肛门括约肌肌电图在鉴别诊断多系统萎缩、帕金森病及晚发型脊髓小脑共济失调中的作用

目的 分析多系统萎缩(multipe system atrophy,MSA)、帕金森病(Parkinson's disease,PD)、晚发型脊髓小脑共济失调(1ate-onset spinocerebellar ataxia,LOSCA)患者的肛门括约肌肌电图(external anal sphincter electromyography,EAS-EMG)的差异等电生理改变特点,为临床鉴别诊断提供依据.方法 分别对88例MSA、69例原发性PD、18例LOSCA患者的电生理检查结果进行回顾性分析.结果 EAS-EMG检查中MSA组有84例(95.5%)患者存在不同程度的神经源性受损,表现为运动单位电位(MUPs)平均时限(12.92±2.59)ms]显著延长、平均波幅(648.6±251.0)μV]增高、多相波百分比(42.6%±21.2%)增加、异常自发电位与卫星电位多见,与PD(8.99±0.47)ms、(470.0±91.9)μV、24.2%±11.0%]及LOSCA组(9.04±0.62)ms、(493.1±113.7)μV、22.0%±12.1%]相比差异有统计学意义(Welch值分别为:94.240、18.093、26.710,均P=0.000).PD及LOSCA组EAS-EMG检查未发现有神经源性受损,也未见自发电位与卫星电位.结论 MSA临床表现可与PD及LOSCA相似,有时容易相互误诊,EAS-EMG检查可提高MSA的正确诊断率,尤其与PD、LOSCA进行鉴别诊断时有较大价值.

Abstract：

Objective To observe the electrophysiological changes, especially in the examination of external anal sphincter electromyography ( EAS-EMG), with those patients diagnosed as multiple system atrophy ( MSA), Parkinson's disease (PD) and late-onset spinocerebellar ataxia (LOSCA) and explore its clinical diagnostic value as well as differential diagnostic value for the three diseases. Methods The clinical data, cranial magnetic resonance imaging (MRI) data as well as results of EAS-EMG for 3 groups patients, including 88-cases MSA, 69-cases PD and 18-cases LOSCA, were analyzed retrospectively.Results EAS-EMG showed that 84 cases (95.5%) in MSA group had varying degrees of neurogenic injury. Meanwhile, mean motor unit potentials (MUPs) duration (( 12.92 ± 2.59)ms), mean MUPs amplitude ( ( 648.6 ± 251.0 ) μV ), and MUPs polyphasicity ( percentage of polyphasic MUPs; 42. 6% ±21.2% ) in MSA group were significantly different from those in PD ( ( 8. 99 ± 0. 47 ) ms, (470. 0 ±91.9) μV, 24.2% ±11.0%) and LOSCA groups ((9.04 ±0.62)ms, (493.1 ± 113.7)μV,22.0% ±12. 1%; Welch:94. 240,18. 093,26. 710,all P =0. 000). The spontaneous potentials and satellite potentials showed more common in MSA group, but not in other groups. Conclusions MSA and PD and LOSCA are easily mutually misdiagnosed because of some similar syndromes, but the method of EAS-EMG could be effective and helpful to enhance accurate diagnostic rate of MSA and its differential diagnosis with PD and LOSCA.

Role of external anal sphincter electromyography for differential diagnosis of multiple system atrophy, Parkinson's disease and late-onset spinocerebellar ataxia

Objective To observe the electrophysiological changes, especially in the examination of external anal sphincter electromyography ( EAS-EMG), with those patients diagnosed as multiple system atrophy ( MSA), Parkinson's disease (PD) and late-onset spinocerebellar ataxia (LOSCA) and explore its clinical diagnostic value as well as differential diagnostic value for the three diseases. Methods The clinical data, cranial magnetic resonance imaging (MRI) data as well as results of EAS-EMG for 3 groups patients, including 88-cases MSA, 69-cases PD and 18-cases LOSCA, were analyzed retrospectively.Results EAS-EMG showed that 84 cases (95.5%) in MSA group had varying degrees of neurogenic injury. Meanwhile, mean motor unit potentials (MUPs) duration (( 12.92 ± 2.59)ms), mean MUPs amplitude ( ( 648.6 ± 251.0 ) μV ), and MUPs polyphasicity ( percentage of polyphasic MUPs; 42. 6% ±21.2% ) in MSA group were significantly different from those in PD ( ( 8. 99 ± 0. 47 ) ms, (470. 0 ±91.9) μV, 24.2% ±11.0%) and LOSCA groups ((9.04 ±0.62)ms, (493.1 ± 113.7)μV,22.0% ±12. 1%; Welch:94. 240,18. 093,26. 710,all P =0. 000). The spontaneous potentials and satellite potentials showed more common in MSA group, but not in other groups. Conclusions MSA and PD and LOSCA are easily mutually misdiagnosed because of some similar syndromes, but the method of EAS-EMG could be effective and helpful to enhance accurate diagnostic rate of MSA and its differential diagnosis with PD and LOSCA.