肛门括约肌肌电图对多系统萎缩与帕金森病鉴别诊断价值的Meta分析

doi:10.3969/j.issn.1004-583X.2022.06.002

摘要/Abstract

摘要：

目的系统评价肛门括约肌肌电图(external anal sphincter electromyography, EAS-EMG)对多系统萎缩(multiple system atrophy, MSA)与帕金森病(Parkinson disease, PD)的鉴别诊断价值。方法计算机检索美国国立医学图书馆(PubMed)、Web of science、Cochrane图书馆、荷兰医学文摘(Embase)、中国生物医学文献库(CBM)、中国知网(CNKI)、万方医学数据库(Wanfang data),收集有关EAS-EMG在MSA及PD诊断方面的相关文献,检索时间为建库至2021-01-01。由两名研究者按照纳入标准及排除标准筛选文献,按照纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale, NOS)对纳入的病例对照研究和队列研究进行质量评价。应用Revman 5.3软件进行数据合并与发表偏倚检测。结果共纳入14篇文献,其中2篇队列研究,12病例对照研究,所有研究的NOS评分均≥6分。Meta分析结果显示MSA组平均运动单位电位(MUP)时限较PD组显著增加(MD=2.70,95%CI=2.07~3.34);MSA组平均MUP波幅较PD组增高(MD=43.21,95%CI=-7.36~93.78); MSA组多相波百分比较PD组显著增加(MD=13.34,95%CI=6.22~20.46);MSA组MUP时限>10 ms%较PD组显著增加(MD=18.88,95%CI=4.89~32.87);MSA组卫星电位百分比较PD组显著增加(MD=8.36,95%CI=3.85~12.86)。本研究存在轻度的发表偏倚。结论 EAS-EMG检查对于MSA与PD的鉴别诊断具有重要的参考价值,平均MUP时限、多相波百分比、MUP时限>10 ms%及卫星电位百分比具有良好的诊断价值,但MUP波幅的诊断价值较小;EAS-EMG对MSA与早期PD的诊断价值可能更大,但尚需进一步研究验证。

关键词: 肛门括约肌肌电图, 多系统萎缩, 帕金森病, Meta分析

Abstract:

Objective To evaluate the diagnostic value of external anal sphincter electromyography (EAS-EMG) in multiple system atrophy (MSA) and Parkinson’s disease (PD). Methods Computer retrieval was applied for PubMed, Web of science, Cochrane library,Embase,CBM disc,CNKI,Wanfang Data, and relevant studies on EAS-EMG in MSA and PD with the retrieval duration extending from the library setup to January 1st,2021 were selected. The literature were screened out based on the inclusion and exclusion criteria by two independent researchers. Quality of studies was assessed according to the Newcastle-Ottawa Scale(NOS). The detection on the data merger and publication bias was performed with Software Revman5.3. Results A total of 14 studies were included, including 2 cohort studies and 12 case-control studies. The NOS scores of all studies were ≥6 points. Meta analysis results showed the duration of mean motor unit potential (MUP) in MSA group was significantly longer than that in PD group (MD=2.70, 95%CI=2.07-3.34); average MUP amplitude in the MSA group was higher than that in the PD group (MD=43.21, 95%CI=-7.36-93.78); the percentage of polyphase wave in the MSA group was significantly higher than that in the PD group (MD=13.34, 95%CI=6.22-20.46); the time limit of MUP >10 ms% in the MSA group was significantly higher than that in the PD group (MD=18.88, 95%CI=4.89-32.87); and the percentage of satellite potential in the MSA group was significantly higher than that in the PD group (MD=8.36, 95%CI=3.85-12.86). The Study was found to have a slight publication bias. Conclusion EAS-EMG delivers important reference value in the differential diagnosis of MSA and PD. The duration of mean MUP, percent of multiphase wavE, MUP duration >10 ms% and satellite potential % in EAS-EMG delivers high diagnostic value, while MUP amplitude exhibits less diagnostic value. EAS-EMG may be of greater value in the differential diagnosis on MSA and early PD, and further studies are required.

Key words: external anal sphincter electromyography, multiple system atrophy, Parkinson’s disease, Meta analysis

中图分类号:

R745.7

孙亚南, 郝一峰, 李晓红. 肛门括约肌肌电图对多系统萎缩与帕金森病鉴别诊断价值的Meta分析[J]. 临床荟萃, 2022, 37(6): 490-496.

Sun Yanan, Hao Yifeng, Li Xiaohong. Meta analysis on diagnostic value of external anal sphincter electromyography in multiple system atrophy and Parkinson's disease[J]. Clinical Focus, 2022, 37(6): 490-496.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.06.002

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I6/490

图/表 7

参考文献 23

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纳入文献	国家	研究类型	组别	例数	平均年龄(岁)	男(%)	病程(年)	NOS评分
Linder J, 2012^[5]	瑞典	队列研究	MSA	16	74.8±2.13	75	2.12±0.81	8
			PD	100	69±7.85	63	1.21±2.45
Schwarz J, 1997^[7]	德国	病例对照研究	MSA	14	57.6±7.33	46.67	未提供	7
			PD	10	64.7±6.17	60	>5
Libelius R, 2000^[8]	瑞典	病例对照研究	MSA	13	65±5	69.23	5.5±0.83	7
			PD	66	66±7	69.7	7.8±4.67
Cao Z, 2020^[10]	中国	病例对照研究	MSA	16	57.31±7.78	56.25	3.06±1.73	7
			PD	26	56.82±6.45	46.15	2.64±1.19
Niu X, 2020^[11]	中国	病例对照研究	MSA	43	52.59±5.43	未提供	0.5-13	7
			中晚期PD	60	53.06±4.90	未提供	>5
			早期PD	60	53.45±4.88	未提供	<5
Qiu F, 2019^[12]	中国	病例对照研究	MSA	99	56±2.08	51.49	2.4±0.42	7
			PD	100	64.7±10	65	3.0±0.65
Winge K, 2010^[13]	丹麦	队列研究	MSA	14	64.4±6	57.14	4.3±1	8
			PD	6	65.6±2.67	100%	5.3±1
Yamamoto T, 2012^[14]	日本	病例对照研究	MSA	263	64±5.83	58.56	3.2	7
			PD	129	66±7	66.67	3.2
胡新颖, 2020^[15]	中国	病例对照研究	MSA	21	60.7±7.0	61.9	3.4±1.6	6
			PD	33	62.2±7.2	60.61	5.4±1.9
吴少婷, 2015^[16]	中国	病例对照研究	MSA	28	63.4±11.6	57.14	2.86±2.37	6
			PD	11	61.5±12.2	45.45	2.92±3.23
曹振汤, 2018^[17]	中国	病例对照研究	MSA	171	60.2±8.0	60.23	2.5±2.0	7
			PD	477	61.0±13.0	56.6	5.0±4.0
戚晓昆, 2011^[18]	中国	病例对照研究	MSA	88	58.5±9.0	60.23	4.0±2.75	7
			PD	69	65.8±9.0	66.67	4.2±1.93
王含, 2011^[19]	中国	病例对照研究	MSA	68	60.9±6.0	51.47	2.19±0.97	7
			PD	60	59.4±8.67	68.33	3.88±3.25
张小瑾, 2009^[20]	中国	病例对照研究	MSA	42	59.2±9.6	59.52	3.0±2.4	7
			PD	51	62.4±11.3	54.9	5.7±4.7

纳入文献	国家	研究类型	组别	例数	平均年龄(岁)	男(%)	病程(年)	NOS评分
Linder J, 2012^[5]	瑞典	队列研究	MSA	16	74.8±2.13	75	2.12±0.81	8
			PD	100	69±7.85	63	1.21±2.45
Schwarz J, 1997^[7]	德国	病例对照研究	MSA	14	57.6±7.33	46.67	未提供	7
			PD	10	64.7±6.17	60	>5
Libelius R, 2000^[8]	瑞典	病例对照研究	MSA	13	65±5	69.23	5.5±0.83	7
			PD	66	66±7	69.7	7.8±4.67
Cao Z, 2020^[10]	中国	病例对照研究	MSA	16	57.31±7.78	56.25	3.06±1.73	7
			PD	26	56.82±6.45	46.15	2.64±1.19
Niu X, 2020^[11]	中国	病例对照研究	MSA	43	52.59±5.43	未提供	0.5-13	7
			中晚期PD	60	53.06±4.90	未提供	>5
			早期PD	60	53.45±4.88	未提供	<5
Qiu F, 2019^[12]	中国	病例对照研究	MSA	99	56±2.08	51.49	2.4±0.42	7
			PD	100	64.7±10	65	3.0±0.65
Winge K, 2010^[13]	丹麦	队列研究	MSA	14	64.4±6	57.14	4.3±1	8
			PD	6	65.6±2.67	100%	5.3±1
Yamamoto T, 2012^[14]	日本	病例对照研究	MSA	263	64±5.83	58.56	3.2	7
			PD	129	66±7	66.67	3.2
胡新颖, 2020^[15]	中国	病例对照研究	MSA	21	60.7±7.0	61.9	3.4±1.6	6
			PD	33	62.2±7.2	60.61	5.4±1.9
吴少婷, 2015^[16]	中国	病例对照研究	MSA	28	63.4±11.6	57.14	2.86±2.37	6
			PD	11	61.5±12.2	45.45	2.92±3.23
曹振汤, 2018^[17]	中国	病例对照研究	MSA	171	60.2±8.0	60.23	2.5±2.0	7
			PD	477	61.0±13.0	56.6	5.0±4.0
戚晓昆, 2011^[18]	中国	病例对照研究	MSA	88	58.5±9.0	60.23	4.0±2.75	7
			PD	69	65.8±9.0	66.67	4.2±1.93
王含, 2011^[19]	中国	病例对照研究	MSA	68	60.9±6.0	51.47	2.19±0.97	7
			PD	60	59.4±8.67	68.33	3.88±3.25
张小瑾, 2009^[20]	中国	病例对照研究	MSA	42	59.2±9.6	59.52	3.0±2.4	7
			PD	51	62.4±11.3	54.9	5.7±4.7

纳入文献	组别	例数	病程 (年)	MUP时限 (ms)	平均波幅 (μV)	多相波 (%)	卫星电位 (%)	平均时限 >10 ms%
Linder J, 2012^[5]	MSA	16	2.12±0.81	9.0±1.02	575±181.17	45±8.33	30±11.67
	PD	100	1.21±2.45	8.4±1.35	549±185.17	40±15		30±13.33
Schwarz J, 1997^[7]	MSA	14	未提供	9.04±1.4		48.1±15.9		32.1±11.4
	PD	10	>5	8.1±1.45		0.5±16.7		23.5±16.2
Libelius R, 2000^[8]	MSA	13	5.5±0.83	14.2±1.9	512±135	57.7±13.6		75.4±10.5
	PD	66	7.8±4.67	9.5±2.3	550±246	33.8±18.9		35.8±25.0
Cao Z, 2020^[10]	MSA	16	3.06±1.73	11.90±1.37	590.63±158.21		10±2.5
	PD	26	2.64±1.19	10.92±1.10	570.78±108.22		5±1.67
Niu X, 2020^[11]	MSA	43	0.5~13	13.9±2.6	502±69.4	65.8±11.6	76.7(33/43)
	中晚期PD	60	>5	12.6±2.1	489±74.2	43.32±12.5	53.3(32/60)
	早期PD	60	<5	8.0±1.9	462±71.0	19.2±11.3	11.7(7/60)
Qiu F, 2019^[12]	MSA	99	2.4±0.42	12.2±0.43	465±39.83	37.1±5.47
	PD	100	3.0±0.65	9.8±0.1875	481±39.46	31.6±2.58
Winge K, 2010^[13]	MSA	14	4.3±1	16.31±2.88		22.15±11.5
	PD	6	5.3±1	7.30±0.78		12.8±4.83
Yamamoto T, 2012^[14]	MSA	263	3.2	9.33±2.38	516.14±824.58
	PD	129	3.2	7.43±1.77	462.28±234.29
胡新颖, 2020^[15]	MSA	21	3.4±1.6	12.64±2.36	626.52±55.35	49.14±12.15	42.9(9/21)
	PD	33	5.4±1.9	10.05±1.18	465.39±58.42	40.55±6.15	12.1(4/33)
吴少婷, 2015^[16]	MSA	28	2.86±2.37	12.1±1.4		56.2±13.8	64.3(18/28)	72.8±18.2
	PD	11	2.92±3.23	9.4±1.6		53.1±13.6	18.2(2/11)	38.8±25.5
曹振汤, 2018^[17]	MSA	171	2.5±2.0	11.6±1.7	567.0±183.0	54.9±17.5	10.0±10.0	70.0±25.0
	PD	477	5.0±4.0	10.6±1.6	542.0±165.5	45.0±30.0	5.0±10.0	55.0±30.0
戚晓昆, 2011^[18]	MSA	88	4.0±2.75	12.92±2.59	648.6±251.0	42.6±21.2	34/88
	PD	69	4.2±1.93	8.99±0.47	470.0±91.9	24.2±11.0	0
王含, 2011^[19]	MSA	68	2.19±0.97	15.4±3.0		63.9±15.8	26.5±15.9
	PD	60	3.88±3.25	12.0±1.6		46.2±19.2	9.5±8.3
张小瑾, 2009^[20]	MSA	42	3.0±2.4	8.1±2.5	319.7±185.8	41.9±19.6
	PD	51	5.7±4.7	6.9±1.2	339.6±256.6	40.6±20.8

纳入文献	组别	例数	病程 (年)	MUP时限 (ms)	平均波幅 (μV)	多相波 (%)	卫星电位 (%)	平均时限 >10 ms%
Linder J, 2012^[5]	MSA	16	2.12±0.81	9.0±1.02	575±181.17	45±8.33	30±11.67
	PD	100	1.21±2.45	8.4±1.35	549±185.17	40±15		30±13.33
Schwarz J, 1997^[7]	MSA	14	未提供	9.04±1.4		48.1±15.9		32.1±11.4
	PD	10	>5	8.1±1.45		0.5±16.7		23.5±16.2
Libelius R, 2000^[8]	MSA	13	5.5±0.83	14.2±1.9	512±135	57.7±13.6		75.4±10.5
	PD	66	7.8±4.67	9.5±2.3	550±246	33.8±18.9		35.8±25.0
Cao Z, 2020^[10]	MSA	16	3.06±1.73	11.90±1.37	590.63±158.21		10±2.5
	PD	26	2.64±1.19	10.92±1.10	570.78±108.22		5±1.67
Niu X, 2020^[11]	MSA	43	0.5~13	13.9±2.6	502±69.4	65.8±11.6	76.7(33/43)
	中晚期PD	60	>5	12.6±2.1	489±74.2	43.32±12.5	53.3(32/60)
	早期PD	60	<5	8.0±1.9	462±71.0	19.2±11.3	11.7(7/60)
Qiu F, 2019^[12]	MSA	99	2.4±0.42	12.2±0.43	465±39.83	37.1±5.47
	PD	100	3.0±0.65	9.8±0.1875	481±39.46	31.6±2.58
Winge K, 2010^[13]	MSA	14	4.3±1	16.31±2.88		22.15±11.5
	PD	6	5.3±1	7.30±0.78		12.8±4.83
Yamamoto T, 2012^[14]	MSA	263	3.2	9.33±2.38	516.14±824.58
	PD	129	3.2	7.43±1.77	462.28±234.29
胡新颖, 2020^[15]	MSA	21	3.4±1.6	12.64±2.36	626.52±55.35	49.14±12.15	42.9(9/21)
	PD	33	5.4±1.9	10.05±1.18	465.39±58.42	40.55±6.15	12.1(4/33)
吴少婷, 2015^[16]	MSA	28	2.86±2.37	12.1±1.4		56.2±13.8	64.3(18/28)	72.8±18.2
	PD	11	2.92±3.23	9.4±1.6		53.1±13.6	18.2(2/11)	38.8±25.5
曹振汤, 2018^[17]	MSA	171	2.5±2.0	11.6±1.7	567.0±183.0	54.9±17.5	10.0±10.0	70.0±25.0
	PD	477	5.0±4.0	10.6±1.6	542.0±165.5	45.0±30.0	5.0±10.0	55.0±30.0
戚晓昆, 2011^[18]	MSA	88	4.0±2.75	12.92±2.59	648.6±251.0	42.6±21.2	34/88
	PD	69	4.2±1.93	8.99±0.47	470.0±91.9	24.2±11.0	0
王含, 2011^[19]	MSA	68	2.19±0.97	15.4±3.0		63.9±15.8	26.5±15.9
	PD	60	3.88±3.25	12.0±1.6		46.2±19.2	9.5±8.3
张小瑾, 2009^[20]	MSA	42	3.0±2.4	8.1±2.5	319.7±185.8	41.9±19.6
	PD	51	5.7±4.7	6.9±1.2	339.6±256.6	40.6±20.8