脑白质高信号患者平衡障碍特点分析  

Characteristics of balance disorders in patients with white matter hyperintensities

作　　者：李雅晴[1] 邱丽娜 王雅静[2] 张玥[1] 巫嘉陵[2] LI Ya-qing;QIU Li-na;WANG Ya-jing;ZHANG Yue;WU Jia-ling(Department of Rehabilitation Medicine,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurological Rehabilitation,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院康复医学科,300350 [2]天津市环湖医院神经康复科,300350

出　　处：《中国现代神经疾病杂志》2019年第7期496-500,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:81671169);天津市科委应用基础重点项目(项目编号:17JCZDJC36500)~~

摘　　要：目的总结脑白质高信号患者平衡障碍特征。方法纳入2018年9-12月确诊的82例脑白质高信号患者,采用Fazekas分级评价脑白质高信号程度,Berg平衡量表(BBS)评价平衡功能,平衡测试仪测定静态平衡功能和稳定极限;Spearman秩相关分析探讨Fazekas分级与BBS评分(总评分、静态平衡功能评分、动态平衡功能评分)和平衡测试仪参数(重心摆动周长、面积和速度,X轴和Y轴标准差,稳定极限)之间的相关性。结果 BBS总评分(rs=-0.322,P=0.027;rs=-0.414,P=0.004)和动态平衡功能评分(rs=-0.368,P=0.011;rs=-0.440,P=0.002)与Fazekas分级侧脑室旁白质高信号和脑深部白质高信号均呈负相关。平衡测试仪各项参数中重心摆动周长(rs=0.239,P=0.030)和重心摆动速度(rs=0.240,P=0.030)仅与Fazekas分级侧脑室旁白质高信号呈正相关,重心摆动面积(rs=0.345,P=0.001;rs=0.340,P=0.002)、X轴标准差(rs=0.302,P=0.006;rs=0.260,P=0.018)、Y轴标准差(rs=0.248,P=0.025;rs=0.253,P=0.022)与Fazekas分级侧脑室旁白质高信号和脑深部白质高信号呈正相关;而稳定极限与Fazekas分级侧脑室旁白质高信号(rs=-0.258,P=0.019)和脑深部白质高信号(rs=-0.224,P=0.043)呈负相关。稳定极限与BBS总评分(rs=0.572,P=0.000)和功能性前伸测验(FRT)评分(rs=0.560,P=0.000)呈正相关。结论侧脑室旁白质高信号可能是导致脑白质高信号患者平衡障碍的影响因素之一;重度脑白质高信号患者静态稳定性、动态平衡功能、稳定极限和姿势稳定性明显下降,存在较高的跌倒风险;FRT测验可作为急诊或床旁评价患者主动姿势控制能力和跌倒风险的简捷方法。Objective To explore the features of balance disorders in patients with white matter hyperintensity(WMH).Methods The clinical data of 82 patients with WMH from September 2018 to December 2018 were collected.Fazekas scale was used to evaluate the level of WMH.Berg Balance Scale(BBS)and visual-feedback balance test-training monitor were used to assessed the performance of balance.Results Fazekas classification periventricular WMH(PWMH)and deep WMH(DWMH)had negative correlation with BBS total score(rs=-0.322,P=0.027;rs=-0.414,P=0.004)and dynamic balance function scores(rs=-0.368,P = 0.011;rs=-0.440,P= 0.002).About the parameters of the balance monitor,the center of gravity sway circumference(rs=0.239,P=0.030)and the center of gravity sway speed(rs=0.240.P = 0.030)were only positively correlated with the PWMH,center of gravity sway area(rs= 0.345,P =0.001;rs=0.340,P=0.002),X-axis standard deviation(r =0.302,P=0.006;rs=0.260,P=0.018),Y-axis standard deviation(rs=0.248,P=0.025;rs=0.253,P=0.022)were positively correlated with DWMH and PWMH;PWMH(rs=-0.258,P=0.019)and DWMH(rs=0.224,P=0.043),were negatively correlated with stability limit.BBS total score(rs=0.572,P=0.000)and functional reach test(FRT,rs=0.560,P=0.000)were positively correlated with stability limit.Conclusions PWMH may be one of the factors influencing the balance disorder in patients with WMH.The static stability,dynamic balance function,stability limit and posture stability of the patients with severe WMH are seriously degraded,there is a high risk of falling.FRT test can be used as a simple fast emergency or bedside evaluation of patients’ active posture control and fall risk.

关 键 词：白质 磁共振成像 姿势平衡 统计学 非参数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]