不安腿综合征患者的临床肌电图学研究

doi:10.16150/j.1671-2870.2019.05.015

摘要/Abstract

摘要：

目的：评估我国不安腿综合征（restless legs syndrome, RLS）患者的主观睡眠、情绪情况和自主神经功能及客观的电生理证据。方法：对15例RLS患者和16例非RLS对照人群（对照组）进行量表评估,所用量表包括匹兹堡睡眠量表（Pittsburgh sleep quality index, PSQI）、爱泼沃斯嗜睡量表（Epworth sleepiness scale, ESS）、汉密尔顿焦虑量表（Hamilton anxiety scale, HAMA）、汉密尔顿抑郁量表（Hamilton depression scale, HAMD）、复合自主症状评分（Composite autonomic symptom score 31, COMPASS-31）、自主神经症状量表（Scale for outcomes in PD for autonomic symptoms, SCOPA-AUT）及肌电图检查（SSR、F波、H反射）。结果：RLS组相较于对照组,PSQI得分更高（P<0.05）,而反映情绪和自主神经功能的量表得分与对照组相比,差异无统计学意义。肌电图检查示,2组间的F波潜伏期、H反射潜伏期、H/M波幅比及SSR起始潜伏期、左下肢SSR波幅、H反射波幅差异无统计学意义,而右下肢SSR波幅（P=0.042）及H反射波幅（P=0.047）在2组间的差异均有统计学意义,但P值均接近0.05,且结合左下肢SSR波幅及H反射波幅在2组之间无明显差异、本研究样本量较小,故考虑假阳性可能大。结论：RLS对于睡眠,尤其是夜间睡眠的影响较为显著;目前通过电生理检测来辅助诊断RLS的依据仍然不足,需要进一步扩大样本进行研究,小纤维（SSR评估的C类无髓小纤维）的受累可能并没有参与RLS的发病机制。

关键词: 不安腿综合征, 量表, 肌电图

Abstract:

Objectives: To evaluate sleep, mood and autonomic function objectively and electrophysiology subjectively in Chinese RLS (Restless legs syndrome, RLS) patients. Methods: A total of 15 RLS patients and 16 non-RLS controls were recruited from out-patient clinics of neurology department. Questionnaires（PSQI、ESS、HAMA、HAMD、COMPASS-31、SCOPA-AUT） were asked and electromyography （SSR、F-wave、H reflex） was conducted. Results: PSQI score was higher in RLS patients than controls. Mood and autonomic score didn't differ between two groups. In addition, F-wave latency, H-reflex latency, H/M amplitude ratio and SSR latency was similar between two groups. H-reflex amplitude and SSR amplitude didn't differ, neither. SSR amplitude (P=0.042) and H-reflex amplitude (P=0.047) was statically significant, but probably false positive. Conclusion: RLS symptom impacts sleep, especially during bedtime over mood and autonomic function. In the meantime, there is still a lack of electromyography biomarker to help diagnose RLS. More studies with bigger sample size are needed in the future. It is possible that small fiber dysfunction is not involved in the pathophysiology of RLS.

Key words: Restless legs syndrome, Scale, Electromyography

中图分类号:

R741

陆燕青, 陈捷, 马建芳, 万燕萍. 不安腿综合征患者的临床肌电图学研究[J]. 诊断学理论与实践, 2019, 18(05): 565-569.

LU Yanqing, CHEN Jie, MA Jianfang, WAN Yanping. Clinical electromyography study of patients with restless legs syndrome in Chinese population[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(05): 565-569.

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项目	RLS组(n=15)	对照组(n=16)	P值
性别,女性[n(%)]	9 (60.00)	9 (56.25)	0.833
年龄 (岁)	66.86±15.47	59.00±14.79	0.166

量表	RLS组(n=15)	对照组(n=16)	P值
PSQI评分	9.36±5.68	3.87±3.02	0.012
ESS评分	1.00±1.26	2.40±2.13	0.074
HAMA评分	6.80±7.04	3.07±4.03	0.163
HAMD评分	3.60±4.43	2.13±2.95	0.517
COMPASS-31评分	12.87±15.39	13.22±12.03	0.823
SCOPA-AUT评分	6.80±3.01	4.87±4.26	0.094

电生理参数		RLS组	对照组	P值
腓浅神经 (m/s)	右下肢	50.34±3.78	48.94±2.93	0.278
	左下肢	50.50±3.30	48.53±3.12	0.128
腓总神经 (m/s)	右下肢	48.24±4.49	48.48±3.47	0.877
	左下肢	49.12±3.50	48.40±2.99	0.572
胫神经 (m/s)	右下肢	46.36±3.66	47.68±3.58	0.357
	左下肢	46.73±3.73	47.88±3.44	0.404

电生理参数	肢侧	RLS组	对照组	P值
F-M均数 (ms)	右下肢	42.49±3.86	42.25±3.59	0.863
	左下肢	42.90±4.44	42.39±3.69	0.736
SSR起始潜伏期 (ms)	右下肢	2.16±0.38	1.98±0.29	0.181
	左下肢	2.06±0.36	1.99±0.30	0.573
SSR波幅 (μv)	右下肢	525.59±469.26	1187.7±983.32	0.042
	左下肢	529.87±464.52	953.89±683.38	0.144
H反射潜伏期(ms)	右下肢	30.09±3.14	29.57±1.75	0.627
	左下肢	30.55±3.51	30.02±2.58	0.687
H反射波幅 (μv)	右下肢	0.87±0.71	2.01±1.21	0.047
	左下肢	0.60±0.76	1.05±0.63	0.067
H/M 波幅比（%）	右下肢	10.74%±8.19%	27.8%±25.17%	0.076
	左下肢	13.38%±16.15%	25.6%±36.07%	0.296