肌萎缩侧索硬化症的电生理及病理与中医证型的关系研究

Study on the Relationship between Electrophysiology and Pathology of Amyotrophic Lateral Sclerosis and Traditional Chinese Medicine Syndrome Type

张忍 ¹高天 ¹韩利震 ²欧梦迪 ¹喻绪恩¹

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作者信息

1. 安徽中医药大学神经病学研究所安徽合肥 230038;安徽中医药大学神经病学研究所附属医院安徽合肥 230000
2. 安徽中医药大学神经病学研究所安徽合肥 230038
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摘要

目的:探讨肌萎缩侧索硬化症(Amyotrophic lateral sclerosis,ALS)电生理和病理特征与中医证侯分型的关联性,为临床中西医结合治疗提供参考依据.方法:回顾性分析2021年8月—2024年2月安徽中医药大学神经病学研究所附属医院确诊的77例ALS患者的临床资料,对其电生理(主要为肌电图)及病理结果进行数据处理及分析.结果:77例ALS患者的中医证型以肝肾亏虚证、脾胃虚弱证为主,肌电图显示广泛性神经源性损害,损害主要集中在延髓段、颈段及腰骶段三段并见(20,26.0％);脾胃虚弱证是胸段神经源性损害的独立安全因素(O R=0.057,95％CI=0.004-0.745,P=0.029);而肝肾亏虚证相较于其他证型,出现延髓段、颈段、胸段、腰骶段四段损害的风险较高(OR=111.067,95％CI=1.971-6258.800,P=0.022).24例ALS患者病理检查中,以小角化纤维和靶纤维为主要病理特征,尤以肝肾亏虚证患者表现更为明显,不同中医证型的靶纤维含量构成存在差异,靶纤维中量与肺热津伤证、肝肾亏虚证显著相关(P＜0.05).结论:在ALS患者的电生理及病理表现与中医证型之间存在显著的相关性,特别是在多节段的神经源性损害中,肝肾亏虚证患者更为常见.肌肉病理以小角化纤维和靶纤维为特征.

Abstract

Objective:To explore the correlations between the electrophysiological and pathological features of Amyotrophic Lateral Sclerosis(ALS)and the syndrome typing of Traditional Chinese Medicine,providing a reference basis for the clinical integrated treatment of Western and Chinese medicine.Methods:Data processing and analysis were performed on the electrophysiological(primarily electromyography)and pathological results from the clinical records of 77 ALS patients diagnosed at the affiliated hospital of the Neurology Institute of Anhui University of Tra-ditional Chinese Medicine(TCM)from August 2021 to February 2024.Results:The TCM syndromes of the 77 ALS patients were mainly liver and kidney deficiency syndrome and spleen and stomach weakness syndrome.Electromyog-raphy showed widespread neurogenic damage,primarily concentrated in the bulbar,cervical,and lumbosacral seg-ments(20 cases,26.0％).Spleen and stomach weakness syndrome was found to be an independent protective factor for neurogenic damage in the thoracic segment(OR=0.057,95％CI=0.004-0.745,P=0.029).Compared with other syndromes,liver and kidney deficiency syndrome was associated with a higher risk of damage in the bulbar,cer-vical,thoracic,and lumbosacral segments(OR=111.067,95％CI=1.971-6258.800,P=0.022).Among the 24 ALS patients who underwent pathological examination,the main pathological features were small angular fibers and target fibers,which were more prominent in patients with liver and kidney deficiency syndrome.There were differences in the composition of target fiber content among different TCM syndromes,with moderate amounts of target fibers sig-nificantly correlated with lung heat and fluid injury syndrome and liver and kidney deficiency syndrome(P＜0.05).Conclusion:A significant correlation exists between the electrophysiological and pathological manifestations observed in ALS patients and the types of TCM syndromes,particularly in cases of multi-segmental neurogenic damage,which is notably prevalent among individuals with liver and kidney deficiency syndrome.The muscle pathology is character-ized by small-angle fibers and target fibers.

关键词

肌萎缩侧索硬化症/肌电图/肌肉病理/中医证型

Key words

Amyotrophic Lateral Sclerosis/Electromyography/Muscle Pathology/Traditional Chinese Medicine Syndrome

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出版年

2025

中医药临床杂志

中华中医药学会

中医药临床杂志

影响因子：0.636

ISSN：1672-7134

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