亚急性期脑卒中康复过程中半球间皮质结构可塑性差异  

Differences of Structural Plasticity between Hemispheres during Rehabilitation for Subacute Stroke

作　　者：张豪杰 王云雷 樊令仲[4,5] 李芳 刘静娅[1,3] 于少泓 侯园园 白晨[1,2,3] 李冰洁 杜晓霞 张通 ZHANG Hao-jie;WANG Yun-lei;FAN Ling-zhong;LI Fang;LIU Jing-ya;YU Shao-hong;HOU Yuan-yuan;BAI Chen;LI Bing-jie;DU Xiao-xia;ZHANG Tong(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;China Rehabilitation Science Institute,Beijing 100068,China;Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Brainnetome Center and National Laboratory of Pattern Recognition,Institute of Automation,Chinese Academy of Sciences,Beijing 100190,China;University of Chinese Academy of Sciences,Beijing 100190,China;Second Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Ji'nan,Shandong 250001,China;the Second Clinical Medical College,Shandong University of Traditional Chinese medicine,Ji'nan,Shandong 250001,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复科学所,北京市100068 [3]中国康复研究中心北京博爱医院,北京市100068 [4]中国科学院自动化研究所模式识别国家重点实验室和脑网络组研究中心,北京市100190 [5]中国科学院大学,北京市100190 [6]山东中医药大学第二附属医院,山东济南市250001 [7]山东中医药大学第二临床医学院,山东济南市250001

出　　处：《中国康复理论与实践》2021年第4期436-444,共9页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中央级公益性科研院所基本科研业务费专项资金项目(No.2018CZ-2;No.2013CZ-26);中国康复研究中心项目(No.2018ZX-10)。

摘　　要：目的探讨脑卒中患者亚急性期康复过程中不同半球间皮质结构可塑性机制差异。方法 2018年11月20日至2020年2月1日,选取本院首次发病的皮质下缺血性脑卒中患者22例,分别在康复前、康复1个月、康复2个月行磁共振扫描和运动功能评估。测量皮质表面积、皮质厚度和皮质体积。采用两因素重复测量方差分析观察皮质结构的动态变化和半球间差异。结果对于双侧半球,时间主效应显著,主要集中在康复前和康复1个月之间。大部分脑区的皮质表面积、厚度和体积主要呈减少趋势,海马旁回的皮质厚度和体积呈升高趋势。半球间主效应显著的脑区为中央后回表面积和体积(F> 4.305, P <0.05),表现为病灶同侧小于病灶对侧。病灶侧中央后回厚度(r=-0.474, P=0.026)和体积(r=-0.432, P=0.044)的减少与运动功能恢复率呈负相关。结论病灶同侧半球与对侧半球在康复过程中存在皮质结构可塑性差异,皮质结构在脑卒中后的前2个月变化最明显,病灶侧中央后回厚度和体积减小越明显,运动功能恢复可能越差。Objective To explore the differences in plasticity mechanism of cortical structure between hemispheres during rehabilitation for stroke patients at subacute stage.Methods From October 20,2018 to February 1,2020,22 patients with first-onset subcortical ischemic stroke completed the assessments of MRI and clinical evaluation at admission,and after one and two months of rehabilitation.Cortical surface area,thickness,and volume were measured to evaluate cortical structure plasticity.Two-way repeated measures analyses of variance were implemented to estimate dynamic cortical morphology changes and differences between hemispheres.Results A significant time effect occurred between admission and after one month of rehabilitation for both hemispheres.Cortical surface area,thickness and volume for most regions in both hemispheres gradually decreased,while parahippocampal gyrus thickness and volume increased.The surface area and volume of postcentral gyrus was significant between both hemispheres(F>4.305,P<0.05),in which ipsilesional hemisphere was lower than contralesional hemisphere.The reduction of the thickness(r=-0.474,P=0.026)and volume(r=-0.432,P=0.044)of postcentral gyrus in ipsilesional hemisphere was negatively correlated with the recovery rate of motor function.Conclusion There are differences in cortical structure plasticity during stroke rehabilitation between hemispheres.Cortical morphology markedly changes in the first two months poststroke.The greater the reduction in thickness and volume of postcentral gyrus in ipsilesional hemisphere is,the worse the recovery of motor function may be.

关 键 词：脑卒中 康复 脑可塑性 皮质厚度 皮质体积 

分 类 号：R743.3[医药卫生—神经病学与精神病学]