摘要
背景:注射A型肉毒毒素后,不仅影响注射局部神经肌肉接头的功能,也可导致远隔部位的改变;F波由运动神经元逆向兴奋引起,故有可能间接评价运动神经元的功能状态。目的:探讨局部注射A型肉毒毒素后远隔部位F波改变及其可能机制。设计:以运动障碍性疾病患者为研究对象的自身对照观察性研究。单位:一所大学医院神经科门诊。对象:2002-09/2003-07就诊于武汉大学人民医院神经科门诊的未接受过A型肉毒毒素局部注射治疗的运动障碍性疾病患者26例,其中19例为偏侧面肌痉挛、5例为Meige综合征、2例为痉挛性斜颈。干预:对26例患者行A型肉毒毒素注射,并在注射前、注射后1周及注射后12～24周,分别检测其尺神经及胫神经F波。主要观察指标:注射A型肉毒毒素前、后F波最短潜伏期、平均潜伏期、负峰波幅、时限、出现率和弥散时值;M波潜伏期及波幅变化。结果:注射1周后3例共5条尺神经未引出肯定波形。与注射前比较,尺、胫神经F波平均潜伏期及尺神经F波时限在注射后1周显著延长,且这种改变与注射剂量无关;注射后12～24周上述两参数与注射前比较,差异均无显著性意义。结论:F波平均潜伏期和时限为评价A型肉毒毒素远隔效应的敏感指标;A型肉毒毒素的远隔效应似与注射部位的距离有关,而与注射剂量无关。
BACKGROUND:After local injection of Botulinum toxin type A(BoTX A), not only the function of the neuromuscular conjunction was affected, but also the changes occurred remote from the injected site.F waves result from the back fire of the motoneuron activation, which may indirectly reflect the functional state of the motoneurons. OBJECTIVE:To evaluate the remote effect of local BoTX A injection by F wave test. DESIGN:Self control study based on patients with movement disorders. SETTING:Neruologic clinic in a university hospital. PARTICIPANTS:Twenty six patients with movement disorders not received previous local BoTX A were selected from Neurological Clinic in Renmin Hospital of Wuhan University between September 2002 and July 2003,including 19 cases with hemificiospasm, 5 Meige syndrome and 2 torticollis spasmodicus. INTERVENTIONS:F and M waves of ulnar and tibial nerves were recorded before 1, 12-24 weeks after local injection of BoTX A in 26 patients. MAIN OUTCOME MEASURES:The following parameters were analyzed:latency(ML) and amplitude (Mamp) of M wave, minimal (Fmin) and average latency (Fave), amplitude of negative peak(Famp), duration (Fdur), persistence (Fper) and chronodispersion (Fchr) of F wave. RESULTS:No definite F response of ulnar nerve stimulation was obtained 1 week after injection in 3 HFS patients (5 nerves). Fave prolonged significantly on ulnar and tibal nerve and Fdur increased significantly on ulnar nerve 1 week after injection, but there was no significant difference 12-24 weeks later, compared with before injection. No significant correlation of the altered F wave parameters was found with the dosage of BoTX A. CONCLUSION:Fdur and Fave could sensitively assess the remote effect, which correlates with distance away from the injected muscle, rather than the dosage of BoTX A.
出处
《中国临床康复》
CSCD
北大核心
2005年第13期168-169,共2页
Chinese Journal of Clinical Rehabilitation
基金
湖北省科技厅基金项目(2001AA307B18)~~
