亚急性期脑卒中康复过程中半球间皮质结构可塑性差异

doi:10.3969/j.issn.1006-9771.2021.04.008

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (4): 436-444.doi: 10.3969/j.issn.1006-9771.2021.04.008

亚急性期脑卒中康复过程中半球间皮质结构可塑性差异

张豪杰^1,^2,³,王云雷^1,^2,³,樊令仲^4,⁵,李芳^1,^2,³,刘静娅^1,³,于少泓^6,⁷,侯园园^1,^2,³,白晨^1,^2,³,李冰洁^1,³,杜晓霞^1,³,张通^1,^2,³()

^1.首都医科大学康复医学院，北京市 100068
^2.中国康复科学所，北京市 100068
^3.中国康复研究中心北京博爱医院，北京市 100068
^4.中国科学院自动化研究所模式识别国家重点实验室和脑网络组研究中心，北京市 100190
^5.中国科学院大学，北京市 100190
^6.山东中医药大学第二附属医院，山东济南市 250001
^7.山东中医药大学第二临床医学院，山东济南市 250001

收稿日期:2021-01-15 修回日期:2021-03-10 出版日期:2021-04-25 发布日期:2021-04-20
通讯作者: 张通 E-mail:tom611@126.com
作者简介:张豪杰(1983-)，男，汉族，河南平顶山市人，博士研究生，主要研究方向：神经康复|张通(1961-)，男，汉族，北京市人，主任医师、教授，博士生导师，主要研究方向：神经康复，神经病学。
基金资助:
中央级公益性科研院所基本科研业务费专项资金项目(2018CZ-2);2.中国康复研究中心项目(2018ZX-10)

Differences of Structural Plasticity between Hemispheres during Rehabilitation for Subacute Stroke

Hao-jie ZHANG^1,^2,³,Yun-lei WANG^1,^2,³,Ling-zhong FAN^4,⁵,Fang LI^1,^2,³,Jing-ya LIU^1,³,Shao-hong YU^6,⁷,Yuan-yuan HOU^1,^2,³,Chen BAI^1,^2,³,Bing-jie LI^1,³,Xiao-xia DU^1,³,Tong ZHANG^1,^2,³()

^1.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
^2.China Rehabilitation Science Institute, Beijing 100068, China
^3.Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
^4.Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
^5.University of Chinese Academy of Sciences, Beijing 100190, China
^6.Second Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250001, China
^7.the Second Clinical Medical College, Shandong University of Traditional Chinese medicine, Ji'nan, Shandong 250001, China

Received:2021-01-15 Revised:2021-03-10 Published:2021-04-25 Online:2021-04-20
Contact: Tong ZHANG E-mail:tom611@126.com
Supported by:
Fundamental Research Funds for Central Public Welfare Research Institutes(2018CZ-2);Key Project Fund of China Rehabilitation Research Center(2018ZX-10)

摘要/Abstract

摘要： 目的

探讨脑卒中患者亚急性期康复过程中不同半球间皮质结构可塑性机制差异。

方法

2018年11月20日至2020年2月1日，选取本院首次发病的皮质下缺血性脑卒中患者22例，分别在康复前、康复1个月、康复2个月行磁共振扫描和运动功能评估。测量皮质表面积、皮质厚度和皮质体积。采用两因素重复测量方差分析观察皮质结构的动态变化和半球间差异。

结果

对于双侧半球，时间主效应显著，主要集中在康复前和康复1个月之间。大部分脑区的皮质表面积、厚度和体积主要呈减少趋势，海马旁回的皮质厚度和体积呈升高趋势。半球间主效应显著的脑区为中央后回表面积和体积(F > 4.305, P < 0.05)，表现为病灶同侧小于病灶对侧。病灶侧中央后回厚度(r = -0.474, P = 0.026)和体积(r = -0.432, P = 0.044)的减少与运动功能恢复率呈负相关。

结论

病灶同侧半球与对侧半球在康复过程中存在皮质结构可塑性差异，皮质结构在脑卒中后的前2个月变化最明显，病灶侧中央后回厚度和体积减小越明显，运动功能恢复可能越差。

关键词: 脑卒中, 康复, 脑可塑性, 皮质厚度, 皮质体积

Abstract: Objective

To explore the differences in plasticity mechanism of cortical structure between hemispheres during rehabilitation for stroke patients at subacute stage.

Methods

From October 20, 2018 to February 1, 2020, 22 patients with first-onset subcortical ischemic stroke completed the assessments of MRI and clinical evaluation at admission, and after one and two months of rehabilitation. Cortical surface area, thickness, and volume were measured to evaluate cortical structure plasticity. Two-way repeated measures analyses of variance were implemented to estimate dynamic cortical morphology changes and differences between hemispheres.

Results

A significant time effect occurred between admission and after one month of rehabilitation for both hemispheres. Cortical surface area, thickness and volume for most regions in both hemispheres gradually decreased, while parahippocampal gyrus thickness and volume increased. The surface area and volume of postcentral gyrus was significant between both hemispheres (F > 4.305, P < 0.05), in which ipsilesional hemisphere was lower than contralesional hemisphere. The reduction of the thickness (r = -0.474, P = 0.026) and volume (r = -0.432, P = 0.044) of postcentral gyrus in ipsilesional hemisphere was negatively correlated with the recovery rate of motor function.

Conclusion

There are differences in cortical structure plasticity during stroke rehabilitation between hemispheres. Cortical morphology markedly changes in the first two months poststroke. The greater the reduction in thickness and volume of postcentral gyrus in ipsilesional hemisphere is, the worse the recovery of motor function may be.

Key words: stroke, rehabilitation, brain plasticity, cortical thickness, cortical volume

中图分类号:

R743.3

张豪杰,王云雷,樊令仲,李芳,刘静娅,于少泓,侯园园,白晨,李冰洁,杜晓霞,张通. 亚急性期脑卒中康复过程中半球间皮质结构可塑性差异[J]. 《中国康复理论与实践》, 2021, 27(4): 436-444.

Hao-jie ZHANG,Yun-lei WANG,Ling-zhong FAN,Fang LI,Jing-ya LIU,Shao-hong YU,Yuan-yuan HOU,Chen BAI,Bing-jie LI,Xiao-xia DU,Tong ZHANG. Differences of Structural Plasticity between Hemispheres during Rehabilitation for Subacute Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(4): 436-444.

图/表 4

表1

病灶同侧与病灶对侧半球两因素重复测量方差分析结果"

脑区	时间		时间×组间		组间		T1 vs. T2 (P值)	T1 vs. T3 (P值)	T2 vs. T3 (P值)
脑区	F值	P值	F值	P值	F值	P值	T1 vs. T2 (P值)	T1 vs. T3 (P值)	T2 vs. T3 (P值)
皮质表面积
dmPOS	4.124	0.023	0.977	0.385	0.089	0.767	0.650	1	0.026
A3ulhf	2.382	0.105	0.347	0.709	5.397	0.025	0.391	1	0.462
OPC	6.717	0.003	1.524	0.230	0.336	0.565	1	0.029^a	0.003^a
皮质厚度
A10l	4.330	0.020	0.058	0.944	0.311	0.580	0.357	0.024	0.094
A44d	13.968	< 0.001	0.502	0.607	0.616	0.437	0.002	< 0.001	0.640
A45c	10.217	< 0.001	1.617	0.205	0.464	0.499	0.026	< 0.001	0.373
A6cvl	14.513	< 0.001	0.377	0.687	1.135	0.293	< 0.001	< 0.001	1
TE1.2	13.671	< 0.001	0.015	0.985	0.851	0.361	< 0.001	< 0.001	1
A22r	4.373	0.016	0.155	0.857	0.007	0.934	0.014	0.419	0.477
A36r	3.607	0.031	0.609	0.546	0.236	0.629	0.016^a	0.369	1
A34	6.459	0.002	0.255	0.775	0.072	0.790	0.052	0.006	0.772
A7c	14.891	< 0.001	0.035	0.966	3.806	0.058	< 0.001	< 0.001	1
A39c	10.531	< 0.001	0.076	0.927	< 0.001	0.983	0.004	< 0.001	1
A39rd	13.161	< 0.001	1.498	0.229	1.789	0.188	0.005	< 0.001	0.809
A40c	10.628	< 0.001	0.823	0.443	2.431	0.126	0.001	0.001	1
A5m	29.349	< 0.001	2.975	0.056	1.801	0.187	< 0.001	< 0.001	0.023
dmPOS	12.465	< 0.001	1.387	0.256	0.087	0.769	0.142	< 0.001	0.028
A3ulhf	7.935	0.001	1.604	0.214	0.097	0.757	0.002	0.001	1
A3tonIa	14.043	< 0.001	1.323	0.272	0.310	0.581	< 0.001	< 0.001	1
A3tru	7.408	0.002	0.726	0.490	0.363	0.550	0.002	0.004	0.923
A32p	6.226	0.003	0.309	0.735	0.086	0.770	0.003	0.057	0.821
OPC	8.132	0.001	0.629	0.536	0.002	0.968	0.139	0.001	0.144
皮质体积
A9m	6.350	0.003	1.723	0.185	0.010	0.921	0.005	0.042	1
A10l	11.527	< 0.001	0.685	0.507	1.963	0.169	0.028	< 0.001	0.172
A44d	16.627	< 0.001	0.064	0.938	0.630	0.432	0.001	< 0.001	0.524
A45c	5.618	0.007	2.313	0.112	< 0.001	0.997	0.157	0.005	0.693
A6cvl	7.769	0.001	0.677	0.511	2.869	0.098	0.040	0.001	0.783
TE1.2	16.223	< 0.001	0.729	0.485	0.059	0.810	< 0.001	< 0.001	1
A22r	3.638	0.031	0.902	0.410	0.115	0.736	0.044	0.119	1
A36r	5.805	0.004	0.177	0.838	0.001	0.980	0.007^a	0.947	0.06
A34	7.155	0.001	2.087	0.130	0.110	0.742	0.290	0.001	0.148
A7c	7.16	0.001	0.578	0.563	0.108	0.744	0.001	0.054	0.963
A39c	10.815	< 0.001	1.644	0.199	0.012	0.914	0.004	0.001	0.923
A39rd	8.368	0.001	0.201	0.819	0.807	0.374	0.072	0.001	0.910
A40c	7.080	0.001	0.588	0.557	0.066	0.798	0.041	0.003	1
A5m	20.528	< 0.001	0.835	0.437	0.547	0.503	0.001	< 0.001	0.115
dmPOS	8.295	0.001	0.030	0.971	0.011	0.915	0.131	< 0.001	0.257
A3ulhf	9.662	< 0.001	1.151	0.321	3.176	0.082	0.013	0.001	1
A3tonIa	13.709	< 0.001	0.280	0.757	4.305	0.044	0.003	< 0.001	0.886
A3tru	7.014	0.002	0.449	0.641	0.727	0.399	0.002	0.003	0.522
A32p	8.083	0.001	0.292	0.749	0.138	0.712	0.001	0.466	0.390
OPC	3.674	0.030	0.126	0.882	0.009	0.924	0.205	0.026	1

表1

图1

表2

图2

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脑区	脑叶	脑回	lh.MNI (X,Y,Z)	rh.MNI (X, Y, Z)
A9m	额叶	额上回	-5, 36, 38	6, 38, 35
A10l		额中回	-26, 60, -6	25, 61, -4
A44d		额下回	-46, 13, 24	45, 16, 25
A45c		额下回	-53, 23, 11	54, 24, 12
A6cvl		中央前回	-49, 5, 30	51, 7, 30
TE1.2	颞叶	颞上回	-50, -11, 1	51, -4, -1
A22r		颞上回	-55, -3, -10	56, -12, -5
A36r		海马旁回	-27, -7, -34	28, -8, -33
A34		海马旁回	-19, -12, -30	19, -10, -30
A7c	顶叶	顶上小叶	-15, -71, 52	19, -69, 54
A39c		顶下小叶	-34, -80, 29	45, -71,20
A39rd		顶下小叶	-38, -61, 46	39, -65, 44
A40c		顶下小叶	-56, -49, 38	57, -44, 38
A5m		楔前叶	-8, -47, 57	7, -47, 58
dmPOS		楔前叶	-12, -67, 25	16, -64,25
A3ulhf		中央后回	-50, -16, 43	50, -14,44
A3tonIa		中央后回	-56, -14, 16	56, -10,15
A3tru		中央后回	-21, -35, 68	20, -33, 69
A32p	边缘叶	扣带回	-6, 34, 21	5, 28, 27
OPC	枕叶	枕叶外皮质	-18, -99, 2	22, -97,4

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亚急性期脑卒中康复过程中半球间皮质结构可塑性差异

Differences of Structural Plasticity between Hemispheres during Rehabilitation for Subacute Stroke

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