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目的研究局部注射美国产与国产Ａ型肉毒毒素（Ｂｏｔｏｘ与ＣＢＴＸ－Ａ）对远隔部位神经肌肉接头的影响。方法在７００余例自愿接受Ｂｏｔｏｘ或ＣＢＴＸ－Ａ注射治疗的患者中，选择条件匹配、积极配合且随访便利的４０例患者，分别在局部注射Ａ型内毒毒素（ＢＴＸ－Ａ）前及注射后２～３周、５～８周和４～５月（第２次注射前），在伸指总肌或胜前肌进行单纤维肌电图（ＳＦＥＭＧ）检测，共检测１１９次。结果上下肢肌肉的ｊｉｔｔｅｒ 增加均在注射后２～３周最为明显，５～８周有所改善，４～５月时趋于正常；注射后２～３周的平均连续波间差（ＭＣＤ）改变与剂量呈正相关；纤维密度（ＦＤ）的变化则较为延迟或同时出现，４～５月时尚未恢复。Ｂｏｔｏｘ组与ＣＢＴＸ－Ａ组的ＳＦＥＭＧ变化差异无显著性意义。结论局部注射治疗剂量的ＢＴＸ－Ａ对远隔部位神经肌肉接头的功能确有临床下影响，毒素通过血液循环全身性分布的机制可能起主要作用；注射剂量直接影响远隔效应的轻重；注射后４～５月ｊｉｔｔｅｒ才趋于恢复，可作为重复治疗间期的参考，以避免出现严重并发症。
Objective To study the effect of botulinum toxin type A (Botox and CBTX-A) injected locally on the neuromuscular junction in the distal part. Methods Forty patients who were treated with Botox or CBTX-A injections were selected before and after injection of BTX-A 2 to 3 weeks, 5 to 8 weeks, and 4 to 5 months (before the second injection), single-fiber electromyography (SFEMG) was performed in extensor or pre-muscle of extensor nerve, and 119 tests were performed. Results The increase of jitter in both upper and lower limb muscles was the most obvious at 2 to 3 weeks after injection, with an improvement from 5 to 8 weeks and normal from April to May. The mean continuous wave difference (MCD) between 2 and 3 weeks after injection was significant Changes were positively correlated with the dose; changes in fiber density (FD) were more delayed or at the same time, 4 to 5 months has not yet recovered. There was no significant difference in SFEMG between Botox group and CBTX-A group. CONCLUSION: Local injection of BTX-A at a dose of 10 mg / kg may have a clinically significant effect on the function of distal neuromuscular junctions. It may play a major role in the mechanism of systemic distribution of toxins through blood circulation. The injection dose directly affects the severity of distant effects. After injection 4 to May jitter only tend to recover, can be used as a reference for repeated treatment interval, in order to avoid serious complications.