重症肌无力病人的临床绝对评分法和相对评分法王秀云许贤豪孙宏韩雄张华国红目的提出并详细描述一种对重症肌无力(MG)病人的临床绝对和相对评分法。方法运用统计学方法对这一评分法的可靠性和敏感性做了检验,对20例MG病人的临床绝对评分结果做Kappa检验;对12例MG病人的相对评分结果做t检验。结果表明本方法可重复性较好,且能敏感地反映出临床病情变化,是一种评价MG病人受累肌群肌肉无力情况及临床治疗效果的较为精确和稳定的量表化方法。结论临床绝对评分法和相对评分法对判断重症肌无力患者的病情和疗效具有一定的必要性和可行性。关键词重症肌无力肌肉无力的严重程度评分方法绝对评分相对评分AclinicalabsoluteandrelativescoresystemformyastheniagravisWangXiuyun,XuXianhao,SunHong,etal.DepartmentofNeurology,BeijingHospital,MinistryofHealth,Beijing100730ObjectiveToproposeaclinicalabsoluteandrelativescoresystemformyastheniagravisandmakeitsevaluation.MethodsThesystemconsistedoftwoparts,theabsolutescoresandtherela2tivescores.Theabsolutescoresincluded8items:ptosis,palpebrasuperiorfatigability,disabilityofocularmotion,fatigabilityoftheupperandlowerextremitymuscles,disabilityofthefacialmuscles,chewingdifficulties,dysphagiaanddisabilityoftherespiratorymuscles.Eachitemhadfivepossiblescores,rangingfrom0(thesignsandsymptomsbeingabsent)to4(themostseveredysfunction).Therelativescoreswereobtainedwiththescoresbeforetreatmentsubtractedbythescoresaftertreatmentandthendividedbythescoresbeforetreatment.Thehighertherelativescores,themoresignificantthechangesofthedisabilities.Ifthescoresweremorethanzero,itindicatedthepatient’sconditionhadimproved.Ontheotherhand,ifthescoresbecamelessthanzero,itsuggestedthatthepatientgotworse.Theabsolutescoresof20MGpatientsobservedby5neurologistsweretestedwithKappavaluestoevaluatethedegreeofagreementamongdifferentobservers(i.e.reliability);andtherelativescoresof12MGpatientsbeforevsaftertreatmentweretestedwithStudent’st2test,toexaminetheirabilitiesofdetectingthechangesintheMGpatientswithdisabilities(i.e.sensitivity).ResultItprovedtobereliableforinterobserveragreement(K=0.51～0.97)andsen2sitive(P<0.001)todetectclinicallyrelevantchanges.ConclusionTheclinicalscoresystemap2pearedtoofferanaccuratequantitativemeansofevaluatingthedisabilitiesinMGpatients.ItwouldbeusefulinmonitoringtheeffectsoftherapyinMGcases.KeywordsMyastheniagravisSeverityofmuscleweaknessScoringsystemAbso2lutescoreRelativescore早在1958年Osserman提出重症肌无力的临床分类方法,以后又经过几次改良[1～3]一直在广为应用。Osserman分型法能反映MG本文部分受卫生部基金资助(No94212091)作者单位:100730卫生部北京医院神经科病人受累肌群的部位、对病人生命的威胁和对工作及日常生活影响的严重程度及病程。Os2serman分型实际上反映了受累肌群的选择性,而并没能完全反映出受累肌群肌肉无力和易疲劳性的严重程度。它与乙酰胆碱受体抗体·78·中华神经科杂志1997年4月第30卷第2期©1995-2004TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.(AChR2ab)滴度及低频重复电刺激的波幅递减程度相关均不密切。因此,不能把它用作临床观察和疗效评定的良好依据和标准[4]。我们曾提出一种临床绝对和相对评分法[4],经一时期的临床应用,发现有些问题,故作了一些修改,并对其进行了可靠性及敏感性检验。资料与方法一、资料选择各型根据典型病史、临床检查、新斯的明试验、实验室检查及EMG检查确诊的MG病人20例,由5名医师同时对1例病人进行检查,分别记录检查结果并评分,此评分结果用做对不同的评分者之间的一致性检验。取MG病人12例,其中6例在新斯的明注射前及注射后20～30分钟分别评分,另外6例病人在入院时及治疗好转出院时分别计分,以此评分结果用做对本评分方...
