基于运动序列学习探讨高频重复经颅磁刺激对脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2025.07.008

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (7): 812-821.doi: 10.3969/j.issn.1006-9771.2025.07.008

基于运动序列学习探讨高频重复经颅磁刺激对脑卒中患者上肢功能的效果

孙婉婷¹, 艾丽皮乃·亚森¹, 龚翔¹, 肖悦¹^,², 甘兆丹¹^,², 刘铭洁¹, 曾兰婷¹, 马姝玥¹, 鲁俊¹^,²(), 许光旭¹^,²^,³()

1.南京医科大学康复医学院，江苏南京市 210029
2.南京医科大学第一附属医院康复医学中心，江苏南京市 210029
3.南京医科大学附属苏州医院，江苏苏州市 215031

收稿日期:2025-03-25 修回日期:2025-05-15 出版日期:2025-07-25 发布日期:2025-07-30
通讯作者: 鲁俊(1989-)，男，汉族，江苏南京市人，主管治疗师，主要研究方向：运动损伤康复，E-mail： lujunrehab@foxmail.com；许光旭(1966-)，男，汉族，江苏徐州市人，主任医师、教授，主要研究方向：中枢神经损伤运动控制分析与康复干预。E-mail： xuguangxu@njmu.edu.cn
作者简介:孙婉婷(1999-)，女，汉族，安徽亳州市人，硕士研究生，主要研究方向：神经调控及脑功能成像。
基金资助:
苏州市姑苏卫生人才项目(GWSW2022073)

Effect of high-frequency repetitive transcranial magnetic stimulation on upper limb function of stroke patients based on motor sequence learning

SUN Wanting¹, YASEN Ailipinai¹, GONG Xiang¹, XIAO Yue¹^,², GAN Zhaodan¹^,², LIU Mingjie¹, ZENG Lanting¹, MA Shuyue¹, LU Jun¹^,²(), XU Guangxu¹^,²^,³()

1. Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China
2. Department of Rehabilitation Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China
3. Suzhou Hospital Affiliated with Nanjing Medical University, Suzhou, Jiangsu 215031, China

Received:2025-03-25 Revised:2025-05-15 Published:2025-07-25 Online:2025-07-30
Contact: LU Jun, E-mail: lujunrehab@foxmail.com; XU Guangxu, E-mail: xuguangxu@njmu.edu.cn
Supported by:
Suzhou Gusu Health Talent Project(GWSW2022073)

摘要/Abstract

摘要：

目的探讨高频重复经颅磁刺激(HF-rTMS)作用于辅助运动区(SMA)或初级运动皮质(M1)在运动序列学习方面对脑卒中患者上肢功能的影响。

方法 2024年4月至2025年2月，于南京医科大学第一附属医院康复医学中心招募住院患者60例，随机分为对照组、SMA组和M1组，每组20例。3组均给予药物治疗和常规康复，在此基础上SMA组接受患侧SMA的HF-rTMS，M1组接受患侧M1的HF-rTMS，共2周。干预前后，比较各组运动诱发电位(MEP)、序列反应时(RT)任务、Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Bathel指数(MBI)评分。

结果 SMA组和M1组各脱落1例。干预后，SMA组和M1组患侧MEP引出率提高(P < 0.05)；SMA组和M1组患侧MEP引出率均优于对照组(χ² > 4.792, P < 0.05)。RT_顺序序列、FMA-UE、MBI评分组内效应显著(|F| > 81.546, P < 0.05)，RT_随机序列、RT_顺序序列、∆RT、MBI评分组间效应显著(F > 3.228, P < 0.05)，RT_随机序列、RT_顺序序列、∆RT、MBI评分交互效应显著(|F| > 3.520, P < 0.05)。干预后，各组RT_顺序序列、∆RT、FMA-UE、MBI评分均改善(P < 0.05)，SMA组较对照组RT_随机序列显著降低(P < 0.017)，SMA组和M1组RT_顺序序列、∆RT、FMA-UE、MBI评分均较对照组改善(P < 0.05)，SMA组与M1组之间无显著性差异(P > 0.05)。

结论脑卒中患者患侧SMA或M1 HF-rTMS均可激活运动序列学习，改善上肢功能。

关键词: 脑卒中, 运动序列学习, 重复经颅磁刺激, 辅助运动区, 初级运动皮质, 上肢

Abstract:

Objective To investigate the effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) applied to the supplementary motor area (SMA) or primary motor cortex (M1) on upper limb function in stroke patients in terms of motor sequence learning.

Methods From April, 2024 to February, 2025, 60 inpatients were recruited from the First Affiliated Hospital with Nanjing Medical University. They were randomly assigned into the control group, SMA group and M1 group, with 20 patients in each group. All the groups received medication and conventional rehabilitation. On this basis, SMA group underwent HF-rTMS on the affected side's SMA, while M1 group received HF-rTMS on the affected side's M1 for two weeks. All the groups were measured with motor evoked potentials (MEP), the serial reaction time (RT) task, Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after intervention.

Results The SMA and M1 groups dropped one case respectively. MEP elicitation rate of the affected side's increased in SMA and M1 groups (P< 0.05), and it was better than that in the control group (χ² > 4.792, P < 0.05). The intra-group effects of RT_{sequential sequence}, FMA-UE and MBI scores were significant (|F| > 81.546, P < 0.05). The inter-group effects of RT_{random sequence}, RT_{sequential sequence}, ∆RT, and MBI scores were significant (F > 3.228, P< 0.05). The interactive effects of RT_{random sequence}, RT_{sequential sequence}, ∆RT, FMA-UE and MBI scores were significant (|F| > 3.520, P > 0.05). After intervention, RT_{sequential sequence}, ∆RT, FMA-UE and MBI scores improved (P < 0.05). RT_{random sequence}was lower in SMA group than in the control group (P< 0.017), RT_{sequential sequence}, ∆RT, FMA-UE and MBI scores improved more in SMA and M1 groups than in the control group (P< 0.05), but no significant difference was found between the SMA group and the M1 group (P > 0.05).

Conclusion HF-rTMS applied to the affected SMA or M1 can activate motor sequence learning and promote the recovery of upper limb function in stroke patients.

Key words: stroke, motor sequence learning, repetitive transcranial magnetic stimulation, supplementary motor area, primary motor cortex, upper limbs

中图分类号:

R743.3

孙婉婷, 艾丽皮乃·亚森, 龚翔, 肖悦, 甘兆丹, 刘铭洁, 曾兰婷, 马姝玥, 鲁俊, 许光旭. 基于运动序列学习探讨高频重复经颅磁刺激对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2025, 31(7): 812-821.

SUN Wanting, YASEN Ailipinai, GONG Xiang, XIAO Yue, GAN Zhaodan, LIU Mingjie, ZENG Lanting, MA Shuyue, LU Jun, XU Guangxu. Effect of high-frequency repetitive transcranial magnetic stimulation on upper limb function of stroke patients based on motor sequence learning[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(7): 812-821.

图/表 9

表1

图1

表2

表3

表4

表5

各指标的重复测量方差分析结果"

变量		平方和	自由度	均方	F值	P值
RT_随机序列	组内	1038160.950	1	1038160.950	0.566	0.452
	组间	11837381.443	2	5918690.7213	3.228	0.040
	组内 $×$ 组间	12908729.071	2	6454364.535	3.520	0.030
RT_顺序序列	组内	195537285.218	1	195537285.218	81.546	< 0.001
	组间	104353851.771	2	52176925.886	21.760	< 0.001
	组内 $×$ 组间	29216678.833	2	14608339.416	6.092	0.002
∆RT	组内	9603225.048	1	9603225.048	3.815	0.051
	组间	78882509.857	2	39441254.928	15.669	< 0.001
	组内 $×$ 组间	46875737.454	2	23437868.727	9.311	< 0.001
FMA-UE	组内	12209.331	1	12209.331	141.535	< 0.001
	组间	508.086	2	254.043	2.945	0.507
	组内 $×$ 组间	832.619	2	416.309	4.826	0.100
MBI	组内	16691.797	1	16691.797	183.791	< 0.001
	组间	1444.114	2	722.057	7.950	0.001
	组内 $×$ 组间	702.546	2	351.273	3.868	0.024

表5

表6

表7

表8

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组别	n	性别(男/女)/n	年龄/岁	卒中性质(梗死/出血)/n	卒中半球(左/右)/n	MMSE/分	病程/月	BMI/(kg·m^-2)
对照组	20	17/3	58.70±16.24	2/18	11/9	26.15(24.25,29.00)	1.64(0.50,2.34)	24.79(23.66,27.04)
SMA组	20	18/2	57.50±17.14	3/17	12/8	28.00(24.00,29.00)	1.09(0.54，2.83)	23.19(20.55,27.40)
M1组	20	15/5	57.30±8.43	6/14	13/7	26.5(22.00,27.00)	0.67(0.67,1.84)	23.88(23.78,24.28)
F/χ²/H值		1.662	0.058	2.823	0.418	2.360	1.073	1.177
P值		0.572^a	0.944^b	0.339^a	0.945^a	0.307^c	0.585^c	0.555^c

组别	n	干预前	干预后	χ²值^a	P值^a
对照组	20	2	3	0.000	> 0.999
SMA组	19	4	11	-	0.022
M1组	19	1	9	-	0.008
χ²值		2.121	8.194
P值		0.373	0.016

组别	组别	干预前χ²值	干预前P值	干预后χ²值	干预后P值
SMA组	M1组	0.921	0.337	0.106	0.745
SMA组	对照组	0.262	0.608	6.038	0.014
M1组	对照组	< 0.001	> 0.999	4.792	0.029

项目	组别	治疗前		治疗后
项目	组别	均数	标准差	均数	标准差
RT_随机序列/ms	对照组	1843.21	1500.38	1935.98	1274.58
	SMA组	1859.22	1436.31	1761.47	1195.67
	M1组	1933.25	1396.62	1867.25	1292.45
RT_顺序序列/ms	对照组	2384.19	1465.39	2235.43	1788.06
	SMA组	2238.65	1712.87	1809.26	1177.94
	M1组	2326.19	1656.09	1930.31	1430.07
∆RT/ms	对照组	1473.34	1485.19	1614.21	1592.12
	SMA组	1426.20	1647.63	1189.48	1538.74
	M1组	1412.78	1614.67	1292.77	1639.48
FMA-UE	对照组	24.65	5.99	37.75	8.19
	SMA组	23.58	8.25	48.84	11.15
	M1组	22.89	9.37	46.11	11.76
MBI	对照组	41.00	5.31	58.10	7.59
	SMA组	43.84	9.29	71.53	11.17
	M1组	42.37	9.65	69.58	12.67

变量	组别	治疗前后平均值差	平均值差标准差	P值	95%CI
变量	组别	治疗前后平均值差	平均值差标准差	P值	下限	上限
RT_随机序列	对照组	-92.776	55.630	0.095	-201.862	16.310
	SMA组	97.748	54.316	0.072	-8.815	204.312
	M1组	66.000	53.829	0.221	-39.554	171.554
RT_顺序序列	对照组	148.764	65.627	0.023	20.072	277.456
	SMA组	429.390	59.134	< 0.001	314.494	544.287
	M1组	395.880	68.178	< 0.001	262.121	529.639
∆RT	对照组	-140.087	64.750	0.030	-267.904	-13.849
	SMA组	236.724	64.674	< 0.001	109.839	363.609
	M1组	120.011	64.310	0.026	14.009	226.013
FMA-UE	对照组	-13.100	4.541	< 0.001	-15.225	-10.975
	SMA组	-25.263	6.723	< 0.001	-28.504	-22.023
	M1组	-23.211	6.933	< 0.001	-26.552	-19.869
MBI	对照组	-17.100	5.015	< 0.001	-19.447	-14.753
	SMA组	-27.684	8.280	< 0.001	-31.675	-23.693
	M1组	-27.211	7.307	< 0.001	-30.733	-23.688

基于运动序列学习探讨高频重复经颅磁刺激对脑卒中患者上肢功能的效果

Effect of high-frequency repetitive transcranial magnetic stimulation on upper limb function of stroke patients based on motor sequence learning

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