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目的探讨单纤维肌电图(SFEMG)在儿童重症肌无力(MG)中的诊断价值。方法对62例MG患儿(MG组)及24例健康儿童(健康对照组)分别行伸指总肌SFEMG、重复神经电刺激(RNS)和血中乙酰胆碱受体抗体(AchRAb)测定,比较这些检查方法的差异。结果 MG组伸指总肌SFEMG颤抖值异常45例(72.6%),表现为颤抖增宽。其中21例伴阻滞;SFEMG异常率随病情加重而增高:MGⅡa、Ⅱb型SFEMG异常率(87.5%、100%)分别与Ⅰ型(68.6%)比较,差异均有统计学意义(χ2=4.14、5.27,Pa<0.05)。MG组颤抖值为(51.7±20.3)μs,颤抖>55μs的电位对百分比为2%～100%[(26.8±19.4)%],阻滞的电位对百分比为0～76%[(22.5±6.5)%],均明显高于健康对照组(t=3.63、4.52、3.81,Pa<0.001)。RNS异常22例(35.5%),AchRAb滴度升高20例(32.3%),诊断MG的敏感性与SFEMG比较差异有统计学意义(χ2=17.1、20.2,Pa<0.001)。但SFEMG正常者仍有RNS、AchRAb异常。结论 SFEMG检查是诊断儿童MG敏感性较高的一种方法,与RNS和AchRAb检查具有互补作用。
Objective To investigate the diagnostic value of single fiber electromyography (SFEMG) in children with myasthenia gravis (MG). Methods Sixty-two children with MG (MG group) and 24 healthy children (healthy control group) were subjected to SFEMG, RNS and AchRAb respectively. Check the method differences. Results In 45 cases (72.6%) of abnormal MG tremor in the extensor digitorum total muscle of MG group, the tremor was widened. The abnormal rate of SFEMG increased with the exacerbations: the abnormal rates of SFEMG of MGⅡa and Ⅱb type were 87.5% and 100%, respectively, which were significantly different from those of type Ⅰ (68.6%) (χ2 = 4.14 , 5.27, Pa <0.05). (51.7 ± 20.3) μs in MG group and 2% -100% [(26.8 ± 19.4)%] in tremble> 55μs, and the percentage of blockage potential was 0-76% [(22.5 ± 6.5) )%], Were significantly higher than the healthy control group (t = 3.63,4.52,3.81, Pa <0.001). There were 22 cases (35.5%) with RNS abnormality and 20 cases (32.3%) with increased AchRAb titer. There was significant difference between the diagnosis of MG and SFEMG (χ2 = 17.1,20.2, Pa <0.001). However, normal SFEMG still RNS, AchRAb abnormalities. Conclusion The SFEMG test is a sensitive method to diagnose children with MG, which is complementary to RNS and AchRAb tests.