發(fā)布時間：2018-06-10 00:42

  本文選題：神經(jīng)肌肉疾病 + 臨床神經(jīng)電生理��； 參考：《北京協(xié)和醫(yī)學院》2012年博士論文

【摘要】：背景近年國內(nèi)神經(jīng)電生理的臨床診斷和研究水平不斷進步,但各地區(qū)電生理技術發(fā)展不平衡。當前,神經(jīng)電生理檢測在我國臨床診斷中是否真正發(fā)揮了其應有的作用?又有何不足之處?明確肌電圖臨床應用現(xiàn)狀,獲得基線資料,對于進一步促進肌電圖規(guī)范化應用具有重要意義。北京協(xié)和醫(yī)院作為國內(nèi)電生理領域的核心單位之一,可以作為國內(nèi)肌電圖技術應用較好的代表,對其應用現(xiàn)狀進行分析,具有一定的意義。 目的通過對北京協(xié)和醫(yī)院肌電圖患者臨床與電生理資料的回顧性分析,獲得肌電圖應用現(xiàn)狀的基線資料,分析我院目前電生理對臨床診斷的價值,并對臨床癥狀、體征和電生理之間的相關性進行探討。 方法回顧性收集我院2008-2010年所有行常規(guī)肌電圖(routine electromyography, rtEMG)、神經(jīng)傳導測定(nerve conduction study, NCS)、重復神經(jīng)電刺激(repetitive nerve stimulation, RNS)患者的臨床和電生理資料,建立數(shù)據(jù)庫,并與1993-2003年資料進行比較。調(diào)查內(nèi)容包括一般情況、臨床情況、相關既往史、相關輔助檢查、診斷結果、電生理結果、臨床與電生理關系,對肌電圖檢測的現(xiàn)狀進行描述性統(tǒng)計,并就臨床和電生理的相關性以及應用價值進行統(tǒng)計分析。 結果1)不同年度行肌電圖檢查例數(shù)及陽性率分別為：1993-1995年3097例,陽性率62.8%；2001-2003年6455例,陽性率60.7%；2008-2010年10161例,陽性率48.9%。2)2008-2010年間,具有不同首發(fā)癥狀的患者EMG陽性率不同,分別為：運動功能障礙68.1%,同時具有運動和感覺障礙67.2%,單純感覺癥狀49%,其他難以歸類的癥狀31.9%,無癥狀30.7%；同時合并感覺癥狀與客觀查體感覺障礙者肌電圖陽性率(69.3%)與僅存在感覺癥狀者的陽性率(38.5%)存在明顯差異(P0.05)。3)在所有行針電極EMG的患者中,39.5%為神經(jīng)源性損害,7.9%為肌源性損害,1.5%同時合并神經(jīng)源性和肌源性損害。肌電圖表現(xiàn)為廣泛神經(jīng)源性損害者546例(占神經(jīng)源性損害的14.7%),包括運動神經(jīng)元病/肌萎縮側索硬化400例(73.3%)、脊肌萎縮癥10例、肯尼迪病7例、平山病9例、神經(jīng)根神經(jīng)病19例、腓骨肌萎縮癥9例、多灶性運動神經(jīng)病3例、其他疾病7例、不能確診者82例。肌電圖表現(xiàn)為上下肢周圍神經(jīng)源性損害者704例,包括糖尿病周圍神經(jīng)病246例、急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病43例、腓骨肌萎縮癥43例、結締組織病相關周圍神經(jīng)病36例、POEMS綜合征22例,慢性炎性脫髓鞘性多發(fā)神經(jīng)病16例,副腫瘤綜合征7例,其他29例,不能確診者262例。4)4688例肌電圖與臨床初步診斷一致,其中1339例(28.5%)肌電圖無異常。2822例肌電圖與初步診斷不一致,其中2010例(71.2%)肌電圖無異常；在肌電圖陽性的812例患者中,250例可解釋原有臨床癥狀并改變了原有診斷,411例肌電圖雖陽性,但與臨床所診治疾病無關,151例預期肌電圖陰性,卻得到了可以解釋病情的陽性結果。 結論：1)近年來肌電圖檢測的病例總數(shù)明顯增加,但陽性率下降。2)不同首發(fā)癥狀、體征對應肌電圖檢測的陽性率不同,其中感覺癥狀陽性率最低,對僅有感覺障礙主訴者進行肌電圖檢測、篩查,是造成肌電圖陽性率下降的原因之一。3)盡管肌電圖檢測對臨床診斷起到了重要的支持作用,但存在過度使用現(xiàn)象。4)同一肌電圖結果,可對應于多種臨床疾病,同一疾病也可有多種電生理表現(xiàn),37.6%的病例臨床診斷和肌電圖診斷無關,因此肌電圖結果的解釋必須結合臨床。
[Abstract]:Background the clinical diagnosis and research level of neurophysiology in China has been progressing in recent years, but the development of electrophysiological technology in various regions is not balanced. The standardized application of the step electromyography is of great significance. As one of the core units in the field of electrophysiology in China, Peking Union Medical College Hospital can be used as a better representative of the domestic electromyography technology, and it is of certain significance to the analysis of its application status.
Objective through the retrospective analysis of clinical and electrophysiological data of electromyography patients in Peking Union Medical College Hospital, the baseline data of electromyographic application were obtained, and the value of electrophysiology in clinical diagnosis in our hospital was analyzed, and the correlation between clinical symptoms, signs and electrophysiology was discussed.
Methods the clinical and electrophysiological materials of patients with routine electromyography (rtEMG), nerve conduction study (NCS), repeated neuroelectrical stimulation (repetitive nerve stimulation, RNS) were collected in our hospital for 2008-2010 years, and a database was established and compared with the data of 1993-2003 years. It includes general situation, clinical situation, related past history, related auxiliary examination, diagnosis results, electrophysiological results, clinical and electrophysiological relationships, descriptive statistics of the current status of electromyography detection, and statistical analysis of clinical and electrophysiological correlation and application value.
Results 1) the number and positive rate of electromyography examination in different years were 3097 cases in 1993-1995 years, the positive rate was 62.8%, 6455 cases in 2001-2003 years, the positive rate was 60.7%, 2008-2010 years 10161 cases, positive rate 48.9%.2), and the positive rate of EMG with different initial symptoms was different, respectively: motor dysfunction 68.1%, and transportation at the same time Dynamic and sensory disorders 67.2%, simple sensory symptoms 49%, other difficult to classify symptoms 31.9%, asymptomatic 30.7%, and the positive rate of electromyography (69.3%) with sensory symptoms (69.3%) and only the presence of sensory symptoms (38.5%) had significant difference (P0.05).3) in all the patients with EMG of the needle electrode, 39.5% were God 7.9% of the myogenic damage, 1.5% combined with neurogenic and myogenic damage, 546 cases (14.7% of neurogenic damage), 400 cases of motor neuron disease / amyotrophic lateral sclerosis (73.3%), 10 cases of spinal muscular atrophy, 7 Kennedy's disease, 9 cases of Pingshan disease, and neuropathic neuropathy. 19 cases, 9 cases of fibula muscular dystrophy, 3 cases of multifocal motor neuropathy, 7 cases of other diseases, 82 cases of undiagnosed, 704 cases of electromyography, 704 cases of peripheral neurogenic damage of upper and lower limbs, 246 cases of diabetic peripheral neuropathy, 43 cases of acute inflammatory demyelinating polyneuropathy, 43 cases of fibula muscular atrophy, and connective tissue disease related gods. 36 cases of disease, 22 cases of POEMS syndrome, 16 cases of chronic inflammatory demyelinating polyneuropathy, 7 cases of paraneoplastic syndrome, 29 cases of other 29 cases and 262 cases of undiagnosed.4) 4688 cases of electromyography and clinical preliminary diagnosis, of which 1339 cases (28.5%) electromyography without abnormal.2822 cases were not consistent with the preliminary diagnosis, 2010 cases (71.2%) electromyography was not abnormality. Of the 812 patients with positive electromyography, 250 were able to explain the original clinical symptoms and changed the original diagnosis. 411 cases were positive in electromyography, but were not related to the clinical diagnosis and treatment of the disease. 151 cases were negative in anticipation of electromyography, but the positive results could be explained.
Conclusions: 1) in recent years, the total number of electromyographic cases increased obviously, but the positive rate decreased.2). The positive rate of electromyography was different in different initial symptoms and physical signs. The positive rate of sensory symptoms was the lowest. The electromyography examination of the only subjects who had only sensory disorders, screening, was one of the reasons for the decrease of electromyography positive rate,.3) Electromyography (EMG) plays an important role in clinical diagnosis, but there is an over use phenomenon.4). The same EMG results can correspond to a variety of clinical diseases, and the same disease can also have a variety of electrophysiological manifestations. 37.6% of the cases are not related to clinical diagnosis and electromyography diagnosis, because the interpretation of this EMG must be combined with clinical.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R741.044

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本文編號：2001385