康复干预对不完全性脊髓损伤脑网络图论属性影响的初步研究  

A preliminary study on the influence of rehabilitation on the brain network by the graph theoretic analysis for patients with incomplete spinal cord injury

作　　者：冯雨桐 葛云祥 窦维蓓[2] 吴琼[1] 潘钰[1] FENG Yutong;GE Yunxiang;DOU Weibei;WU Qiong;PAN Yu(Department of Rehabilitation Medicine,Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital,Beijing 102218,P.R.China;Department of Electronic Engineering,Tsinghua University,Beijing 100084,P.R.China)

机构地区：[1]清华大学附属北京清华长庚医院康复医学科,北京102218 [2]清华大学电子工程系,北京100084

出　　处：《华西医学》2021年第7期882-888,共7页West China Medical Journal

基　　金：清华大学精准研究计划(20219990001);北京清华长庚医院青年科研启动基金(12019C1013)。

摘　　要：目的利用头颅静息态功能磁共振扫描成像(resting state functional magnetic resonance imaging,rsfMRI)技术从各脑区图论属性变化的角度探讨不完全性脊髓损伤(incomplete spinal cord injury,ISCI)患者康复治疗的脑重塑机制。方法选择2017年1月—2020年6月入住北京清华长庚医院康复医学科的ISCI患者,并选择同时期招募的右利手正常受试者。ISCI患者进行2周康复治疗,包括运动疗法、功能性电刺激踏车、步行训练等。正常受试者及ISCI患者治疗前、后分别进行头颅rs-fMRI。ISCI患者治疗前、后进行美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤神经学分类下肢运动评分及感觉评分、肌张力评估、疼痛评估、脊髓损伤步行指数评价、脊髓损伤独立性评估。结果共纳入23例ISCI患者及22名正常受试者。治疗2周后ISCI患者ASIA下肢运动评分(P<0.001)、ASIA感觉评分(P=0.005)、疼痛视觉模拟评分(P=0.027)、脊髓损伤步行指数(P=0.005)及脊髓损伤独立性评估(P<0.001)较治疗前显著改善。ISCI患者治疗前与正常受试者比较,R38脑区介数中间性下降;L21、L22、L39、L41、L42、L44、L48、R22、R39脑区局部效率下降;L22、L39、L41、L44、L48、R22、R39脑区加权度下降。ISCI患者治疗后与正常受试者比较,R5、R6、R7、AR111、AL112脑区介数中间性升高;R6、AR94脑区聚集系数升高。ISCI患者治疗后较治疗前L21、R21脑区局部效率及加权度升高。结论基于图论属性的全脑网络功能分析可敏感反映ISCI患者脑网络重塑变化,脊髓损伤可引起听觉中枢相关脑区的图论属性下降,康复治疗后感觉运动皮质、听觉中枢及椎体外系相关脑区在全脑网络中信息传递能力提高,提示康复训练可能通过激活感觉运动中枢和非运动中枢相关脑区参与脑功能重塑。Objective To explore the effect mechanism of rehabilitation therapy post incomplete spinal cord injury(ISCI)in the view of graph theoretic analysis of the whole brain regions by the means of resting state functional magnetic resonance imaging(rs-fMRI).Methods Patients with ISCI admitted to the Department of Rehabilitation Medicine of Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from January 2017 to June 2020 were selected and healthy subjects recruited in the same period were also selected.The patients were given comprehensive rehabilitation treatment for 2 weeks,including physical therapy,functional electrical stimulation treadwheel,walking training,etc.Healthy subjects and patients before and after treatment course were examined by rs-fMRI.While patients were assessed using the motor and sensory scores of American Spinal Injury Association(ASIA),muscle tone assessment,pain assessment,Walking Index for spinal cord injury(WISCI)as well as the Spinal Cord Independence Measure(SCIM).Results A total of 23 ISCI patients and 22 healthy subjects were included.After 2 weeks of treatment,ASIA lower limb motor function scores(P<0.001),ASIA sensory scores(P=0.005),Visual Analogue Scale(VAS)(P=0.027),WISCI(P=0.005)and SCIM(P<0.001)scores of the patients were significantly improved compared with before treatment.Before treatment,compared with healthy subjects,ISCI patients had lower betweenness centrality(BC)in the brain regions of R38,lower local efficiency(LE)in L21,L22,L39,L41,L42,L44,L48,R22,R39 and lower weighted degree(WD)in L22,L39,L41,L44,L48,R22,R39.After treatment,compared with the healthy subjects,the BC of R5,R6,R7,AR111 and AL112 of ISCI patients increased and in R6 and AR94,the clustering coefficient increased.The LE and WD of L21 and R21 in ISCI patients after treatment were higher than those before treatment.Conclusions The functional analysis of the whole brain network based on graph analysis can sensitively reflect the changes of brain network remodeling in patients with ISCI.Spinal co

关 键 词：脊髓损伤 脑网络 图论属性 

分 类 号：R651.2[医药卫生—外科学] R493[医药卫生—临床医学]