目的:本研究旨在比较2010年欧洲神经学会联合会/周围神经学会(EFNS/PNS)多灶性运动神经病(MMN)诊断标准与美国电诊断医学协会(AAEM)诊断标准的敏感性和特异性。
方法:回顾性评估了53例MMN患者和280例轴索性周围神经病变对照的两组标准的敏感性和特异性,炎性脱髓鞘性多发性神经病,或者肌萎缩侧索硬化症.还评估了使用不同数量的神经进行神经传导研究的效用比较。
结果:2010年EFNS/PNS标准对确定的MMN的敏感性为47%,对可能/确定的MMN的敏感性为57%。而AAEM标准对确定的MMN的敏感性为28%,对可能/确定的MMN的敏感性为53%。与振幅降低来定义传导阻滞相比,当利用面积时,AAEM标准的灵敏度更高。使用支持标准,2010年EFNS/PNS标准对可能/确定MMN的敏感性增加到64%,另有36%的患者符合标准(可能为MMN).与EFNS/PNS标准(98.5%和97%)相比,AAEM标准(100%)的确定和可能/确定MMN的特异性值略高。扩展的神经传导研究对两组标准的诊断敏感性均略有增加,而不会显着影响特异性。
结论:在我们的患者人群中,与AAEM标准相比,2010年EFNS/PNS标准显示出更高的灵敏度,但特异性略低.建议延长神经传导研究以实现稍高的灵敏度,同时保持非常高的特异性。
OBJECTIVE: This study was undertaken to compare the sensitivity and specificity of the 2010 European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria for multifocal motor neuropathy (
MMN) with those of the American Association of Electrodiagnostic Medicine (AAEM).
METHODS: Sensitivity and specificity of the two sets of criteria were retrospectively evaluated in 53 patients with MMN and 280 controls with axonal peripheral neuropathy, inflammatory demyelinating polyneuropathy, or amyotrophic lateral sclerosis. Comparison of the utility of nerve conduction studies with different numbers of nerves examined was also assessed.
RESULTS: The 2010 EFNS/PNS criteria had a sensitivity of 47% for definite
MMN and 57% for probable/definite
MMN, whereas the AAEM criteria had a sensitivity of 28% for definite
MMN and 53% for probable/definite
MMN. The sensitivity of the AAEM criteria was higher when utilizing area compared to amplitude reduction to define conduction block. Using supportive criteria, the sensitivity of the 2010 EFNS/PNS criteria for probable/definite MMN increased to 64%, and an additional 36% patients fulfilled the criteria (possible
MMN). Specificity values for definite and probable/definite MMN were slightly higher with the AAEM criteria (100%) compared to the EFNS/PNS criteria (98.5% and 97%). Extended nerve conduction studies yielded slightly increased diagnostic sensitivity for both sets of criteria without significantly affecting specificity.
CONCLUSIONS: In our patient populations, the 2010 EFNS/PNS criteria demonstrated higher sensitivity but slightly lower specificity compared to the AAEM criteria. Extended nerve conduction studies are advised to achieve slightly higher sensitivity while maintaining very high specificity.