摘要：

目的: 分析表面肌电图（sEMG）记录的帕金森病患者肱二头肌和肱三头肌表面积分肌电值（iEMG）与肌强直程度的关系，探讨iEMG值作为帕金森病患者肌强直程度客观量化指标的可行性。方法: 纳入2022年9月至2023年11月在安徽医科大学第一附属医院就诊的51例原发性帕金森病患者（PD组）以及性别、年龄相匹配的19例正常对照者（对照组），采用统一帕金森病评价量表第三部分（UPDRSⅢ）评估受试者运动症状及上肢肌强直程度；sEMG采集受试者上肢被动运动时肱二头肌、肱三头肌表面肌电信号，并计算iEMG值；随机选择其中32例帕金森病患者进行左旋多巴冲击试验，收集冲击前后iEMG值和UPDRSⅢ上肢肌强直评分；Spearman秩相关分析iEMG值与上肢肌强直评分的相关性。结果: PD组症状较重侧肱二头肌（Z = -4.874，P = 0.000）和肱三头肌（Z = -4.880，P = 0.000）iEMG值高于症状较轻侧。Spearman秩相关分析显示，PD组上肢肌强直评分（0 ~ 3分）与肱二头肌（r_s = 0.735，P = 0.000）和肱三头肌（r_s = 0.545，P = 0.000）iEMG值呈正相关关系。PD组上肢肌强直评分为1分（肱二头肌Z = 5.344，P = 0.000；肱三头肌Z = 5.146，P = 0.000）、2分（肱二头肌Z = 7.421，P = 0.000；肱三头肌Z = 6.891，P = 0.000）、3分（肱二头肌Z = 5.340，P = 0.000；肱三头肌Z = 5.145，P = 0.000）的肌肉iEMG值均高于对照组。左旋多巴冲击试验发现，冲击后症状较重侧肌强直评分、肱二头肌和肱三头肌iEMG值均下降（Z = -3.317，P = 0.001；Z = -2.375，P = 0.018；Z = -2.618，P = 0.009）；此外，PD组左旋多巴冲击前（肱二头肌r_s = 0.664，P = 0.000；肱三头肌r_s = 0.386，P = 0.029）和冲击后（肱二头肌r_s = 0.620，P = 0.000；肱三头肌r_s = 0.588，P = 0.000）症状较重侧肌强直评分与iEMG值均呈正相关关系。结论: 帕金森病患者肱二头肌和肱三头肌iEMG值可反映肌强直程度，可作为帕金森病患者肌强直程度的量化评估指标。

关键词: 帕金森病, 肌强直, 上肢, 肌电描记术

Abstract:

Objective: To analyze the relationship between biceps, triceps surface integrated electromyography (iEMG) recorded by surface electromyography (sEMG) and the degree of myotonia in patients with Parkinson's disease (PD), and to explore the feasibility of iEMG value as an objective quantitative index of the degree of myotonia in patients with PD. Methods: A total of 51 patients with PD who were admitted to The First Affiliated Hospital of Anhui Medical University from September 2022 to November 2023 were included, as well as 19 healthy controls matched by sex and age. The motor symptoms and myotonic degree of the subjects were evaluated by Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ). sEMG was used to collect the sEMG signals of the biceps and triceps of the subjects during passive upper limb movement, and the iEMG value was calculated. A total of 32 patients with PD were randomly selected for Levodopa Shock Test. iEMG values and UPDRS Ⅲ myotonic scores of upper limbs were collected before and after the test. Spearman rank correlation analysis was used to analyze the correlation between iEMG values and UPDRS Ⅲ myotonic scores of upper limbs. Results: In PD group, the iEMG values of biceps muscle (Z = - 4.874, P = 0.000) and triceps muscle (Z = - 4.880, P = 0.000) of more severe symptoms side were higher than those of less severe symptoms side. Spearman rank correlation analysis showed that myotonic scores of upper limbs (0-3 points) in PD group was positively correlated with biceps (r_s = 0.735, P = 0.000) and triceps (r_s = 0.545, P = 0.000) iEMG values. The iEMG values of muscles with myotonia score of 1 (biceps Z = 5.344, P = 0.000; triceps Z = 5.146, P = 0.000), 2 (biceps Z = 7.421, P = 0.000; triceps Z = 6.891, P = 0.000), 3 (biceps Z = 5.340, P = 0.000; triceps Z = 5.145, P = 0.000) in PD group were higher than those in control group. In addition, before levodopa impact (biceps r_s = 0.664, P = 0.000; triceps r_s = 0.386, P = 0.029) and after impact (biceps r_s = 0.620, P = 0.000; triceps r_s = 0.588, P = 0.000) in PD group, there was a positive correlation between myotonic scores of upper limbs and iEMG values. Conclusions: The iEMG values of biceps and triceps can reflect the severity of myotonia in PD patients, and can be used as a quantitative evaluation index of myotonia in PD patients.

Key words: Parkinson disease, Myotonia, Upper extremity, Electromyography