肌電圖干擾相轉(zhuǎn)折—波幅云圖分析在神經(jīng)肌肉疾病的應(yīng)用研究
發(fā)布時(shí)間：2019-05-20 13:33
【摘要】：研究背景肌電檢測是臨床上一種重要的電生理檢測手段,是神經(jīng)肌肉病變診斷過程中非常重要的一個(gè)環(huán)節(jié)。隨著電子技術(shù)的迅猛發(fā)展,肌電圖檢查逐漸趨向定量化。最早采用人工定量肌電圖的方法,起始于40年代,所分析的是單個(gè)運(yùn)動單位電位(motor unit potential,MUP),即平均運(yùn)動單位動作電位量化分析(quantitative evaluation of mean motor unit potential,QMUP)。此方法要求選取至少20個(gè)不同的MUP樣本,并分析平均時(shí)限、平均波幅以及多相電位所占的百分率。分析單個(gè)MUP的缺點(diǎn)是單個(gè)不同的MUP只能在輕收縮情況下獲取,收縮力量僅為最大隨意收縮(maximal voluntary contraction,MVC)的4%左右。隨著力量的增加,動作電位數(shù)增加,產(chǎn)生動作電位的干擾,即干擾相(interferencepattern;,IP),以致不可能識別各不同的單個(gè)MUP。因此,此方法僅代表輕收縮時(shí)激活的運(yùn)動單位,而不能顯示較強(qiáng)收縮時(shí)激活的運(yùn)動單位的異常情況。由于干擾相分析可提供多種閾值水平運(yùn)動單位的功能狀態(tài)情況,包括轉(zhuǎn)折、波幅、復(fù)雜性和募集型等信息,對輕度失神經(jīng)支配更敏感,因此建立干擾相分析方法非常必要。人眼無法識別較強(qiáng)收縮時(shí)肌電信號的干擾,因此需要用自動化方法來分析。60年代以后建立了多種干擾相自動分析方法(automated interference pattern analysis,IPA)。目前對肌電干擾型的研究方法多種多樣,采用的參數(shù)特性也各有不同,包括轉(zhuǎn)折-波幅分析、過零率、峰值比率、功率譜、云圖分析等。其中轉(zhuǎn)折-波幅云圖分析(turns-amplitude cloud analysis)為最成熟和完善的方法之一,即也稱Willison analysis。該技術(shù)由Stalberg等在1983年改良:在所測肌肉的幾個(gè)不同部位,從輕收縮到大力收縮的不同力量水平記錄肌電IP信息,最后以平均波幅作為轉(zhuǎn)折數(shù)/秒的函數(shù)作散點(diǎn)圖,利用特殊的算法畫出這些點(diǎn)的上限、下限、最大轉(zhuǎn)折數(shù)、最大波幅,所得圖形即為云圖,該圖包含正常人群90%以上的數(shù)據(jù)點(diǎn),而神經(jīng)源性損害患者的大多數(shù)點(diǎn)落在云圖的上限之上,肌源性損害患者的數(shù)據(jù)點(diǎn)大多落在云圖的下限之下。此后多項(xiàng)研究證實(shí)此方法對于神經(jīng)源性與肌源性疾病的鑒別具有較好的敏感性和特異性。因?yàn)椴恍枰湛s力測定,此法既可靠又快速。但正常值范圍確定困難,且是否受到種族、年齡、性別、肌肉、左右側(cè)等諸多因素影響仍不明確,故沒有得到廣泛應(yīng)用。國內(nèi)相關(guān)領(lǐng)域研究較少,云圖正常值范圍及相關(guān)影響因素尚未建立,神經(jīng)源性及肌源性疾病的云圖診斷標(biāo)準(zhǔn)也未確立,上述諸多因素是否會影響此方法對國內(nèi)神經(jīng)肌肉疾病患者的診斷率仍不明確。目的:本研究旨在應(yīng)用云圖分析方法檢測國內(nèi)健康的成年人及神經(jīng)肌肉疾病患者的IP信號,分析其轉(zhuǎn)折、波幅特點(diǎn),探討我國成年人IP云圖的形狀及正常值范圍,及正常云圖的影響因素,比較IP云圖分析方法(IPA)和傳統(tǒng)手工定量肌電圖方法(QMUP)對神經(jīng)肌肉疾病診斷的敏感性及特異性。本研究的開展將為建立我國成年人正常云圖,利用云圖技術(shù)提高神經(jīng)源性與肌源性疾病的診斷率提供科學(xué)依據(jù)。方法:(1)入組2014年9月～2016年3月于臨沂市人民醫(yī)院體檢中心行健康體檢的部分成年人,門診和病房中部分具有局部神經(jīng)疾病但未累及所檢查部位的病人,以及部分醫(yī)務(wù)人員和學(xué)生為正常志愿者,并收集同期在門診和病房的部分典型神經(jīng)肌肉疾病者為患者組。運(yùn)用IP云圖方法檢測正常志愿者肢體肌肉,收集轉(zhuǎn)折-波幅數(shù)據(jù),對患者組和對照組(選取部分同期志愿者為對照組)肢體肌肉同時(shí)運(yùn)用傳統(tǒng)定量針極肌電圖和IP云圖分析兩種方法進(jìn)行檢測,并記錄受試者年齡、性別、肌肉名稱。(2)分析受試者肌肉IP信號的轉(zhuǎn)折及波幅分布情況。(3)分析年齡、性別、肌肉和優(yōu)勢或非優(yōu)勢側(cè)別對云圖的影響。根據(jù)影響因素分組,分別確定正常云圖。(4)根據(jù)建立的正常云圖,比較云圖分析與傳統(tǒng)定量肌電圖兩種方法對國人神經(jīng)肌肉疾病的診斷率,并分析與國外報(bào)道的異同。結(jié)果:(1)共收集60例正常者、27例神經(jīng)肌肉疾病患者和20例正常對照者信息。(2)數(shù)據(jù)分布結(jié)果顯示:受試者肌肉IP信號的轉(zhuǎn)折和對應(yīng)波幅值有相關(guān)性,分別取對數(shù)值后均呈正態(tài)分布,用線性回歸分析呈線性相關(guān)。(3)正常云圖受年齡、性別、肌肉的影響。分別按年齡、性別、肌肉分組,計(jì)算回歸分析參數(shù),分別確定正常云圖。(4)兩種方法對國人神經(jīng)肌肉疾病診斷的敏感性和特異性相似。結(jié)論:IP信號自動分析技術(shù)之轉(zhuǎn)折-波幅云圖分析在檢測人群肌肉轉(zhuǎn)折-波幅值中具有較高的便捷性,利用此技術(shù)測得的值可分別計(jì)算出國人五塊肌肉(肱二頭肌、三角肌、指總伸肌、脛骨前肌、股四頭肌)的正常云圖;性別及年齡是正常成人肌肉云圖主要影響因素;云圖對神經(jīng)肌肉疾病診斷的敏感性和特異性與傳統(tǒng)定量針極肌電圖方法類似。應(yīng)用云圖技術(shù)可以較好地診斷神經(jīng)肌肉疾病。國人IP信號波幅正常值稍低于國外研究推薦的標(biāo)準(zhǔn),故建議使用該方法時(shí)需要考慮人種差異,建立適合不同人種的診斷標(biāo)準(zhǔn)。
[Abstract]:The research background myoelectric detection is an important method of electrophysiological detection in the clinic, which is a very important part in the diagnosis of neuromuscular disease. With the rapid development of the electronic technology, the electromyogram examination gradually becomes quantitative. The first method of using artificial quantitative electromyography, which began in the 1940s, was analyzed as a single motor unit potential (MUP), i.e., an average motion unit action potential quantitative analysis (QMUP). This method requires that at least 20 different MUP samples be selected and the mean time, mean amplitude, and the percentage of the polyphase potential are analyzed. The disadvantage of the analysis of a single MUP is that a single different MUP can only be obtained in the case of light shrinkage, and the contraction force is only about 4% of the maximum random contraction (MVC). As the power increases, the number of action potentials increases, resulting in an interference of the action potential, i. e., an interference pattern, ip, so that it is not possible to identify the different individual mups. Therefore, this method only represents a motion unit that is activated at light shrinkage, and does not display an abnormal condition of the active unit that is activated when a strong contraction is not displayed. Because of the interference phase analysis, the functional state of a plurality of threshold level moving units can be provided, including the information such as turning, amplitude, complexity and raised type, which is more sensitive to the control of the slight loss of nerve, and therefore it is necessary to establish an interference-phase analysis method. The human eye can't recognize the disturbance of the muscle electrical signal at the time of the strong contraction, so it is necessary to use the automatic method to analyze. The automatic interference pattern analysis (IPA) is set up in the '60s. At present, the research methods of the myoelectric interference type are various, and the parameter characteristics adopted are also different, including the turning-wave amplitude analysis, the zero crossing rate, the peak ratio, the power spectrum, the cloud image analysis, and the like. The transformation-amplitude cloud analysis is one of the most mature and perfect methods, that is, it is also known as wilson analysis. The technique is modified by Stalkberg et al. in 1983: at several different parts of the measured muscle, the myoelectric IP information is recorded from the light of different strength levels of light contraction to the large-scale contraction, and finally, the average amplitude is used as a function of the turning number/ second as a scatter diagram, and the upper limit and the lower limit of the points are drawn by using a special algorithm. The maximum number of turns and the maximum amplitude, the resulting graph is the cloud picture, which contains more than 90% of the data points in the normal population, and most of the point of the neurogenic damage patients fall above the upper limit of the cloud picture, and the data points of the patients with the myogenic damage fall below the lower limit of the cloud picture. After that, a number of studies have confirmed that this method has better sensitivity and specificity for the identification of neurogenic and myogenic diseases. This method is both reliable and fast because no shrinkage force is required. However, that range of normal value is difficult, and the influence of many factors, such as race, age, sex, muscle, left and right side, is still unclear, so it is not widely used. The research of the related fields in China is less, the normal range of the cloud image and the related influencing factors have not been established, and the diagnostic standard of the nephogram of the neurogenic and myogenic diseases is not established, and whether the above factors will affect the diagnosis rate of the patients with internal neuromuscular diseases is still unclear. Objective: The purpose of this study is to use the cloud image analysis method to detect the IP signals of adult and neuromuscular diseases in China, and to analyze the change and amplitude characteristics of the adult IP nephogram in China, and to explore the influence factors of the shape and normal value of the adult IP nephogram in our country, and the influence factors of the normal cloud picture. To compare the sensitivity and specificity of the method (IPA) and traditional manual quantitative electromyography (QMUP) to the diagnosis of neuromuscular diseases. The development of this study will provide a scientific basis for the establishment of the normal cloud image of adult adults and the improvement of the diagnostic rate of neurogenic and myogenic diseases by using the cloud image technique. Methods: (1) The patients who were enrolled in the health examination at the health examination center of the People's Hospital of Linyi City from September 2014 to March 2016, the patients in the outpatient department and the ward, the patients not involved in the examination site, and some of the medical personnel and the students were the normal volunteers. And collecting part of the typical neuromuscular disease in the clinic and the ward for the same period as the patient group. using the method of the IP nephogram to detect the limb muscle of the normal volunteers, the turning-wave amplitude data is collected, and the limb muscles of the patient group and the control group (the selected part of the same period of the same time as the control group) are used for detecting the limb muscles of the normal volunteers at the same time, The subject's age, sex, and muscle name were recorded. (2) The change of the muscle IP signal and the amplitude distribution of the subject's muscle were analyzed. (3) Analyze the influence of age, sex, muscle and advantage or non-dominant side on the cloud picture. And according to the influence factors, the normal cloud picture is respectively determined. (4) according to the established normal cloud picture, comparing the cloud image analysis and the traditional quantitative electromyogram to the diagnosis rate of the Chinese neuromuscular diseases, and analyzing the similarities and differences with the foreign reports. Results: (1) A total of 60 normal subjects,27 patients with neuromuscular disease and 20 normal controls were collected. (2) The results of data distribution show that there is a correlation between the transition of the muscle IP signal and the corresponding amplitude of the subject's muscle. (3) The normal cloud picture is affected by age, sex and muscle. And calculating the regression analysis parameters according to the age, the sex and the muscle group respectively, and respectively determining the normal cloud picture. (4) The sensitivity and specificity of the two methods to the diagnosis of neuromuscular diseases in the Chinese are similar. Conclusion: The change of the auto-analysis technology of IP signal-amplitude cloud image has a higher convenience in the detection of the muscle-turn-amplitude value of the population, and the value measured by this technique can be used to calculate the five-block muscle (biceps, deltoid, finger total extensor, and pretibial muscle). Normal nephogram of quadriceps femoris (quadriceps femoris); gender and age are the main influencing factors of the normal adult muscle nephogram; the sensitivity and specificity of nephogram to the diagnosis of neuromuscular diseases are similar to that of traditional quantitative needle-electrode electromyography. The neuromuscular disease can be well diagnosed by the application of the cloud image technique. The normal value of the Chinese IP signal is slightly lower than the standard recommended by the foreign research, so it is recommended that the method be used to consider the ethnic difference and establish a diagnostic standard suitable for different ethnic groups.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R746
本文編號：2481680
[Abstract]:The research background myoelectric detection is an important method of electrophysiological detection in the clinic, which is a very important part in the diagnosis of neuromuscular disease. With the rapid development of the electronic technology, the electromyogram examination gradually becomes quantitative. The first method of using artificial quantitative electromyography, which began in the 1940s, was analyzed as a single motor unit potential (MUP), i.e., an average motion unit action potential quantitative analysis (QMUP). This method requires that at least 20 different MUP samples be selected and the mean time, mean amplitude, and the percentage of the polyphase potential are analyzed. The disadvantage of the analysis of a single MUP is that a single different MUP can only be obtained in the case of light shrinkage, and the contraction force is only about 4% of the maximum random contraction (MVC). As the power increases, the number of action potentials increases, resulting in an interference of the action potential, i. e., an interference pattern, ip, so that it is not possible to identify the different individual mups. Therefore, this method only represents a motion unit that is activated at light shrinkage, and does not display an abnormal condition of the active unit that is activated when a strong contraction is not displayed. Because of the interference phase analysis, the functional state of a plurality of threshold level moving units can be provided, including the information such as turning, amplitude, complexity and raised type, which is more sensitive to the control of the slight loss of nerve, and therefore it is necessary to establish an interference-phase analysis method. The human eye can't recognize the disturbance of the muscle electrical signal at the time of the strong contraction, so it is necessary to use the automatic method to analyze. The automatic interference pattern analysis (IPA) is set up in the '60s. At present, the research methods of the myoelectric interference type are various, and the parameter characteristics adopted are also different, including the turning-wave amplitude analysis, the zero crossing rate, the peak ratio, the power spectrum, the cloud image analysis, and the like. The transformation-amplitude cloud analysis is one of the most mature and perfect methods, that is, it is also known as wilson analysis. The technique is modified by Stalkberg et al. in 1983: at several different parts of the measured muscle, the myoelectric IP information is recorded from the light of different strength levels of light contraction to the large-scale contraction, and finally, the average amplitude is used as a function of the turning number/ second as a scatter diagram, and the upper limit and the lower limit of the points are drawn by using a special algorithm. The maximum number of turns and the maximum amplitude, the resulting graph is the cloud picture, which contains more than 90% of the data points in the normal population, and most of the point of the neurogenic damage patients fall above the upper limit of the cloud picture, and the data points of the patients with the myogenic damage fall below the lower limit of the cloud picture. After that, a number of studies have confirmed that this method has better sensitivity and specificity for the identification of neurogenic and myogenic diseases. This method is both reliable and fast because no shrinkage force is required. However, that range of normal value is difficult, and the influence of many factors, such as race, age, sex, muscle, left and right side, is still unclear, so it is not widely used. The research of the related fields in China is less, the normal range of the cloud image and the related influencing factors have not been established, and the diagnostic standard of the nephogram of the neurogenic and myogenic diseases is not established, and whether the above factors will affect the diagnosis rate of the patients with internal neuromuscular diseases is still unclear. Objective: The purpose of this study is to use the cloud image analysis method to detect the IP signals of adult and neuromuscular diseases in China, and to analyze the change and amplitude characteristics of the adult IP nephogram in China, and to explore the influence factors of the shape and normal value of the adult IP nephogram in our country, and the influence factors of the normal cloud picture. To compare the sensitivity and specificity of the method (IPA) and traditional manual quantitative electromyography (QMUP) to the diagnosis of neuromuscular diseases. The development of this study will provide a scientific basis for the establishment of the normal cloud image of adult adults and the improvement of the diagnostic rate of neurogenic and myogenic diseases by using the cloud image technique. Methods: (1) The patients who were enrolled in the health examination at the health examination center of the People's Hospital of Linyi City from September 2014 to March 2016, the patients in the outpatient department and the ward, the patients not involved in the examination site, and some of the medical personnel and the students were the normal volunteers. And collecting part of the typical neuromuscular disease in the clinic and the ward for the same period as the patient group. using the method of the IP nephogram to detect the limb muscle of the normal volunteers, the turning-wave amplitude data is collected, and the limb muscles of the patient group and the control group (the selected part of the same period of the same time as the control group) are used for detecting the limb muscles of the normal volunteers at the same time, The subject's age, sex, and muscle name were recorded. (2) The change of the muscle IP signal and the amplitude distribution of the subject's muscle were analyzed. (3) Analyze the influence of age, sex, muscle and advantage or non-dominant side on the cloud picture. And according to the influence factors, the normal cloud picture is respectively determined. (4) according to the established normal cloud picture, comparing the cloud image analysis and the traditional quantitative electromyogram to the diagnosis rate of the Chinese neuromuscular diseases, and analyzing the similarities and differences with the foreign reports. Results: (1) A total of 60 normal subjects,27 patients with neuromuscular disease and 20 normal controls were collected. (2) The results of data distribution show that there is a correlation between the transition of the muscle IP signal and the corresponding amplitude of the subject's muscle. (3) The normal cloud picture is affected by age, sex and muscle. And calculating the regression analysis parameters according to the age, the sex and the muscle group respectively, and respectively determining the normal cloud picture. (4) The sensitivity and specificity of the two methods to the diagnosis of neuromuscular diseases in the Chinese are similar. Conclusion: The change of the auto-analysis technology of IP signal-amplitude cloud image has a higher convenience in the detection of the muscle-turn-amplitude value of the population, and the value measured by this technique can be used to calculate the five-block muscle (biceps, deltoid, finger total extensor, and pretibial muscle). Normal nephogram of quadriceps femoris (quadriceps femoris); gender and age are the main influencing factors of the normal adult muscle nephogram; the sensitivity and specificity of nephogram to the diagnosis of neuromuscular diseases are similar to that of traditional quantitative needle-electrode electromyography. The neuromuscular disease can be well diagnosed by the application of the cloud image technique. The normal value of the Chinese IP signal is slightly lower than the standard recommended by the foreign research, so it is recommended that the method be used to consider the ethnic difference and establish a diagnostic standard suitable for different ethnic groups.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R746
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