不同病程脑卒中患者上肢体感诱发电位与感觉、运动功能的相关性

doi:10.3969/j.issn.1006-9771.2024.06.010

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (6): 701-708.doi: 10.3969/j.issn.1006-9771.2024.06.010

不同病程脑卒中患者上肢体感诱发电位与感觉、运动功能的相关性

杨世宁¹^,², 马将¹(), 李红¹^,², 郭立颖³, 刘先莹⁴, 张莉芳¹

1.石家庄市人民医院康复医学科，河北石家庄市 050030
2.河北师范大学体育学院，河北石家庄市 050024
3.华北理工大学护理与康复学院，河北唐山市 063210
4.河北医科大学研究生学院，河北石家庄市 050011

收稿日期:2023-11-14 修回日期:2024-04-23 出版日期:2024-06-25 发布日期:2024-07-03
通讯作者: 马将，男，博士，主任医师，主要研究方向：神经康复，肌骨康复，E-mail： majiangtutor@sina.com。
作者简介:杨世宁(1998-)，女，汉族，河北定州市人，硕士，初级治疗师，主要研究方向：神经康复，运动康复。
基金资助:
河北省中医药管理局科研计划项目(2024130)

Correlation of upper extremity somatosensory evoked potentials with sensory and motor functions in stroke patients in different stages

YANG Shining¹^,², MA Jiang¹(), LI Hong¹^,², GUO Liying³, LIU Xianying⁴, ZHANG Lifang¹

1. Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, Hebei 050030, China
2. College of Physical Education, Hebei Normal University, Shijiazhuang, Hebei 050024, China
3. School of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, Hebei 063210, China
4. Graduate School of Hebei Medical University, Shijiazhuang, Hebei 050011, China

Received:2023-11-14 Revised:2024-04-23 Published:2024-06-25 Online:2024-07-03
Supported by:
Hebei Provincial Administration of Traditional Chinese Medicine Scientific Research Program(2024130)

摘要/Abstract

摘要：

目的探讨不同病程脑卒中患者上肢体感诱发电位(SEP)与感觉、运动功能的相关性。

方法 2021年6月到2023年10月，连续纳入石家庄市人民医院脑卒中患者177例，根据病程分为急性期组(14 d之内，n = 25)、恢复早期组(14 d~1个月，n = 110)和恢复中晚期组(1~6个月，n = 42)。记录患者的一般资料；行SEP检查，记录N20潜伏期和振幅；采用单丝和两点辨别工具分别测试患者手的单丝触觉和两点辨别觉；Fugl-Meyer评定量表上肢部分(FMA-UE)评估运动功能。分析各组SEP与感觉和运动各项指标评分的相关性。

结果 3组单丝触觉和两点辨别觉评分无显著性差异(P > 0.05)。相关性分析结果显示，急性期组SEP与感觉和运动功能不相关(P > 0.05)。恢复早期组N20潜伏期与单丝触觉呈负相关(r = -0.267, P = 0.005)，与两点辨别觉呈正相关(r = 0.220, P = 0.021)；N20振幅与单丝触觉(r = 0.328, P < 0.001)和FMA-UE评分呈正相关(r = 0.418, P < 0.001)，与两点辨别觉呈负相关(r = -0.405, P < 0.001)。恢复中晚期组N20潜伏期与FMA-UE呈负相关(r = -0.313, P = 0.044)，N20振幅与单丝触觉(r = 0.598, P < 0.001)和FMA-UE评分 (r = 0.393, P = 0.010) 呈正相关，与两点辨别觉呈负相关(r = -0.591, P < 0.001)。多元线性回归分析显示，恢复中晚期患者单丝触觉的评分与N20潜伏期水平呈负相关(β = -0.510，P = 0.046)，FMA-UE评分与N20振幅水平呈正相关(β = 0.313, P = 0.026)；恢复早期患者两点辨别觉评分与N20振幅水平呈负相关(β = -0.270, P = 0.039)。

结论病程越长，SEP与感觉和运动功能的相关性越显著。

关键词: 脑卒中, 感觉功能, 运动功能, 体感诱发电位, 神经电生理

Abstract:

Objective To investigate the correlation between somatosensory evoked potentials (SEP) of upper limbs, and sensory and motor functions in stroke patients in different stages.

Methods From June, 2021 to October, 2023, 177 stroke patients in Shijiazhuang People's Hospital were diveded into acute stage group (within 14 days, n = 25), early recovery group (14 days to one month, n = 110) and middle to late recovery group (one to six months, n = 42) according to the duration of the disease. General information of the patients was recorded; SEP examination was performed, and N20 lantency and amplitude were recorded. Monofilament touch and two-point discrimination sensation of the patient's hands were tested using the monofilament and two-point discrimination tools, respectively; and motor function was assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE). The correlation between SEP, and the sensory and motor scores in each group was analyzed.

Results There was no significant difference in the monofilament tactile and two-point discrimination scores among the three groups (P > 0.05). SEP was not correlated with sensory and motor functions in the acute stage group (P > 0.05); in the early recovery group, N20 latency was negatively correlated with monofilament tactile sensation (r = -0.267, P = 0.005) and positively correlated with two-point discrimination sensation (r = 0.220, P = 0.021), and N20 amplitude was positively correlated with monofilament tactile sensation (r = 0.328, P < 0.001) and FMA-UE score (r = 0.418, P < 0.001), and negatively correlated with two-point discrimination (r = -0.405, P < 0.001); in the middle to late recovery group, the N20 latency was negatively correlated with FMA-UE score (r = -0.313, P = 0.044), and N20 amplitude was positively correlated with monofilament tactile sensation (r = 0.598, P < 0.001) and FMA-UE score (r = 0.393, P = 0.010), and negatively correlated with two-point discrimination (r = -0.591, P < 0.001). Multiple linear regression analyses showed that the score of monofilament tactile sensation was negatively correlated with N20 latency (β = -0.510, P = 0.046), and the FMA-UE score was positively correlated with N20 amplitude (β = 0.313, P = 0.026) in the middle to late recovery group; in the early recovery group, the two-point discriminative sensation score was negatively correlated with N20 amplitude (β = -0.270, P = 0.039).

Conclusion The correlation between SEP and sensory and motor functions becomes more significant with the prolongation of disease.

Key words: stroke, sensory function, motor function, somatosensory evoked potentials, neurophysiology

中图分类号:

R743.3

杨世宁, 马将, 李红, 郭立颖, 刘先莹, 张莉芳. 不同病程脑卒中患者上肢体感诱发电位与感觉、运动功能的相关性[J]. 《中国康复理论与实践》, 2024, 30(6): 701-708.

YANG Shining, MA Jiang, LI Hong, GUO Liying, LIU Xianying, ZHANG Lifang. Correlation of upper extremity somatosensory evoked potentials with sensory and motor functions in stroke patients in different stages[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 701-708.

图/表 6

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组别	n	年龄/岁	病程/d	Brunnstrom手分期	Brunnstrom上肢分期
急性期组	25	56.68±13.86	12.00(9.50, 13.00)	1.00(1.00, 2.00)	1.00(1.00, 2.50)
恢复早期组	110	54.96±11.20	20.00(16.00, 25.00)	2.00(1.00, 4.00)	3.00(1.00, 4.00)
恢复中晚期组	42	53.98±12.49	60.50(48.75, 109.50)	3.00(1.00, 4.00)	3.00(2.00, 4.00)
F/H值		0.404^a	131.252^b	8.176^b	14.024^b
P值		0.668	< 0.001	0.017	0.001

组别	n	单丝触觉	两点辨别觉	FMA-UE
急性期组	25	5.00(1.50, 5.00)	8.00(6.00, 16.00)	6.00(4.50, 23.00)
恢复早期组	110	4.00(1.00, 5.00)	8.00(5.00, 16.00)	19.50(7.00, 40.50)
恢复中晚期组	42	4.00(0.00, 5.00)	8.50(5.00, 16.00)	17.00(8.00, 43.25)
H值		1.903	0.600	10.296
P值		0.386	0.741	0.006

组别	指标	B	SE	β	t值	P值	容差	方差膨胀因子
急性期组	常量	20.082	1.702	-	11.797	< 0.001	-	-
	单丝触觉	-0.023	0.222	-0.029	-0.102	0.920	0.547	1.829
	两点辨别觉	0.079	0.089	0.250	0.889	0.384	0.556	1.800
	FMA-UE评分	-0.010	0.023	-0.090	-0.425	0.675	0.966	1.035
恢复早期组	常量	21.482	1.094	-	19.633	< 0.001	-	-
	单丝触觉	-0.187	0.146	-0.170	-1.283	0.202	0.492	2.032
	两点辨别觉	0.024	0.066	0.049	0.365	0.716	0.473	2.114
	FMA-UE评分	-0.017	0.013	-0.140	-1.323	0.189	0.770	1.299
恢复中晚期组	常量	23.892	1.607	-	14.863	< 0.001	-	-
	单丝触觉	-0.452	0.219	-0.510	-2.065	0.046	0.362	2.761
	两点辨别觉	-0.146	0.094	-0.385	-1.563	0.126	0.363	2.758
	FMA-UE评分	-0.021	0.015	-0.217	-1.364	0.180	0.869	1.151

组别	指标	B	SE	β	t值	P值	容差	方差膨胀因子
急性期组	常量	-0.672	2.102		-0.320	0.752
	单丝触觉	0.440	0.275	0.446	1.603	0.124	0.547	1.829
	两点辨别觉	0.109	0.110	0.274	0.995	0.331	0.556	1.800
	FMA-UE评分	0.017	0.028	0.126	0.601	0.555	0.966	1.035
恢复早期组	常量	3.903	1.335	-	2.924	0.004	-	-
	单丝触觉	0.084	0.178	0.060	0.475	0.636	0.492	2.032
	两点辨别觉	-0.168	0.080	-0.270	-2.095	0.039	0.473	2.114
	FMA-UE评分	0.023	0.016	0.152	1.500	0.137	0.770	1.299
恢复中晚期组	常量	2.066	1.347	-	1.534	0.133	-	-
	单丝触觉	0.167	0.183	0.190	0.909	0.369	0.362	2.761
	两点辨别觉	-0.106	0.078	-0.282	-1.353	0.184	0.363	2.758
	FMA-UE评分	0.030	0.013	0.313	2.321	0.026	0.869	1.151

不同病程脑卒中患者上肢体感诱发电位与感觉、运动功能的相关性

Correlation of upper extremity somatosensory evoked potentials with sensory and motor functions in stroke patients in different stages

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组别	指标	N20潜伏期		N20振幅
组别	指标	r值	P值	r值	P值
急性期组	单丝触觉	-0.135	0.393	0.299	0.057
	两点辨别觉	0.121	0.443	-0.158	0.311
	FMA-UE评分	-0.103	0.491	-0.042	0.776
恢复早期组	单丝触觉	-0.267	0.005	0.328	< 0.001
	两点辨别觉	0.220	0.021	-0.405	< 0.001
	FMA-UE评分	-0.184	0.054	0.418	< 0.001
恢复中晚期组	单丝触觉	-0.119	0.453	0.598	< 0.001
	两点辨别觉	0.040	0.802	-0.591	< 0.001
	FMA-UE评分	-0.313	0.044	0.393	0.010

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