弥散张量成像评估急性脑梗死康复治疗前后运动功能变化与预后的相关性  

Correlation study of diffusion tensor imaging between motor function and prognosis in the patients with acute cerebral infarction before and after rehabilitation treatment

作　　者：曾皎 陈红群[1] 刘芳[1] 

机构地区：[1]贵阳医学院附属医院神经内科,贵州贵阳550004 [2]新乡医学院第二附属医院神经内科,河南新乡453002

出　　处：《中风与神经疾病杂志》2016年第4期334-337,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的利用磁共振弥散张量成像(DTI)和神经功能评定量表(FMA)研究急性脑梗死患者康复治疗前后CST类型、部分各向异性(FA)值变化与运动功能恢复及临床预后之间的关系,探讨影响脑梗死患者神经功能恢复的相关因素。方法 40例急性脑梗死患者,随机分为治疗组与康复组。在发病3 d内及发病3 m时行3.0T常规磁共振(MRI)和DTI检查,分别测量病灶侧、对侧皮质脊髓束FA值。通过Fugl-Meyer量表(FMA)评分,探讨影响预后的相关因素。结果 3 m后两组患者FMA值评分均较入院时明显增高(P<0.05),康复组CSTⅡ型、CSTⅢ型患者的FMA值较治疗同组有显著提高(P<0.05)。预后以CSTⅠ型最好,CSTⅡ型次之,CSTⅢ型最差。所有患者入院时病灶侧FA值均较健侧减低,FA值CSTⅠ型>CSTⅡ型>于CSTⅡ型,P<0.05。3 m复查病灶侧FA值仍低于健侧,且较入院时各型FA值均有下降。结论早期康复训练有助于促进患者运动功能恢复。皮质脊髓束受损重、白质纤维断裂者,运动功能恢复较差。但通过康复训练结果仍好于未康复训练者。FA值与神经功能损害呈正相关。Objective To study the relationship among the type of corticospinal tract,FA value,motor function and clinical prognosis in the patients with acute cerebral infarction before and after rehabilitation treatment by diffusion tensor imaging（ DTI） and nerve function score（ FMA）,and to discuss the related factors that can affect neurological recovery in cerebral infarction patients. Methods 40 cases of acute cerebral infarction were divided into rehabilitation and treatment group randomly. Conventional magnetic resonance imaging（ MRI） and DTI were acquired in the patients on a 3. 0T MR imaging scanner in the first 3 days and 3 months. Their fractional anisotropy value of the infrared focus and the contralateral corresponding brain tissues were measured. The change of nerve function was measured by Fugl-Meyer motor assessment scale（ FMA）,in order to understand the related factors that can affect neurological recovery. Results The FMA value scores of patients in two groups were significantly higher on admission（ P〈0. 05）,group CST Ⅱ in rehabilitation group improved significantly than treatment in patients with type Ⅲ group,P〈0. 05. Among the prognosis of corticospinal tract in three types,CST Ⅰ was the best and the CST Ⅲ was worst. All the patients admitted to hospital at the level of lesion showed that the value of FA in lesion were significantly lower than that in the region of opposite side（ P〈0. 05）,CST Ⅰ was the highest and the CST Ⅲ was lowest. The value of FA in lesion were significantly lower than in the region of opposite side after 3 months,and it dropped to each types of corticospinal tract admitted to hospital. Conclusion It indicates rehabilitation training in the early contributed to movement functional recovery. Who damaged corticospinal tract and fracture white matter fiber motor function recovery poorly. But the outcome of rehabilitation training is better than the treatment group. FA value and neural function damage were positively correlated.

关 键 词：弥散张量成像 脑梗死 康复 运动功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]