弥散张量成像各向异性分数与缺血性脑卒中患者上肢运动功能的相关性

doi:10.3969/j.issn.1006-9771.2020.07.002

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 749-752.doi: 10.3969/j.issn.1006-9771.2020.07.002

弥散张量成像各向异性分数与缺血性脑卒中患者上肢运动功能的相关性

刘建华^1,²,魏清川³,胡秀茹⁴,叶赛青³,闫志宇^1,²,高强³()

1.中国康复研究中心北京博爱医院运动疗法科,北京市 100068
2.首都医科大学康复医学院,北京市 100068
3.四川大学华西医院康复中心,四川成都市 610041
4.日本国际医疗福祉大学理学疗法学科,日本大田原市

收稿日期:2020-04-13 修回日期:2020-05-19 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 高强 E-mail:gaoqiang_hxkf@163.com
作者简介:刘建华(1966-),男,汉族,北京市人,硕士,副主任技师,主要研究方向：神经康复和运动疗法。
基金资助:
四川省科技厅重点研发项目(2018FZ0103)

Relationship between Fractional Anisotropy of Diffusion Tensor Imaging and Motor Function after Ischemic Stroke

LIU Jian-hua^1,²,WEI Qing-chuan³,HU Xiu-ru⁴,YE Sai-qing³,YAN Zhi-yu^1,²,GAO Qiang³()

1. Department of Physical Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
3. Rehabilitation Medicine Center of West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
4. Science and Therapeutics, Japan International Medical Welfare University, Otawara, Japan

Received:2020-04-13 Revised:2020-05-19 Published:2020-07-25 Online:2020-07-24
Contact: GAO Qiang E-mail:gaoqiang_hxkf@163.com
Supported by:
Sichuan Science and Technology Department Key Research and Development Project(2018FZ0103)

摘要/Abstract

摘要：

目的探讨不同区域弥散张量成像(DTI)参数与缺血性脑卒中患者上肢运动功能恢复的关系。方法 2019年1月至12月,缺血性脑卒中患者20例接受常规药物和康复治疗3周,治疗前后,DTI测量梗死灶及对侧相应部位,患侧和健侧大脑脚、内囊后肢各向异性分数(FA),计算双侧FA比(rFA)。同时采用Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。结果治疗后,患者FMA-UE评分显著增加(t = 9.074, P < 0.001)。梗死灶FA与rFA显著升高( t > 14.519, P< 0.001)。治疗前后各部位患侧FA和rFA差值均与FMA-UE评分差值正相关(r = 0.445~0.565, P< 0.05),以患侧内囊后肢相关性最强。结论缺血性脑卒中,脑内FA的改变与上肢运动功能恢复相关,尤其是内囊后肢。

关键词: 缺血性脑卒中, 运动功能, 上肢, 弥散张量成像, 康复

Abstract:

Objective To explore the relationship between diffusion tensor imaging (DTI) parameter of fractional anisotropy (FA) and recovery of upper-extremity motor function in patients with ischemic stroke. Methods From January to December, 2019, 20 ischemic stroke patients accepted routine medication and rehabilitation for three weeks. They received DTI examination and were measured FA of the infarct and the corresponding area on the contralateral side, the cerebral foot and the posterior limb of internal capsule of affected and unaffected sides, while the bilateral FA ratio (rFA) of them were calculated, before and after treatment. Meanwhile, all the patients were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Results The FMA-UE score improved after treatment (t = 9.074, P < 0.001), while FA and rFA increased in infarct area ( t > 14.519, P< 0.001). The difference before and after treatment of FA and rFA in all of the areas positively correlated with that of FMA-UE scores (r = 0.445~0.565, P< 0.05), which was the most in posterior limb of internal capsule of the affected side.Conclusion FA of DTI alters with the recovery of motor function of the upper extremity after ischemic stroke, especially in the posterior limb of internal capsule.

Key words: ischemic stroke, motor function, upper limb, diffusion tensor imaging, rehabilitation

中图分类号:

R743.3

刘建华,魏清川,胡秀茹,叶赛青,闫志宇,高强. 弥散张量成像各向异性分数与缺血性脑卒中患者上肢运动功能的相关性[J]. 《中国康复理论与实践》, 2020, 26(7): 749-752.

LIU Jian-hua,WEI Qing-chuan,HU Xiu-ru,YE Sai-qing,YAN Zhi-yu,GAO Qiang. Relationship between Fractional Anisotropy of Diffusion Tensor Imaging and Motor Function after Ischemic Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 749-752.

图/表 2

参考文献 22

[1]	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204): 1145-1158. doi: 10.1016/S0140-6736(19)30427-1
[2]	Hankey G J. Stroke[J]. Lancet, 2017, 389(10069): 641-654. doi: 10.1016/S0140-6736(16)30962-X
[3]	Powers W J, Rabinstein A A, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49(3): e46-e110.
[4]	Lindenberg R, Renga V, Zhu L L, et al. Structural integrity of corticospinal motor fibers predicts motor impairment in chronic stroke[J]. Neurology, 2010, 74(4): 280-287. doi: 10.1212/WNL.0b013e3181ccc6d9 pmid: 20101033
[5]	Lope-Piedrafita S. Diffusion tensor imaging (DTI)[J]. Methods Mol Biol, 2018, 1718:103-116. doi: 10.1007/978-1-4939-7531-0_7 pmid: 29341005
[6]	Welniarz Q, Dusart I, Roze E. The corticospinal tract: evolution, development, and human disorders[J]. Dev Neurobiol, 2017, 77(7): 810-829. doi: 10.1002/dneu.22455 pmid: 27706924
[7]	Jang S H. The corticospinal tract from the viewpoint of brain rehabilitation[J]. J Rehabil Med, 2014, 46(3): 193-199. doi: 10.2340/16501977-1782
[8]	陈丹凤, 燕铁斌, 黎冠东, 等. 磁共振弥散张量成像参数与脑卒中早期患者下肢运动功能恢复的相关性研究[J]. 中国康复医学杂志, 2018, 33(7): 812-816.
	Chen D F, Yan T B, Li G D, et al. Predictive study of magnetic resonance diffusion tensor imaging in the rehabilitation of lower limb in patients with early stage stroke[J]. Chin J Rehabil Med, 2018, 33(7): 812-816
[9]	黄东锋, 李乐, 毛玉瑢, 等. 脑卒中后神经网络损害与下肢步行功能结局的关系[J]. 中国康复医学杂志, 2012, 27(9): 787-791.
	Huang D F, Li L, Mao Y R, et al. The relationship between neural network damage and the gait function in lower limbs in patients post-stroke[J]. Chin J Rehabil Med, 2012, 27(9): 787-791.
[10]	赖喜新, 倪莹莹, 赵春梅, 等. 脑卒中患者磁共振弥散张量成像检查皮质脊髓束与下肢肌力恢复的关系[J]. 中华老年心脑血管病杂志, 2014, 16(4): 395-397.
	Lai X X, Ni Y Y, Zhao C M, et al. Role of DTI in demonstrating the relation between lateral CST repair and lower limb muscle strength recovery in IS patients[J]. Chin J Geriatr Heart Brain Vessel Dis, 2014, 16(4): 395-397.
[11]	Le Bihan D, Mangin J, Poupon C, et al. Diffusion tensor imaging: concepts and applications[J]. J Magn Reson Imaging, 2001, 13(4): 534-546. pmid: 11276097
[12]	Park C H, Kou N, Boudrias M H, et al. Assessing a standardised approach to measuring corticospinal integrity after stroke with DTI[J]. Neuroimage Clin, 2013, 2(5): 21-33.
[13]	Koyama T, Marumoto K, Miyake H, et al. Relationship between diffusion tensor fractional anisotropy and motor outcome in patients with hemiparesis after corona radiata infarct[J]. J Stroke Cerebrovasc Dis, 2013, 22(8): 1355-1360. doi: 10.1016/j.jstrokecerebrovasdis.2013.02.017
[14]	谢运娟, 廖伶艺, 高强. 弥散张量成像在脑卒中患者运动功能预后评估中的研究进展[J]. 中国康复理论与实践, 2019, 25(5): 546-549.
	Xie Y J, Liao L Y, Gao Q. Advance in diffusion tensor imaging for predicting motor function outcome after stroke[J]. Chin J Rehabil Theory Pract, 2019, 25(5): 546-549.
[15]	王旭, 刘斌, 杨明, 等. 扩散张量成像与急性脑干缺血性卒中患者运动功能预后的相关性[J]. 中国医学影像学杂志, 2014, 23(4): 255-259.
	Wang X, Liu B, Yang M, et al. Diffusion tensor imaging in predicting the motor function of patients with acute ischaemic stroke in the brainstem[J]. Chin J Med Imag, 2014, 23(4): 255-259.
[16]	Wang R R, Li C, Zhang S, et al. Diffusion tensor imaging change in crus cerebri in striatocapsular infarction and correlation with upper extremity motor dysfunction[J]. Radiol Med, 2015, 120(11): 1064-1070. doi: 10.1007/s11547-015-0534-0
[17]	Kwak S Y, Yeo S S, Choi B Y, et al. Corticospinal tract change in the unaffected hemisphere at the early stage of intracerebral hemorrhage: a diffusion tensor tractography study[J]. Eur Neurol, 2010, 63(3): 149-153. doi: 10.1159/000281108
[18]	Fan Y T, Lin K C, Liu H L, et al. Changes in structural integrity are correlated with motor and functional recovery after post-stroke rehabilitation[J]. Restor Neurol Neurosci, 2015, 33(6): 835-844.
[19]	Puig J, Blasco G, Schlaug G, et al. Diffusion tensor imaging as a prognostic biomarker for motor recovery and rehabilitation after stroke[J]. Neuroradiology, 2017, 59(4): 343-351. doi: 10.1007/s00234-017-1816-0
[20]	Thomalla G, Glauche V, Koch M A, et al. Diffusion tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke[J]. Neuroimage, 2004, 22(4): 1767-1774. pmid: 15275932
[21]	Puig J, Pedraza S, Blasco G, et al. Wallerian degeneration in the corticospinal tract evaluated by diffusion tensor imaging correlates with motor deficit 30 days after middle cerebral artery ischemic stroke[J]. Am J Neuroradiol, 2010, 31(7): 1324-1330. doi: 10.3174/ajnr.A2038
[22]	凌晴, 林丽萍, 胡世红, 等. 脑卒中后上肢运动功能恢复大脑可塑性的磁共振弥散张量成像研究[J]. 中国康复理论与实践, 2015, 21(9): 1058-1063.
	Ling Q, Lin L P, Hu S H, et al. Brain plasticity of upper extremity motor function recovery after stroke: a diffusion tensor imaging study[J]. Chin J Rehabil Theory Pract, 2015, 21(9): 1058-1063.

项目		治疗前	治疗后	t值	P值
FMA-UE		28.25±7.15	34.75±7.21	9.074	< 0.001
患侧FA	梗死灶	0.546±0.071	0.612±0.072	14.519	< 0.001
	内囊后肢	0.578±0.154	0.594±0.161	2.087	0.051
	大脑脚	0.646±0.139	0.661±0.153	1.976	0.063
rFA	梗死灶	0.616±0.084	0.691±0.084	14.858	< 0.001
	内囊后肢	0.652±0.171	0.670±0.178	2.058	0.054
	大脑脚	0.730±0.160	0.748±0.176	2.028	0.057

项目		差值	r值	P值
FMA-UE		6.500±3.204
患侧FA	梗死灶	0.067±0.021	0.492	0.028
	内囊后肢	0.016±0.035	0.564	0.001
	大脑脚	0.015±0.035	0.445	0.049
rFA	梗死灶	0.075±0.023	0.448	0.047
	内囊后肢	0.019±0.040	0.565	< 0.001
	大脑脚	0.018±0.039	0.503	0.024

弥散张量成像各向异性分数与缺血性脑卒中患者上肢运动功能的相关性

Relationship between Fractional Anisotropy of Diffusion Tensor Imaging and Motor Function after Ischemic Stroke

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