敏感性。本研究评估了通过CMAP波幅、MUNIX和MScan - MUNE（SI）法得出的SI在ALS中的临床应用价值。
前瞻性招募了62例连续的有神经肌肉症状的患者（36例ALS患者和26例ALS疑似患者）。SI通过将记录于第一背侧骨间肌和拇短展肌的CMAP波幅、MUNIX和MScan - MUNE值的乘积除以记录于小指展肌的值来得出。
在ALS患者中，SI、SI和SI均显著降低，其中SI（曲线下面积（AUC） = 0.801）和SI（AUC = 0.805）的诊断效用高于SI（AUC = 0.713）。SI和SI与手部固有肌功能残疾和无力的临床指标显著相关。
SI可将ALS与疑似疾病区分开来，其中SI和SI的应用价值更大。
劈手指数有望成为ALS的一种潜在诊断生物标志物。
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