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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 4

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

References 48

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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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Differences of Structural Plasticity between Hemispheres during Rehabilitation for Subacute Stroke

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