卒中患者脑白质损伤与运动功能的相关性研究  

Correlation between cerebral white matter damage and motor function in stroke patients

作　　者：李鹏岳[1] 张静娜[1] 杨君[2] 颜如冰[3] 王莉[1] 张晔[1] 邱明国[1] 

机构地区：[1]第三军医大学生物医学工程系医学图像学教研室,重庆400038 [2]第三军医大学西南医院放射科,重庆400038 [3]第三军医大学西南医院康复科,重庆400038

出　　处：《第三军医大学学报》2016年第10期1116-1120,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81171866);教育部留学回国人员科研启动基金(2012);国家重点基础研究发展计划(973计划;2014CB541602)~~

摘　　要：目的研究卒中偏瘫患者脑白质结构的损伤程度,并探讨脑白质损伤与运动功能障碍的相关性。方法对17例卒中偏瘫患者和21例健康对照进行大脑DTI数据扫描,应用TBSS方法对两组被试的部分各项异性(FA)、轴向弥散系数(λ_1)、径向弥散系数(λ23)进行统计分析;通过约翰霍普金斯白质分区图谱提取卒中患者组的感兴趣区域,并与上肢肢体运动功能评分进行相关分析。结果卒中患者在患侧皮质脊髓束、额枕下束、钩束、丘脑前辐射、上纵束、胼胝体额部和双侧胼胝体枕部的FA值显著降低(P<0.005);患侧皮质脊髓束的λ_1值也显著降低(P<0.05),患侧皮质脊髓束、额枕下束、钩束、丘脑前辐射、胼胝体额部以及双侧上纵束、胼胝体枕部的λ_(23)值显著升高(P<0.01)。患侧皮质脊髓束的λ_1值与上肢Fugl-Meyer运动功能评分存在显著正相关(P<0.05)。结论卒中患者脑白质纤维束的结构完整性有明显损伤,患侧皮质脊髓束的λ_1值可以反映卒中患者运动功能障碍的程度。Objective To investigate the damage of cerebral white matter in stroke patients,and explore the correlation between the white matter damage and the motor dysfunction. Methods Seventeen stroke patients and twenty-one healthy controls were recruited to collect the cerebral diffusion tensor imaging（ DTI） data. Fractional anisotropy（ FA）,axial diffusivity（ λ1） and radial diffusivity（ λ23） were analyzed for differences between the 2 groups using tract-based spatial statistics（ TBSS）. The regions of interest（ ROI）were defined based on Johns Hopkins white matter partition atlas. The correlations between the parameters of ROI and Fugl-Meyer assessment（ FMA） scores of the stroke patients were also analyzed. Results Compared with the healthy controls,the FA of white matter fiber bundles was reduced in the ipsilesional corticospinal tract,inferior fronto-occipital fasciculus,uncinate fasciculus,anterior thalamic radiation,superior longitudinal fasciculus,forceps minor and bilateral forceps major of the stroke patients（ P〈 0. 005）. The λ1values of white matter fiber bundles were reduced in the ipsilesional corticospinal tract（ P 〈0. 05）. The λ23 values of white matter fiber bundles were increased in the ipsilesional corticospinal tract, inferior fronto-occipital fasciculus,uncinate fasciculus, anterior thalamic radiation, forceps minor, bilateral forceps major and superior longitudinal fasciculus（ P〈 0. 01）. A positive correlation was found between λ1value of ipsilesional corticospinal tract and FMA score of stroke patients（ P 〈0. 05）. Conclusion Abnormal white matter structure is found in the stroke patients,and the value of λ1in the ipsilesional corticospinal tract can reflect the motor dysfunction.

关 键 词：卒中 扩散张量成像 白质纤维束 部分各项异性 轴向弥散系数 径向弥散系数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]