不同中医证型腕管综合征患者的神经电生理特点
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摘要
目的研究不同中医证型腕管综合征(CTS)患者的神经电生理特点。方法选择2017年1～9月广东省佛山市中医院(以下简称"我院")收治的CTS患者80例为研究对象。根据患者中医证型不同将其分为寒湿阻络组(38例)与气阴两虚组(42例),另取同期于我院接受健康体检的正常人员40名记为对照组。采用英国Medelec Synerg肌电/诱发电位仪对三组人员进行常规神经电生理检测,分别测量三组正中神经的运动神经传导速度(MCV)、复合肌肉动作电位波幅(CMAP)、感觉神经传导速度(SNCV)及末端运动潜伏期(DML)、尺神经SNCV及DML情况。结果气阴两虚组MCV、CMAP水平均低于寒湿阻络组与对照组,而寒湿阻络组CMAP低于对照组,差异均有统计学意义(均P <0.05)。气阴两虚组指1至腕、指3至腕SNCV水平低于寒湿阻络组与对照组,且寒湿阻络组低于对照组(均P <0.05);而气阴两虚组DML高于寒湿阻络组与对照组,且寒湿阻络组高于对照组(均P <0.05)。三组尺神经SNCV、DML水平比较,差异无统计学意义(P> 0.05)。结论寒湿阻络型与气阴两虚型CTS患者的正中神经MCV、CMAP、SNCV以及DML水平存在明显差异,临床上可通过对上述指标进行检测,从而有利于对CTS患者的中医辨证分型。
Objective To study the characteristics of nerve electrophysiology in different TCM syndrome types of patients with carpal tunnel syndrome(CTS). Methods From January to September 2017, 80 patients with CTS treated in Foshan Hospital of Traditional Chinese Medicine in Guangdong Province("our hospital" for short) were selected as research objects. According to different TCM syndromes, the patients were divided into cold dampness blocking collaterals group(38 cases) and deficiency of qi and yin group(42 cases). In addition, 40 normal persons who received physical examination in our hospital at the same time were taken as control group. British Medelec Synerg/evoked potentiometer was used to detect the conventional nerve electrophysiology of the three groups. The motor nerve conduction velocity(MCV), compound muscle action potential(CMAP), sensory nerve conduction velocity(SNCV) and distal motor latency(DML) and the SNCV, DML of ulnar nerve in the three groups were measured. Results The levels of MCV and CMAP in deficiency of qi and yin group were lower than those of cold dampness blocking collaterals group and control group, and the CMAP of cold dampness blocking collaterals group was lower than the control group, the differences were all statistically significant(all P < 0.05). The levels of SNCV of finger 1 to wrist and finger 3 to wrist in deficiency of qi and yin group were lower than those of cold dampness blocking collaterals group and control group, and cold dampness blocking collaterals group was lower than control group(all P < 0.05); the DML in deficiency of qi and yin group was higher than the cold dampness blocking collaterals group and control group, and cold dampness blocking collaterals group was higher than the control group(all P < 0.05). The differences of SNCV and DML levels of ulnar nerve in the three groups were not statistically significant(P > 0.05). Conclusion There is a significant difference in median nerve MCV, CMAP, SNCV and DML levels in CTS patients with cold dampness blocking collaterals type and deficiency of qi and yin type, the above indexes can be detected in clinic, which are beneficial for TCM syndrome differentiation of CTS patients.
Objective To study the characteristics of nerve electrophysiology in different TCM syndrome types of patients with carpal tunnel syndrome(CTS). Methods From January to September 2017, 80 patients with CTS treated in Foshan Hospital of Traditional Chinese Medicine in Guangdong Province("our hospital" for short) were selected as research objects. According to different TCM syndromes, the patients were divided into cold dampness blocking collaterals group(38 cases) and deficiency of qi and yin group(42 cases). In addition, 40 normal persons who received physical examination in our hospital at the same time were taken as control group. British Medelec Synerg/evoked potentiometer was used to detect the conventional nerve electrophysiology of the three groups. The motor nerve conduction velocity(MCV), compound muscle action potential(CMAP), sensory nerve conduction velocity(SNCV) and distal motor latency(DML) and the SNCV, DML of ulnar nerve in the three groups were measured. Results The levels of MCV and CMAP in deficiency of qi and yin group were lower than those of cold dampness blocking collaterals group and control group, and the CMAP of cold dampness blocking collaterals group was lower than the control group, the differences were all statistically significant(all P < 0.05). The levels of SNCV of finger 1 to wrist and finger 3 to wrist in deficiency of qi and yin group were lower than those of cold dampness blocking collaterals group and control group, and cold dampness blocking collaterals group was lower than control group(all P < 0.05); the DML in deficiency of qi and yin group was higher than the cold dampness blocking collaterals group and control group, and cold dampness blocking collaterals group was higher than the control group(all P < 0.05). The differences of SNCV and DML levels of ulnar nerve in the three groups were not statistically significant(P > 0.05). Conclusion There is a significant difference in median nerve MCV, CMAP, SNCV and DML levels in CTS patients with cold dampness blocking collaterals type and deficiency of qi and yin type, the above indexes can be detected in clinic, which are beneficial for TCM syndrome differentiation of CTS patients.
引文
[1]胡继兵,秦全菊,程佳,等.107例腕管综合征患者神经肌电图与临床分析[J].医学研究杂志,2013,42(9):131-133.
[2]刘英,孟娟,雷虹,等.高频超声在腕管综合征临床分型判定中的价值[J].中国超声医学杂志,2017,33(11):1000-1002.
[3]陈香葵,张晓莺.30例腕管综合征患者的神经电生理检测与临床分析[J].癫痫与神经电生理学杂志,2008,17(3):166-167.
[4]左贵松,申才良,潘宏,等.腕管综合征术后正中神经形态变化研究分析[J].基因组学与应用生物学,2017,36(1):23-29.
[5]管艳敏,范玉兰,局雪,等.50例神经电生理检查诊断腕管综合征临床观察[J].中国实用医药,2013,8(29):93-94.
[6]Jdp B.Nerve Conduction Studies for Carpal Tunnel Syndrome:Gold Standard or Unnecessary Evil[J].Orthopedics,2017,40(4):198.
[7]王栋,曾政,李国湘,等.神经电生理检测对腕管综合征临床诊断的意义[J].中国实验诊断学,2015,19(11):1850-1852.
[8]葛迪,李华南,海兴华,等.以推拿为主的综合疗法治疗腕管综合征临床疗效的Meta分析[J].中医外治杂志,2017,26(6):57-59.
[9]徐士军,李智琳,杨建国,等.神经传导测定技术对腕管综合征病情评估的价值[J].现代生物医学进展,2014,14(28):5503-5506.
[10]Martins RS,Siqueira MG.Conservative therapeutic management of carpal tunnel syndrome[J].Arq Neuropsiquiatr,2017,75(11):819-824.
[11]Chen L,Xue L,Li S,et al.Clinical research on mild and moderate carpal tunnel syndrome treated with contralateral needling technique at distal acupoints and acupuncture at local acupoints[J].Zhongguo Zhen Jiu,2017,37(5):479-482.
[12]汪仁斌,刘尊敬,汪伟,等.腕管综合征合并神经根型颈椎病的临床与电生理特点[J].中华医学杂志,2015,95(35):2846-2850.
[13]冯淑艳,朱愈,李六一,等.尺神经共同刺激影响腕管综合征正中神经远端潜伏期:避免误差的定量测定[J].中华物理医学与康复杂志,2016,38(10):730-734.(上接第125页)
[14]朱连海,丁莉,李新玲,等.高压氧联合甲钴胺治疗腕管综合征的神经电生理疗效观察[J].中华航海医学与高气压医学杂志,2016,23(5):390-393.
[15]曹珍兰,徐继扬,朱文荣,等.腕管综合征的神经电生理学特点[J].临床神经病学杂志,2013,26(6):463-465.
[16]邵静雯,曹曼林.腕管综合征的诊疗进展[J].中国康复,2014,29(2):141-146.
[17]Sucher BM,Richter K,Andary MT.Re:Electrosonodiagnosis in Carpal Tunnel Syndrome:A Proposed Diagnostic Algorithm Based on an Analytic Literature Review[J].PMR,2016,8(10):1024.
[18]叶永成.不同方法治疗腕管综合征的临床分析[J].中外医疗,2018,37(6):47-48,54.
[19]鲁亚蕊,毕宠刚,张晓楠,等.神经-肌电图电生理检查应用于腕管综合征的诊断价值探讨[J].基层医学论坛,2017,21(10):1256-1257.
[20]张硕.腕管综合征中医证型与神经电生理表现相关性研究[D].福州:福建中医药大学,2011.
[2]刘英,孟娟,雷虹,等.高频超声在腕管综合征临床分型判定中的价值[J].中国超声医学杂志,2017,33(11):1000-1002.
[3]陈香葵,张晓莺.30例腕管综合征患者的神经电生理检测与临床分析[J].癫痫与神经电生理学杂志,2008,17(3):166-167.
[4]左贵松,申才良,潘宏,等.腕管综合征术后正中神经形态变化研究分析[J].基因组学与应用生物学,2017,36(1):23-29.
[5]管艳敏,范玉兰,局雪,等.50例神经电生理检查诊断腕管综合征临床观察[J].中国实用医药,2013,8(29):93-94.
[6]Jdp B.Nerve Conduction Studies for Carpal Tunnel Syndrome:Gold Standard or Unnecessary Evil[J].Orthopedics,2017,40(4):198.
[7]王栋,曾政,李国湘,等.神经电生理检测对腕管综合征临床诊断的意义[J].中国实验诊断学,2015,19(11):1850-1852.
[8]葛迪,李华南,海兴华,等.以推拿为主的综合疗法治疗腕管综合征临床疗效的Meta分析[J].中医外治杂志,2017,26(6):57-59.
[9]徐士军,李智琳,杨建国,等.神经传导测定技术对腕管综合征病情评估的价值[J].现代生物医学进展,2014,14(28):5503-5506.
[10]Martins RS,Siqueira MG.Conservative therapeutic management of carpal tunnel syndrome[J].Arq Neuropsiquiatr,2017,75(11):819-824.
[11]Chen L,Xue L,Li S,et al.Clinical research on mild and moderate carpal tunnel syndrome treated with contralateral needling technique at distal acupoints and acupuncture at local acupoints[J].Zhongguo Zhen Jiu,2017,37(5):479-482.
[12]汪仁斌,刘尊敬,汪伟,等.腕管综合征合并神经根型颈椎病的临床与电生理特点[J].中华医学杂志,2015,95(35):2846-2850.
[13]冯淑艳,朱愈,李六一,等.尺神经共同刺激影响腕管综合征正中神经远端潜伏期:避免误差的定量测定[J].中华物理医学与康复杂志,2016,38(10):730-734.(上接第125页)
[14]朱连海,丁莉,李新玲,等.高压氧联合甲钴胺治疗腕管综合征的神经电生理疗效观察[J].中华航海医学与高气压医学杂志,2016,23(5):390-393.
[15]曹珍兰,徐继扬,朱文荣,等.腕管综合征的神经电生理学特点[J].临床神经病学杂志,2013,26(6):463-465.
[16]邵静雯,曹曼林.腕管综合征的诊疗进展[J].中国康复,2014,29(2):141-146.
[17]Sucher BM,Richter K,Andary MT.Re:Electrosonodiagnosis in Carpal Tunnel Syndrome:A Proposed Diagnostic Algorithm Based on an Analytic Literature Review[J].PMR,2016,8(10):1024.
[18]叶永成.不同方法治疗腕管综合征的临床分析[J].中外医疗,2018,37(6):47-48,54.
[19]鲁亚蕊,毕宠刚,张晓楠,等.神经-肌电图电生理检查应用于腕管综合征的诊断价值探讨[J].基层医学论坛,2017,21(10):1256-1257.
[20]张硕.腕管综合征中医证型与神经电生理表现相关性研究[D].福州:福建中医药大学,2011.