脑卒中后肢体运动功能障碍的生物学评估指标分析  

Biomarkers for assessing motor dysfunction after stroke

作　　者：杨雅馨 李颖[1] 袁海峰[1] 傅静[1] 李文娟[1] 张慧[1] 马奔[1] 张巧俊[1] Yang Yaxin;Li Ying;Yuan Haifeng;Fu Jing;Li Wenjuan;Zhang Hui;Ma Ben;Zhang Qiaojun(Department of Rehabilitation Medicine,The Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710000,China)

机构地区：[1]西安交通大学第二附属医院康复医学科,西安710000

出　　处：《中华物理医学与康复杂志》2019年第10期740-744,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的探讨弥散张量成像(DTI)及运动诱发电位(MEP)能否作为评估脑卒中后肢体运动能障碍程度的生物学指标。方法选取60例脑卒中偏瘫患者并给予简式Fugl-Meyer运动功能(FMA)评定,同时进行DTI及MEP检查,分析DTI、MEP参数与肢体FMA评分间的相关性,并利用受试者工作特征曲线(ROC)明确其在评定重度运动功能障碍时的检验效能。结果①DTI参数大脑脚部分各向异性不对称系数(aFA)与患侧上、下肢FMA评分均具有负相关性(P<0.05);内囊后肢aFA值与患侧上肢FMA评分具有负相关性(P<0.05),与患侧下肢FMA评分无明显相关性(P>0.05);MEP参数中枢运动传导时间(CMCT)、运动阈值(MT)异常程度均与该侧肢体FMA评分具有负相关性(P<0.05);②ROC曲线显示内囊后肢aFA值为评定上肢重度运动功能障碍的最佳指标,分界值为0.167,具有较好的检验效能;MEP波形缺失作为重度运动功能障碍的评定标准,其灵敏度较高,但特异度较低;③联合DTI及MEP进行系列检查,可提高识别上肢重度运动功能障碍的特异度。结论DTI及MEP相关参数可作为评估脑卒中后肢体运动功能障碍的生物学指标,且对评定上肢重度运动功能障碍具有较好效能。Objective To investigate whether diffusion tensor imaging(DTI)and motor evoked potentials(MEP)can be used as biomarkers to assess the degree of motor dysfunction of stroke survivors.Methods Sixty partially-paralyzed stroke survivors were given Fugl-Meyer assessments(FMAs)and MEP tests and assessed using DTI seeking any correlations among the results.The receiver operating characteristics curves(ROCs)were prepared to determine the tests′efficacy in assessing severe motor dysfunction.Results①Asymmetry in the fractional anisotropy(aFA)of the peduncles cerebra as measured by DTI was negatively correlated with the FMA scores of the upper and lower limbs on the affected side.The aFA values of the posterior limb of the internal capsule(PLIC)were negatively correlated with the FMA scores of the affected upper limb,but not with the FMA scores of the affected lower limbs.The abnormalities in central motor conduction time and motor threshold,which are MEP parameters,were negatively correlated with the FMA scores of the affected limbs.②The ROCs showed that the aFA value of the PLIC was the best indicator for assessing severe upper limb motor dysfunction,with a cut-off value of 0.167 giving the best discrimination.MEP waveform loss could also be used.It has high sensitivity but low specificity.③A combination of DTI and MEP can improve specificity in assessing severe motor dysfunction in the upper limbs.Conclusion DTI and MEP can both be used to evaluate motor dysfunction in stroke survivors.They have high clinical value for assessing severe motor dysfunction of the upper limbs.

关 键 词：脑卒中 运动功能障碍 弥散张量成像 运动诱发电位 

分 类 号：R74[医药卫生—神经病学与精神病学]