小脑中脚扩散张量成像参数预测大脑中动脉梗死患者步行能力恢复的临床价值  

Diffusion tensor imaging can predict long-term functional outcomes after ischemic stroke

作　　者：王大明[1] 李捷[2] 王金辉[3] 罗芳富 赵瀛[1] 王凌燕[1] 李永祥[5] 张明贵[2] 宋杰[5] 

机构地区：[1]浙江中医药大学附属金华中医院康复医学科,浙江金华321017 [2]浙江中医药大学附属金华中医院放射科,浙江金华321017 [3]杭州师范大学认知与脑疾病研究中心 浙江省认知障碍评估技术重点实验室 [4]浙江绍兴市诸暨中医医院神经内科 [5]浙江中医药大学第三临床学院

出　　处：《中华物理医学与康复杂志》2017年第1期11-16,共6页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：浙江省金华市科技局社会发展重点项目（2013-3-015）

摘　　要：目的探讨扩散张量成像（DTI）检查脑梗死恢复期患者小脑中脚的扩散参数在起病3个月内及1年左右的动态改变，分析其与脑卒中后远期步行能力的可能关系。方法选取有偏瘫体征的首次发病的亚急性期大脑中动脉供血区梗死病例10例，分别于发病后3个月内（首次）及发病1年左右（第2次），基于兴趣区方法在大脑脚锥体束解剖学区域和小脑中脚桥小脑束解剖学区域测定左右两侧的部分各向异性（FA）值，作为影像学参数；采用国立卫生研究所卒中量表（NIHSS）对入选患者的神经功能缺损情况进行评估，包括上下肢运动评定部分，并作为偏瘫分级（PG）的依据，即上肢和下肢运动评分之和，均于DTI检测时同步评定，并于最后1次随访的同时，分别采用Brunel平衡量表（BBA）、改良的Rankin量表（mRS）和功能独立性评定量表（FIM）评定患者的平衡功能、功能预后和生活自理能力。结果①发病3个月内，首次扫描的大脑脚病灶受累侧的FA值（0．396±0．102）和发病后1年时的FA值（0．447±0．067）较未受累侧的FA值[（0．540±0．109）和（0．535±0．081）]明显降低（P〈0．01）；而首次扫描的小脑中脚受累侧的FA值（0．599±0．116）和发病后1年时的FA值（0．539±0．102）较未受累侧FA值[（0．489±0．047）、（0．483±0．070）]明显升高（P〈0．05）；②首次大脑脚的rFA值与同时间点上下肢运动各自PG分值及运动结局总PG分值均呈明显相关（P〈0．05），亦与发病1年随访时NIHSS、上肢运动PG分值、运动总PG分值以及与mRS和FIM评分呈显著相关（P〈0．05）；③首次小脑中脚的rFA值与同时间点的上肢运动PG分值及运动总PG分值呈明显相关（P〈0．05），亦与发病1年随访时的NIHSS、上肢运动PG分值、运动总PG分值、mRS和FIM评分呈显著相关（P〈0．05），而与发病1年随访时下肢运动PG�Objective To quantify and predict long-term motor outcomes after ischemic stroke using diffusion tensor imaging （ DTI）. Methods Ten patients with middle cerebral artery infarction were prospectively studied using DTI within 3 months and 1 year after the onset. A region-of-interest-based analysis was performed for the fractional anisotropy （FA） of the pyramidal tract in the cerebral peduncles （CP） and the pontocerebellar tract in the middle cerehellar peduncles （ MCP）. Neurological function was evaluated using the National Institutes of Health＇s stroke scale （NIHSS） and the degree of paresis was assessed at the same time using paresis grading （PG） . During the last follow-up, the functional outcome, ability in the activities of daily living and balance function were evaluated using the modified Rankin scale （mRS） , functional independence measures （FIMs） and the Brunel balance assessment （BBA） respectively. Results The average fractional anisotropy on the affected side of the CP was significantly lower than that of healthy persons at both 3 months and 1 year after onset. The FA of the MCP was signifi- cantly higher than on the healthy side. The ratio of the FA on the affected side to that on the unaffected side （rFA） in both the CP and MCP was significantly correlated with the paresis grading within 3 months, and significantly cor- related to the NIHSS score, the upper extremity＇s PG, total PG, mRS score and FIM score at the end of the follow- up. At the end of follow-up, the rFA of the MCP correlated in a better tendency with the lower limb PGs and bal- ance ability than that of the MCP, although the differences were not significant. Long-term motion function was not significantly correlated with a patient＇s age, motion dysfunction, size of focus, or the rFA of the CP and MCP. However, lower limb function was significantly correlated with the size of the focus and the rFA of the MCP, while upper limb mobility was significantly correlated with age, the size of the focu

关 键 词：脑梗死 扩散张量成像 预后 小脑中脚 步行 

分 类 号：R743.33[医药卫生—神经病学与精神病学]