本文選題：咬肌　切入點(diǎn)：單纖維肌電圖　出處：《鄭州大學(xué)》2015年博士論文

【摘要】：背景和目的:單纖維肌電圖(single fiber electromyography,SFEMG)借助的是一種特殊的針電極,通過其側(cè)面小的記錄面積來識(shí)別和記錄單個(gè)肌纖維的動(dòng)作電位,SFEMG作為一種具有較高敏感性的診斷方法,現(xiàn)已廣泛應(yīng)用于臨床,尤其是對(duì)重癥肌無力(myasthenia gravis,MG)的臨床識(shí)別診斷有著非常重要的臨床意義。本文就咬肌的單纖維肌電圖對(duì)重癥肌無力、炎性肌病的診斷價(jià)值以及治療對(duì)其結(jié)果的影響進(jìn)行了一系列前瞻性研究,以期更好的指導(dǎo)臨床實(shí)踐。方法:第一部分:隨機(jī)選取自愿參與研究的鄭州大學(xué)第五附屬醫(yī)院健康職工48例,在同一天同一時(shí)段,由專業(yè)肌電圖技師對(duì)48名受試者先后完成SSFEMG和VSFEMG檢查,兩次測試時(shí)間間隔至少大于5分鐘。每人均在咬肌和拇短展肌上測試jitter值及FD值。第二部分:對(duì)30例MG患者均在入院后同一天同一時(shí)段依次進(jìn)行臨床QMG評(píng)分、咬肌低頻RNS檢查和SFEMG檢查。第三部分:對(duì)23例炎性肌病患者行肌酶譜檢測,肱二頭肌、股四頭肌、脛前肌、拇短展肌的常規(guī)肌電圖(EMG)檢查,運(yùn)動(dòng)、感覺神經(jīng)傳導(dǎo)速度檢查,咬肌的單纖維肌電圖檢測以及肌肉病理檢查。結(jié)果:第一部分:推薦中國人群咬肌的jitter正常參考值為33μs和22μs,此結(jié)果與國外同類研究推薦結(jié)果基本一致;jitter、FD正常值會(huì)隨著年齡的增加而增加,咬肌的單纖維肌電圖的jitter、FD值與性別無關(guān);拇短展肌jitter值、FD值與年齡成正相關(guān),與性別無關(guān);拇短展肌的jitter值和FD值的正常上限值均較咬肌的高。第二部分:結(jié)果顯示MG組與正常對(duì)照組受試者咬肌的MCD值,顫抖增寬的電位對(duì)比例,阻滯電位對(duì)比例均顯著高于對(duì)照組,OMG與GMG組相比較,OMG型患者的發(fā)病年齡顯著低于GMG型患者;RNS的方法對(duì)于GMG的檢測陽性率高于OMG;SFEMG的診斷技術(shù)的總體敏感性為90.0%,高于RNS的60.0%;30名MG患者通過包括了膽堿酯酶抑制劑、激素治療、霉酚酸酯免疫抑制劑、咪唑硫嘌呤免疫抑制劑、靜脈注射免疫球蛋白、胸腺切除術(shù)、血漿交換等治療后,利用美國QMG方法對(duì)治療前后病情變化進(jìn)行相對(duì)計(jì)分,無效組和好轉(zhuǎn)組患者的病情變化與jitter值變化兩者之間無線性相關(guān)關(guān)系,而顯效組和痊愈組中兩者之間均有線性相關(guān),呈正相關(guān)關(guān)系,痊愈組比顯效組的相關(guān)性更大,病情好轉(zhuǎn)的程度越高,jitter值的變化與病情的變化相關(guān)性越大,在病情改善明顯的患者應(yīng)用jitter值更能客觀的評(píng)價(jià)治療效果。第三部分:結(jié)果顯示肱二頭肌、脛前肌在插入電位異常率、纖顫電位、正銳波、平均時(shí)限縮短指標(biāo)均高于拇短展肌;不伴有間質(zhì)性肺病的患者組的肱二頭肌和股四頭肌測定結(jié)果異常率在纖顫電位、正銳波、平均時(shí)限縮短指標(biāo)中均顯著高于4例伴發(fā)有間質(zhì)性肺病的患者;對(duì)23名患者的咬肌進(jìn)行單纖維肌電圖檢測均顯示異常,其中肌纖維密度(FD)值異常升高的最明顯,異常值占96%,jitter值檢測結(jié)果也較正常值升高,異常值占78%,但FD值異常率偏低;分析比較單纖維肌電圖檢測FD值與血清肌酶譜檢測CK值相關(guān)性顯示,兩者之間存在顯著正相關(guān)。結(jié)論:咬肌可以作為單纖維肌電圖理想的受試肌肉;在病情改善明顯的重癥肌無力患者,咬肌的jitter值更能客觀的評(píng)價(jià)治療效果。在炎性肌病處于恢復(fù)期階段,肌酸激酶檢測正常時(shí),SFEMG的檢測技術(shù)更加有價(jià)值。
[Abstract]:Background and objective: single fiber electromyography (single fiber electromyography, SFEMG) with is a kind of special needle electrode, action potentials recorded by the side of the small area to identify and record the individual muscle fibers, SFEMG as a diagnostic method with high sensitivity, has been widely used in clinical, especially for myasthenia gravis (myasthenia gravis, MG) have very important clinical significance in clinical diagnosis. The identification of single fiber electromyography masseter muscle of myasthenia gravis, influence of inflammatory myopathy diagnosis and treatment of the results of the research a series of forward-looking, in order to guide clinical practice better. Methods: the first part: random from the Fifth Affiliated Hospital of Zhengzhou University volunteered to participate in the study of the health workers in 48 cases, on the same day at the same time, by professional technicians EMG of 48 subjects completed SSFEMG and VS FEMG examination, two test time interval of at least 5 minutes. Each value of the test value of jitter and FD were in the masseter muscle and abductor pollicis brevis. The second part: 30 cases of MG patients were admitted to hospital after the same period in clinical QMG score, masseter muscle low frequency RNS examination and SFEMG examination. The third part: the biceps in 23 cases of inflammatory myopathy patients with myocardial enzyme detection, unit four quadriceps, tibialis anterior muscle, EMG of the abductor pollicis brevis (EMG) examination, movement, sensory nerve conduction velocity, masseter single fiber electromyography and muscle biopsy. Results: the first part: the value of 33. S and 22 s normal reference population jitter recommended China masseter muscle, the results are consistent with other similar studies recommended results; jitter increases with age in normal value FD, single fiber electromyography masseter muscle jitter, FD value has nothing to do with sex; the abductor pollicis brevis jitter, F The value of D was positively correlated with age, regardless of gender; the abductor pollicis brevis jitter value and FD value of the upper limit of normal value than the masseter muscle. The second part: the results showed that the high MG group and normal control subjects of masseter muscle MCD value, shaking potential broadening in proportion, block potential contrast cases OMG was significantly higher than the control group, compared with GMG group, the age of onset of OMG patients was significantly lower than that in patients with type GMG; RNS method is higher than that of OMG for the positive detection rate of GMG; overall sensitivity of diagnosis technology of SFEMG was 90%, higher than 60% RNS; 30 MG patients by including a cholinesterase inhibitor, hormone treatment of immunosuppressant mycophenolate mofetil, azathioprine immunosuppression, intravenous immunoglobulin, thymectomy, plasma exchange treatment, using the QMG method to change the relative score before and after the treatment condition, invalid group and improved group of patients. No linear correlation between jitter value and the change, while the effective group and cure group had linear correlation between the two. The positive correlation between the cured group markedly more correlation than the group, the higher the better the degree of correlation varied with the jitter value of the larger, significant improvement in the patients with jitter value the disease can objectively evaluate the therapeutic effect. The third part: the results show that the biceps brachii, anterior tibial muscle insertion potential in the abnormal rate of fibrillation potentials and positive sharp wave, the average duration index was higher than the abductor pollicis brevis; without between the biceps and femoral head four muscle group of patients with interstitial lung disease were abnormal rate the fibrillation potentials and positive sharp wave, the average duration index was significantly higher than that of 4 patients with interstitial lung disease patients; in 23 patients the masseter muscles were single fiber electromyography showed abnormalities, including muscle fiber density Degree (FD) increased the most obvious anomalies, abnormal value accounted for 96%, the value of jitter detection results than the normal value increased, the abnormal value accounted for 78%, but the value of FD abnormal rate is low; analysis and comparison of single fiber electromyography FD values showed a correlation with serum muscle enzyme spectrum detection CK, there was a significant positive correlation between the two. Conclusion: the masseter muscle can be used as the ideal test of single fiber electromyography muscle; significantly improved in patients with myasthenia gravis disease, the masseter muscle jitter value objectively. Can the treatment effect on inflammatory myopathy in the recovery stage, normal creatine kinase detection, SFEMG detection technology is more valuable.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R746.1;R741.044

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