脑梗死恢复早期患者肘关节屈伸任务下皮质激活特征的功能性近红外光谱研究

doi:10.3969/j.issn.1006-9771.2024.12.009

摘要/Abstract

摘要：

目的观察脑梗死患者恢复早期的脑功能重组。

方法 2023年4月至2024年4月，选择首都医科大学附属北京康复医院住院的右半球脑梗死患者20例(试验组)，病程2~4周，左侧重度偏瘫；20例健康受试者作为对照组。所有被试完成模块设计左侧屈肘任务，进行功能性近红外光谱检查；对照组只完成1次检查；试验组每2周检查1次，共5次，计算偏侧化指数；并于每次检查前采用Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。

结果 FMA-UE评分逐渐上升(P < 0.05)；偏侧化指数显示，试验组全脑、初级运动皮质和辅助运动区由右侧优势逐渐趋于平衡，背外侧前额叶皮质由平衡转为右侧优势，前运动皮质从右侧优势转为左侧优势。

结论脑卒中患者恢复早期，随着上肢运动功能改善，多数运动皮质区从患侧优势激活逐步转为左右平衡激活；但少数脑区可能转变为健侧或患侧优势激活。

关键词: 脑卒中, 运动功能, 脑激活, 功能性近红外光谱, 偏侧化指数

Abstract:

Objective To observe the rule of functional reorganization in stroke patients during early recovery.

Methods From April, 2023 to April, 2024, 20 patients with serious left hemiplegia for right cerebral infarction of two to four weeks were included as experimental group, from Beijing Rehabilitation Hospital Affiliated to Capital Medical University; meanwhile, 20 healthy subjects were included as control group. All the subjects finished a block designed left elbow flexing task, and were measured with functional near-infrared spectroscopy. The control group finished the test once; and the experimental group finished the test once per two weeks, for five times, and laterality indexes were calculated; they were also assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE) before each test.

Results The score of FMA-UE increased time by time (P < 0.05). For the experimental group, laterality index showed that the activation shifted from right dominance to balance in the whole brain, primary motor cortex and supplementary motor area; and it shifted from balance to right dominance in dorsolateral prefrontal cortex, and form right dominance to left dominance in premotor cortex.

Conclusion At the early recovery stage of stroke patients, the upper limb motor function is gradually improving, with the activation in most motor cortex shifting from affected hemisphere dominance to bilateral hemisphere balance; however, the activation may become affected or unaffected dominance in some brain areas.

Key words: stroke, motor function, brain activation, functional near infrared spectroscopy, lateralization index

中图分类号:

R743.3

蒋金金, 张玉婷, 王璐怡, 汪杰. 脑梗死恢复早期患者肘关节屈伸任务下皮质激活特征的功能性近红外光谱研究[J]. 《中国康复理论与实践》, 2024, 30(12): 1436-1441.

JIANG Jinjin, ZHANG Yuting, WANG Luyi, WANG Jie. Cerebral activation under elbow flexion and extension tasks for patients with stoke after early rehabilitation: a functional near infrared spectroscopy study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(12): 1436-1441.

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参考文献 32

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感兴趣区	左	右
DLPFC	5,6,7,9	17,19,20,21
M1	28,29,32	34,35,36
SMA	31,33	38,39
PMC	27,30	40,41

次数	n	均值	标准差
第1次	20	10.7	4.8
第2次	20	19.7	9.0
第3次	20	25.1	11.8
第4次	20	28.6	15.0
第5次	20	30.9	15.7

次数	次数	平均差值	P值	95%CI
次数	次数	平均差值	P值	上限	下限
第1次	第2次	-9.000	< 0.001	-12.537	-5.463
第1次	第3次	-14.400	< 0.001	-20.272	-8.528
第1次	第4次	-17.900	0.001	-26.500	-9.300
第1次	第5次	-20.200	0.001	-29.291	-11.109
第2次	第3次	-5.400	0.007	-8.908	-1.892
第2次	第4次	-8.900	0.012	-15.347	-2.453
第2次	第5次	-11.200	0.005	-18.002	-4.398
第3次	第4次	-3.500	0.037	-6.739	-0.261
第3次	第5次	-5.800	0.005	-9.382	-2.218
第4次	第5次	-2.300	< 0.001	-2.979	-1.621

组别	次数	通道	均值	标准差	t值	P值	组别	次数	通道	均值	标准差	t值	P值
试验组	第1次	5	0.514	0.339	4.791	0.001	试验组	第3次	19	0.722	0.818	2.790	0.021
		6	0.501	0.471	3.362	0.008			20	0.598	0.585	3.232	0.010
		7	0.771	0.613	3.976	0.003			27	0.844	0.961	2.78	0.021
		17	0.438	0.392	3.536	0.006			28	0.636	0.733	2.742	0.023
		19	0.699	0.616	3.589	0.006			30	0.757	0.606	3.947	0.003
		21	0.371	0.320	3.667	0.005			33	0.514	0.680	2.392	0.040
		29	0.527	0.691	2.409	0.039			38	0.682	0.666	3.237	0.010
		34	1.358	1.770	2.427	0.038		第4次	5	0.309	0.385	2.539	0.032
		35	1.124	1.292	2.751	0.022			17	0.370	0.415	2.819	0.020
		36	0.869	1.169	2.35	0.043			19	0.767	0.500	4.852	0.001
		38	0.706	0.583	3.832	0.004			20	0.345	0.297	3.667	0.005
		39	0.773	0.905	2.701	0.024			21	0.347	0.397	2.759	0.022
		40	0.863	0.905	3.014	0.015			27	0.480	0.567	2.675	0.025
	第2次	6	0.396	0.510	2.454	0.036			30	0.413	0.515	2.539	0.032
		7	0.514	0.416	3.909	0.004			36	0.838	1.111	2.386	0.041
		19	0.656	0.662	3.133	0.012			38	0.382	0.437	2.759	0.022
		20	0.516	0.492	3.316	0.009			41	0.580	0.567	3.234	0.010
		21	0.298	0.305	3.086	0.013		第5次	17	0.433	0.433	3.164	0.011
		27	1.056	1.323	2.525	0.032			19	0.537	0.600	2.831	0.020
		33	0.564	0.730	2.443	0.037			20	0.398	0.515	2.445	0.037
		34	0.615	0.574	3.392	0.008			21	0.377	0.363	3.284	0.009
		38	0.660	0.677	3.084	0.013			29	0.838	1.148	2.307	0.046
		39	0.663	0.664	3.157	0.012			32	1.233	1.699	2.294	0.047
	第3次	5	0.419	0.481	2.756	0.022			34	0.370	0.442	2.646	0.027
		6	0.342	0.448	2.412	0.039			35	0.884	1.231	2.272	0.049
		7	0.756	0.840	2.848	0.019	对照组		5	0.232	0.268	3.877	0.001
		9	0.443	0.472	2.967	0.016			7	0.314	0.371	3.787	0.001
		17	0.575	0.732	2.484	0.035			19	0.321	0.414	3.471	0.003

脑区	第1次	第2次	第3次	第4次	第5次
全脑	-0.15	-0.08	-0.23	0.00	-0.02
DLPFC	0.03	-0.26	-0.10	-0.09	-0.32
M1区	-0.44	-0.48	0.23	0.08	-0.02
SMA	-0.38	-0.43	-0.38	0.18	0.10
PMC	-0.52	-0.45	-0.41	-0.18	0.64