摘要
目的:分析重复神经电刺激(repetitive nerve stimulation,RNS)与重症肌无力严重程度的相关性及电生理特点,探讨其在中西医结合治疗全身型重症肌无力(generalized myasthenia gravis,GMG)疗效评价中的应用。方法:选取武汉市中西医结合医院2021年5月至2023年12月收治的脾肾亏虚型成人GMG患者,随机分为西药组和中西医结合组。比较所有入组患者RNS神经电生理特点,包括阳性率、阳性肌肉分布、复合肌肉动作电位(compound muscle action potential,CMAP)的最大波幅衰减比率;分析CMAP最大波幅衰减比率与定量重症肌无力评分量表(quantitative myasthenia gravis score,QMGs)、重症肌无力日常生活量表(MG-activity of daily living,MG-ADL)及中医症候评分在GMG病情评估中的相关性;比较2组患者在治疗前、治疗3个月及6个月后CMAP最大波幅衰减比率、QMGs评分、MG-ADL评分和中医症候积分的变化并进行相关分析。结果:共纳入GMG患者74例,实际完成临床观察66例(西药组35例,中西医结合组31例)。入组患者中,RNS阳性率为81.82%~94.44%,美国重症肌无力基金会(Myasthenia Gravis Foundation of America,MGFA)分型不同的患者的RNS阳性率差异无统计学意义(P>0.05);RNS阳性肌肉的分布与肌无力累及范围一致,且均表现为面神经>副神经>正中神经。随着MGFA分型升高,患者的CMAP最大波幅衰减比率呈现上升趋势,但差异无统计学意义(P>0.05)。在治疗前、治疗后3个月和6个月,CMAP最大波幅衰减比率与QMGs评分均无显著相关性(P>0.05);在治疗前和治疗后6个月,CMAP最大波幅衰减比率与MG-ADL评分有相关性(P<0.05);在治疗前,CMAP最大波幅衰减比率与中医症候积分有相关性(P<0.05)。2组患者在治疗后,CMAP最大波幅衰减比率、QMGs评分、MG-ADL评分和中医症候积分均较治疗前显著降低(P<0.01)。组间比较结果显示,治疗3个月和6个月时,中西医结合组的中医症候积分低于西药组(P<0.05)。结论:在GMG患者中,RNS阳性率较高;CMAP最大波幅衰减比率在评估GMG患者病情严重程度、GMG患者日常生活能力及中医症候积分的改善程度上有参考意义。
Objective:To analyze the correlation between repetitive nerve stimulation(RNS)characteristics and the severity of myasthenia gravis(MG),and to explore its application in evaluating the efficacy of integrated traditional Chinese and Western medicine treatment for generalized myasthenia gravis(GMG).Methods:Adult GMG patients with spleen-kidney deficiency type,admitted to Wuhan Integrated Hospital of Traditional Chinese and Western Medicine from May 2021 to December 2023,were selected and randomly divided into a Western medicine group and an integrated traditional Chinese and Western medicine group.The neuro-electrophysiologic-al characteristics of RNS in all enrolled patients were compared,including the positive rate,distribution of positive muscles,and the maximum amplitude decrement ratio of the compound muscle action potential(CMAP).The correlation between theCMAPmaximum amplitude decrement ratio and the Quantitative Myasthenia Gravis Score(QMGs),the Myasthenia Gravis Activities of Daily Living(MG-ADL)scale,and the traditional Chinese medicine(TCM)symptom score in assessing GMG condition was analyzed.Changes in the CMAP maximum amplitude decrement ratio,QMGs score,MG-ADL score,and TCM symptom score before treatment,and at 3 and 6 months after treatment were compared and analyzed between the two groups.Results:A total of 74 GMG patients were enrolled,with 66 actually completing the clinical observation(35 in the Western medicine group,31 in the integrated medicine group).Among the enrolled patients,the RNS positive rate was 81.82%to 94.44%,with no statistically significant difference in positive rates among patients of differentMGFA types(P>0.05).The distribution of RNS positive muscles was consistent with the range of myasthenia involvement,showing facial nerve>accessory nerve>median nerve.As the MGFA type increased,theCMAP maximum amplitude decrement ratio showed an upward trend,but the difference was not statistically significant(P>0.05).Before treatment,and at 3 and 6 months after treatment,there was no significant correlation between the CMAP maximum amplitude decrement ratio and the QMGs score(P>0.05).Before treatment and at 6 months after treatment,there was a correlation between the CMAPmaximum amplitude decrement ratio and the MG-ADL score(P<0.05).Before treatment,there was a correlation between theCMAP maximum amplitude decrement ratio and the TCM symptom score(P<0.05).After treatment,the CMAP maximum amplitude decrement ratio,QMGs score,MG-ADL score,and TCM symptom score in both groups were significantly lower than before treatment(P<0.01).Intergroup comparison results showed that at 3 and 6 months of treatment,the TCM symptom score in the integrated medicine group was lower than that in the Westem medicine group(P<0.05).Conclusion:In GMG patients,the RNS positive rate is high.TheCMAP maximum amplitude decrement ratio has reference significance in assessing the severity of GMG,the improvement in patients’daily living ability,and the improvement in TCM symptom scores.
作者
万梅
罗利俊
魏东生
朱心怡
叶彤
杨洁
WAN Mei;LUO Lijun;WEI Dongsheng;ZHU Xinyi;YE Tong;YANG Jie(Department of Neurology,Wuhan Integrated Hospital of Traditional Chinese and Western Medicine,Wuhan 430033,China;The First Clinical Medical Institute,Hubei University of Traditional Chinese Medicine,Wuhan 430065,China)
出处
《神经损伤与功能重建》
2025年第12期705-710,共6页
Neural Injury and Functional Reconstruction
基金
武汉市卫健委中医类重大项目(健脾益肾举陷汤对全身型重症肌无力患者T细胞免疫功能的调节作用及临床疗效研究,No.WZ21M01)。
关键词
重症肌无力
重复神经电刺激
中西医结合治疗
电生理特点
myasthenia gravis
repetitive nerve stimulation
integrated Chinese and Western medicine treatment
electrophysiological characteristics
