摘要
目的:观察视神经脊髓炎型和经典多发性硬化型患者电刺激诱发瞬目反射的差异。方法:多发性硬化患者为河南省人民医院1996-01/2005-06门诊随诊及住院的临床确诊病例49例。健康对照组为河南省肿瘤医院及河南省人民医院健康体检人员及部分工作人员47例,多发性硬化组又分为视神经脊髓炎型(n=21)和经典多发性硬化型(n=28)。瞬目反射检查方法采用诱发电位仪,用表面电极刺激和记录,记录电极置于眼轮匝肌外侧,左右两侧对称,参考电极置于鼻骨两侧,接地电极置于颌部,刺激电极放在眶上切迹处。双导同时记录刺激侧所见的早反射和晚反射及对侧的晚反射。测定其潜伏期和波幅。双侧进行,共测4次,计算出瞬目反射各波的平均潜伏期和波幅。异常瞬目反射的判定标准:①各波潜伏期超过正常高限(x+2.5s)(早反射11.5ms,晚反射38.8ms,对侧的晚反射40.1ms)和/或波幅低于正常低限(x-2.5s)(早反射62.5μV,晚反射43.0μV,对侧的晚反射7.0μV)。②除外操作错误、仪器故障和患者不合作等因素,瞬目反射未引出者为异常。神经功能缺损程度按EDSS进行评分。结果:49例多发性硬化患者和47例正常对照均完成检查,全部进入结果分析。①视神经脊髓炎型患者发病年龄、EDSS评分均显著高于经典多发性硬化型患者(P<0.01)。②视神经脊髓炎型和经典多发性硬化型瞬目反射各波潜伏期均较对照组显著延长(P<0.01～0.001),经典多发性硬化型患者的瞬目反射各波潜伏期与视神经脊髓炎型相比也显著延长(P<0.01～0.001);经典多发性硬化型患者的瞬目反射各波波幅与对照组和视神经脊髓炎型相比显著降低(P<0.01～0.001),视神经脊髓炎型患者的瞬目反射各波波幅与对照组相比差异无显著性意义(P>0.05)。③经典多发性硬化型患者的瞬目反射各波异常率均显著高于视神经脊髓炎型(P<0.001)。结论:视神经脊髓炎型和经典多发性硬化型是多发性硬化的两种不同的临床类型;瞬目反射的改变可反映脑干病变的部位和范围。
AIM： To explore the differences of electrically elicited blink reflex （BR） between neuromyelitis optica （NMO） and classic muhiple sclerosis （MS）. METHODS： Forty-nine cases of clinical definite MS from January 1996 to June 2005 in Henan Provincial People＇s Hospital were selected, and 47 healthy examinees or staffs from Henan Provincial Tumor Hospital and Henan Provincial People＇s Hospital were involved as control group. MS group was divided into NMO （n=21） and classic MS （n=28）, BR was conducted with evoked potential instrument. Superficial electrodes were used as stimulating and recording. Recording electrodes were placed on the left and right orbicularis oculi muscules symmetrically. Reference electrodes were placed on both sides of nose bone. Connecting-to-ground electrode was placed on the lower jaw. Stimulating electrode was placed on the supraorbital hollow. Early reaction （Rt） and delayed reaction （R2） on the stimulating side and delayed reaction （R2＇） on the contralateral side were recorded simultaneously. The average latencies and amplitudes of all waves were calculated by four times recording results. The criteria of abnormal BR as follows： ①The latencies of each wave were prolonged over normal values （x^-＋2.5s, R1： 11.5 ms, R2： 38.8 ms, R2： 40,1 ms） and/or amplitudes were lowered over normal values（x^- -2.5 s, R1： 62.5 μV, R2：43.0 μV, and R2＇：7.0 μV）. ② BR could not be elicited without operating errors, instrument breakdown, not cooperation of patients etc. The degree of neurological function deficit was scored by expanded disability status scale （EDSS）. RESULTS： Forty-nine cases of MS and 47 cases of healthy controls completed the tests, All entered the result analysis. ①Age at onset and EDSS scores in NMO patients were significantly higher than those in classic MS （P 〈 0.01）.②The latencies of all waves of BR in NMO and classic MS were significantly prolonged in comparison with those of healthy control （P 〈 0.01-0,001）. The latencies of all waves of BR in classic MS were also markedly prolonged in comparison with those in NMO （P 〈 0.01-0.001）. The amplitudes of all waves of BR in classic MS were significantly lower than those in healthy control and NMO respectively （P 〈 0.01-0.001）; while the amplitudes of all waves of BR in NMO showed no significant differences compared with healthy control （P 〉 0.05）. ③The abnormal rates of all waves of BR in classic MS were significantly higher than those in NMO （P 〈 0.001）. CONCLUSION： NMO and classic MS are two distinct types of MS; the changes of BR may reflect the location and range of brainstem lesion.
出处
《中国临床康复》
CSCD
北大核心
2006年第34期13-15,共3页
Chinese Journal of Clinical Rehabilitation
基金
河南省自然科学基金资助项目(0211044300)~~
