缺血性脑卒中手功能障碍患者静息态脑功能的活动特征

doi:10.3969/j.issn.1006-9771.2025.11.002

摘要/Abstract

摘要：

目的采用静息态功能磁共振成像(rs-fMRI)探究缺血性脑卒中手功能障碍患者大脑自发功能活动的特征。

方法 2024年8月至2025年6月，选取徐州医科大学附属淮安医院缺血性脑卒中手功能障碍患者23例(患者组)，并招募年龄相匹配的健康成年人10例作为健康对照组。收集患者组Fugl-Meyer运动功能量表上肢部分(FMA-UE)、Wolf运动功能测试量表(WMFT)和改良Lindmark量表评分。所有受试者均进行rs-fMRI检查，比较两组低频振幅(ALFF)、比率低频振幅(fALFF)和局部一致性(ReHo)的z转换值。基于独立成分分析构建静息态功能网络，进行功能网络连接分析。对患者组rs-fMRI的所有指标与临床量表评分进行相关性分析。

结果与健康对照组相比，患者组左(患)侧中央前回zALFF值降低(P < 0.05，FWE校正)，右(健)侧Cerebelum-Crus2-R的zfALFF值降低(P < 0.05，FWE校正)，右(健)侧豆状壳核ReHo值降低(P < 0.05，Alpha Sim校正)；患者组在执行网络的右(健)侧岛盖部额下回(IFGoperc.R)功能连接(FC)增强(P < 0.05，Alpha Sim校正)，在背侧注意网络(DAN)的左(患)侧枕中回(MOG.L)的FC减弱(P < 0.05，Alpha Sim校正)。患者组DAN中MOG.L的FC与FMA-UE评分(r = 0.439, P = 0.036)、WMFT评分(r = 0.516, P = 0.012)和改良Lindmark量表评分(r = 0.425, P = 0.043)相关。

结论缺血性脑卒中手功能障碍患者在静息状态下，大脑、小脑和基底节部分脑区自发活动减弱，部分脑网络连接异常，且MOG.L的FC可能成为评价患者手功能障碍的客观影像学依据。

关键词: 缺血性脑卒中, 手功能, 静息态功能性磁共振

Abstract:

Objective To explore the characteritics of spontaneous brain functional activities for patients with hand dysfunction after ischemic stroke using resting state functional magnetic resonance imaging (rs-fMRI).

Methods From August, 2024 to June, 2025, 23 patients with hand dysfunction after ischemic stroke were as patients group, and ten age-matched healthy adults were recruited as healthy control group. The patients group was assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT) and modified Lindmark Scale. All subjects underwent rs-fMRI examinations, and the amplitude of low frequency fluctuations (ALFF), fractional amplitude of low frequency fluctuations (fALFF) and regional homogeneity (ReHo) were compared between two groups. The resting state functional network was constructed based on independent component analysis, and the functional connectivity (FC) were analyzed. The rs-fMRI indicators of the patients and the clinical scale scores were analyzed.

Results Compared with the healthy control group, the zALFF value decreased in the precentral gyrus (P < 0.05, FWE corrected) in the patient group, as well as the values of zfALFF in Cerebelum-Crus2-R (P < 0.05, FWE corrected), and ReHo values in the putamen (P < 0.05, corrected by Alpha Sim). FC of the inferior frontal gyrus (IFGoperc.R) in the executive control network enhanced (P < 0.05, Alpha Sim corrected), while FC of the middle occipital gyrus (MOG.L) in the dorsal attention network (DAN) weakened (P < 0.05, Alpha Sim corrected). There was a positive correlation between FC of MOG.L in the patient's DAN and the scores of FMA-UE (r = 0.439, P = 0.036), WMFT (r = 0.516, P =0.012), and modified Lindmark Scales (r = 0.425, P = 0.043).

Conclusion The resting state spontaneous activity of some brain areas of the cerebrum, cerebellum and basal ganglia is reduced in patients with hand dysfunction after ischemic stroke, and some brain network connections are abnormal. FC of MOG.L may serve as an objective imaging marker for evaluating hand dysfunction.

Key words: ischemic stroke, hand function, resting state functional magnetic resonance imaging

中图分类号:

R743.3

王辉煌, 李雪静, 刘福, 陈思航, 李疏影, 蒲昱帆. 缺血性脑卒中手功能障碍患者静息态脑功能的活动特征[J]. 《中国康复理论与实践》, 2025, 31(11): 1256-1264.

WANG Huihuang, LI Xuejing, LIU Fu, CHEN Sihang, LI Shuying, PU Yufan. Characteritics of resting state brain functional activities in patients with hand dysfunction after ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1256-1264.

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