张秀莉,董思雨,邓维维,等.多维度电生理检测在神经源性下尿路功能障碍评估中的应用研究[J].中华物理医学与康复杂志,2025,47(11):1017-1021
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| 多维度电生理检测在神经源性下尿路功能障碍评估中的应用研究 |
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| DOI：10.3760/cma.j.cn421666-20250815-00695 |
| 中文关键词: 骶神经根 磁刺激 神经源性下尿路功能障碍 骶反射 |
| 英文关键词: Sacral nerve root Magnetic stimulation Neurogenic dysfunction, Lower urinary tract Sacral reflexes |
| 基金项目:国家自然科学基金（8217542） |
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| 摘要点击次数: 116 |
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| 中文摘要: |
| 目的 探讨经颅磁刺激、经骶神经根磁刺激结合骶反射、肛门外括约肌肌电图（EAS-EMG）及阴部神经诱发电位在神经源性下尿路功能障碍（NLUTD）评估中的诊断价值。 方法 选取21例NLUTD患者（桥上损伤1例、脊髓损伤5例、马尾损伤5例、盆底疾病10例）。采用针极肌电图（EMG）记录由经颅磁刺激、经骶神经根磁刺激诱发的，与EAS相关的经颅运动诱发电位（tc-MEP）和经骶神经根运动诱发电位（ts-MEP）；将电刺激作用于阴部神经（阴茎背神经/阴蒂），记录与EAS相关的骶反射潜伏期；计算中枢运动传导时间（CMCT）和tc/ts-MEP比率，以区分中枢病变与外周病变。 结果 1例桥上损伤患者的tc-MEP及ts-MEP潜伏期虽然在正常范围内，但CMCT延长（28.2 ms），且tc/ts-MEP比率增高（7.4）。在5例脊髓损伤患者中，有1例患者的tc-MEP潜伏期（50.6 ms）及CMCT（47.8 ms）延长，tc/ts-MEP比率增高（18.1）。5例马尾损伤和10例盆底疾病继发NLUTD患者的CMCT均在正常范围内［分别为（22.9±4.9 ms）和（24.2±3.5 ms）］，但ts-MEP潜伏期延长［分别为（7.1±2.1 ms）和［（8.6±3.7 ms）］，tc/ts-MEP比率降低［分别为（4.4±0.9）和（4.3±1.5）］。在病损检测方面，tc/ts-MEP比率这一指标的异常检出率为93.8%，在所有评估指标中检出率最高，且其曲线下面积（AUC）达0.99，提示敏感性较好。 结论 tc/ts-MEP比率在区分中枢与外周病变方面具有重要意义。tc/ts-MEP比率显著增加可在一定程度上提示存在中枢神经系统损伤，降低则提示可能存在外周神经系统损伤。 |
| 英文摘要: |
| Objective To explore the diagnostic value of transcranial magnetic stimulation (TMS), transsacral magnetic root stimulation combined with sacral reflexes, external anal sphincter electromyography and pudendal nerve somatosensory evoked potentials in the assessment of neurogenic lower urinary tract dysfunction (NLUTD). Methods Twenty-one NLUTD patients (1 with a supra-pontine lesion, 5 with a spinal cord injury, 5 with a cauda equina injury, and 10 with pelvic floor disorders) were enrolled. Needle electromyography (EMG) was used to record TMS-induced and transsacral magnetic stimulation-induced motor evoked potentials (tc-MEPs and ts-MEPs, respectively) related to the external anal sphincter (EAS). The dorsal nerve of the penis or clitoris was stimulated electrically to record the latency of the sacral reflex related to the EAS. Central motor conduction time (CMCT) and the tc/ts-MEP latency ratio were calculated to distinguish central from peripheral lesions. Results In the one patient with a supra-pontine lesion, although the tc-MEP and ts-MEP latencies were within normal limits, the CMCT was prolonged (28.2ms) and the tc/ts-MEP ratio was large (7.4). Among the five patients with a spinal cord injury, one exhibited prolonged tc-MEP latency (50.6ms) and CMCT (47.8ms), along with a large tc/ts-MEP ratio (18.1). In the five patients with cauda equina injury and the ten with NLUTD secondary to pelvic floor disorders, CMCT was within the normal range ［averaging (22.9±4.9ms) and (24.2±3.5ms), respectively］, but the ts-MEP latency was prolonged ［(7.1±2.1ms) and (8.6±3.7ms), respectively］, and the tc/ts-MEP ratio was small ［(4.4±0.9) and (4.3±1.5), respectively］. The tc/ts-MEP ratio demonstrated the best rate of abnormality detection (93.8%), with an area under the curve of 0.99, indicating good sensitivity. Conclusions The tc/ts-MEP ratio can be useful for distinguishing central and peripheral lesions. A markedly increased tc/ts-MEP ratio may suggest central nervous system injury, whereas a decreased ratio may indicate peripheral nervous system injury. |
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