摘要
目的 探讨面神经电图(ENoG)检测多块面肌方法在贝尔麻痹(BP)患儿面神经功能评估及早期预测预后中的价值.方法 选取2020年6月至2022年9月在昆明医科大学附属儿童医院诊治的90例BP患儿,首诊时应用ENoG检测额肌、鼻肌、口轮匝肌、上眼轮匝肌及下眼轮匝肌等5块面肌的ENoG值及复合肌肉动作电位(CMAP)波幅,并采用House Brackmann分级系统(HBGS)对患儿的面神经功能进行评估,随访至完全恢复或至首诊后6个月,通过HBGS再次评估患儿的面神经功能.分析比较不同面肌的ENoG值在各年龄组(婴幼儿组、学龄前儿童组、学龄儿童组)及各预后组(完全恢复组、不完全恢复组)间的差异,以及与首诊HBGS评级的相关性.绘制受试者工作特征曲线并计算曲线下面积(AUC),以评估早期不同面肌的ENoG值对BP患儿预后的价值.结果 首诊时患儿各部位ENoG值越低,则对应的首诊HBGS评级越高(P＜0.05);鼻肌、上眼轮匝肌及下眼轮匝肌表现更显著(P＜0.01).首诊时的鼻肌、上眼轮匝肌及下眼轮匝肌的ENoG值显示,完全恢复组的秩平均值高于不完全恢复组(P＜0.05);首诊时鼻肌、上眼轮匝肌及下眼轮匝肌的ENoG值可用于评估BP患儿的预后,AUC值分别为0.732、0.695及0.796(P＜0.05);将上眼轮匝肌与鼻肌ENoG值联合、上眼轮匝肌与下眼轮匝肌ENoG值联合、下眼轮匝肌与鼻肌ENoG值联合,准确性进一步提升,AUG分别为0.740、0.799及0.806(P＜0.01);首诊HBGS Ⅱ～Ⅲ级患儿的预后明显好于Ⅳ～Ⅴ级患儿(P＜0.01).结论 BP发病初期鼻肌、上眼轮匝肌及下眼轮匝肌的ENoG值与HBGS评级一样可反映患儿病情的严重程度,较低的ENoG值提示BP可能恢复不完全,增加ENoG面肌检测部位可提高BP患儿预后评估的准确性.
Abstract
Objective To explore the value of facial electroneurography(ENoG)for detecting multiple facial muscles in evaluating facial nerve function and early predicting the prognosis of pediatric Bell's palsy(BP).Methods A total of 90 children with BP were selected from the Childrens Hospital affiliated to Kunming Medical University from June 2020 to September 2022.At their first visit,ENoG was applied to detect ENoG values and compound motor action potential(CMAP)amplitudes of frontalis muscle,nasalis muscle,orbicularis oris muscle,the upper orbicularis oculi muscle and the lower orbicularis oculi muscle.Facial nerve function of the children was evaluated using House-Brack-mann grading system(HBGS).Follow-up lasted until complete recovery or 6 months after the first di-agnosis,and HBGS was applied to re-evaluate the facial nerve functions of the patients.The differ-ences in ENoG values of different facial muscles were analyzed and compared among different age groups(infant group,preschool group,school age group)and prognosis groups(complete recovery group,incomplete recovery group).The correlation was analyzed between ENoG values and the first visit HBGS scores.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the predictive value of early ENoG values of different facial muscles for the prognosis of the children with Bell's palsy.Results At the first diagnosis,the lower the ENoG values in various parts of the children,the higher the corresponding HBGS rating(P＜0.05).Nasal muscle,the upper orbicularis oculi muscle and the lower orbicularis oculi muscle showed more significant performance(P＜0.01).At the first diagnosis,ENoG values of nasalis muscle,the upper orbicularis oculi muscle and the lower orbicularis oculi muscle showed that the median value of complete recovery group was higher than that of incomplete recovery group(P＜0.05).ENoG values of nasal muscle,the upper orbicularis oculi muscle and the lower orbicularis oculi muscle can be used to evaluate the prognosis of BP children,with AUC values of 0.732,0.695 and 0.796,respectively(P＜0.05).The accuracy was further improved by combining ENoG values of the upper orbicularis oculi muscle with nasal muscle,the upper orbicularis oculi muscle with the lower orbicularis oculi muscle,the lower orbicularis oculi muscle with nasal muscle,and the AUC values were 0.740,0.799 and 0.806,respectively(P＜0.01).The prognosis of the children diagnosed as HBGS grade Ⅱ-Ⅲwas significantly better than that of the children with HBGS grade Ⅳ-Ⅴ at the first visit(P＜0.01).Conclusion In the early onset of BP,HBGS rating and the ENoG values of nasal muscle,the upper orbicularis oculi muscle and the lower orbicularis oculi muscle can reflect the severity of the children with BP.Lower ENoG values suggest that BP may not fully recover.Increasing the detection sites of facial ENoG can improve the accuracy of prognosis assessment in children with BP.
基金项目
云南省高层次卫生计生技术人才培养工程(L-2019019)
兴滇英才计划(RLMY20200005)
昆明市卫生科技项目(2020-06-04-111)
维普
万方数据