脑卒中偏瘫上肢早期被动运动时功能性磁共振成像对临床预后的判断价值  

The value of fMRI for predicting the clinical outcome of passive movement of a hemiplegic upper limb after stroke

作　　者：周龙江[1] 王苇[1] 张新江[1] 李澄[1] 

机构地区：[1]江苏省扬州市第一人民医院神经介入中心,扬州225001

出　　处：《中华物理医学与康复杂志》2014年第3期194-198,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：江苏省自然科学基金资助项目（BK2011482）

摘　　要：目的研究脑卒中所致完全单侧上肢瘫患者在执行早期被动手指伸展（FE）任务时其颅内功能性磁共振（fMRI）成像与肢体运动功能恢复间的关联性。方法共选取19例初次发病的非M1区急性脑梗死伴单侧严重上肢瘫患者作为研究对象。于发病后1周内对患者执行偏瘫侧上肢手指被动伸展任务，同时进行fMRI检查，通过SPM5软件观察各患者颅内初级感觉运动区（SMC）、辅助运动区（SMA）及运动前区（PM）激活情况。于发病1周内、发病1个月时及发病3个月时分别采用简化Fugl—Meyer评分（FMA）上肢部分对人选患者上肢运动功能恢复情况进行评定。结果根据入选患者早期被动手指运动时脑区激活特点可分为三种类型：I型以病变侧为主、双侧SMC区及SMA区均激活；Ⅱ型以单纯病变侧SMC区及SMA区激活；Ⅲ型仅病变侧SMC区激活。发病1周内I型、Ⅱ型及Ⅲ型患者上肢FM评分分别为（4．5±4．5）分、（4．7±5．1）分及（6．2±4．1）分，组间差异均无统计学意义（P〉0．05）；发病1个月后发现I型、Ⅱ型及Ⅲ型患者上肢FM评分分别为（47．1±5．5）分、（36．0±6．7）分及（11．2±3．1）分，组间差异均具有统计学意义（P〈0．05）；发病3个月后I型与Ⅱ型患者上肢FM评分分别为（61．1±3．8）分、（59．0±5．2）分，组间差异无统计学意义（P〉0．05），且均显著高于Ⅲ型患者上肢FM评分[（10．8±5．6）分]（P〈0．05）。结论脑卒中后偏瘫上肢早期被动运动时的fMRI成像能用于临床预后早期评估，并指导临床康复治疗。Objective To study the potential of functional MRI （fMRI） during passive finger extension （FE） for predicting the motor function recovery of hemiplegic stroke survivors. Methods Nineteen survivors of a 1 st cere- bral infarction in the non-M1 cortex with complete paralysis on one side were selected for study. Within 1 week after the stroke, fMRI was performed while one of the patient＇s paralyzed fingers was passively flexed and extended, fMRI signals were acquired from the sensorimotor cortex （ SMC ）, the supplementary motor area （ SMA ） and the premotor area （PM）. Fugl-Meyer （FM） scores of arm motor function were recorded one week, one month and three months after the stroke. Results The early fMRI results were used to classify cortex activation performances as type I （activation mainly on the affected side, but SMC and SMA activated bilaterally） , type II （activation of the SMC and SMA only on the affected side） or type III （only activation of the SMC on the affected side）. At one week after stroke the average FM scores of the three groups were not significantly different. At one month the three average FM scores were 47.1 ± 5.5 points, 36 ± 6.7 points and 11.2 ± 3.1 points, for groups I, II and III respectively, each significantly different from the others. At three months the average FM ratings of groups I （61.1 ± 3.8 points） and II （59 ± 5.2 points） were not significantly different, but both were significantly higher than the average score of group III（ 10.8 ± 5.6 points）. Conclusion The early stage fMRI characteristics of hemiplegic patients can be used for predicting motor outcomes.

关 键 词：脑卒中 功能性磁共振成像 被动运动 功能重组 

分 类 号：R743[医药卫生—神经病学与精神病学]