患侧感觉运动区在皮质下脑梗死后上肢运动功能恢复中的意义  

Significance of affected side sensorimotor area in recovery of upper limb motor function after subcortical cerebral infarction

作　　者：周龙江[1,2] 李华东 赵义[1] 符雪涛[3] 张新江 王苇[1] Zhou Longjiang;Li Huadong;Zhao Yi;Fu Xuetao;Zhang Xinjiang;Wang Wei(Department of Medical Imaging,the Affiliated Hospital of Yangzhou University,Yangzhou 225009,China;Department of Neurosurgery,Jinling Hospital,School of Medicine,Nanjing University,Nanjing 210002,China;Department of Neurology,the Affiliated Hospital of Yangzhou University,Yangzhou 225009,China)

机构地区：[1]扬州大学附属医院影像科,225009 [2]南京医科大学金陵临床医学院(东部战区总医院)神经外科,210002 [3]扬州大学附属医院神经内科,225009

出　　处：《中华神经科杂志》2021年第8期794-801,共8页Chinese Journal of Neurology

基　　金：江苏省博士后科研资助计划(2020Z117);扬州市“十三五”科教强卫工程重点人才资助项目(ZDRC201818)。

摘　　要：目的运用血氧水平依赖功能磁共振成像(BOLD-fMRI)技术探讨纹状体内囊梗死(SCI)后患侧感觉运动区(SMC)在上肢运动功能恢复中的价值和意义。方法纳入扬州大学附属医院神经内科2015年6月至2017年12月经严格筛选的17例初次发病的SCI伴单侧严重上肢瘫患者作为研究对象,并选取15名健康志愿者作为对照。于发病1周内、1个月及3个月时行偏瘫侧被动手指屈伸任务下BOLD-fMRI,通过SPM8软件观察患侧SMC激活情况。通过Xjview软件对BOLD-fMRI相应脑激活区进行激活并观察,并同标准脑激活区行动态比较。采用简化Fugl-Meyer评定量表上肢部分(FM-UL)对入选患者患侧上肢运动功能于发病1周内、发病1个月及发病3个月时在fMRI扫描前行运动功能评估。结果对照组被动手指屈伸任务下BOLD-fMRI显示主要脑激活区位于对侧SMC及双侧辅助运动区。17例患者初次BOLD-fMRI均可见患侧SMC存在激活表现,但激活强度存在明显差别。根据患侧SMC激活时程及与标准脑激活区强度比较结果,将试验病例分成3组:组1共6例患者,其发病初期患侧SMC激活强度即强于标准脑激活区;组2共5例患者,发病1个月时患侧SMC激活强度强于标准脑激活区;组3共6例患者,发病3个月时患侧SMC激活强度逐渐增强,但仍未超过标准脑激活区。组1患者初次、1个月及3个月时患侧SMC激活体素值为3570.2±1125.9、1205.8±328.2及1121.5±407.5,组内差异有统计学意义(F=12.8,P=0.001);组2患者患侧SMC激活体素值分别为556.2±171.7、648.6±177.3及993.2±182.9,组内差异有统计学意义(F=6.5,P=0.018);组3患者患侧SMC激活体素值分别为520.0±375.9、573.5±375.0及680.9±359.8,组内差异无统计学意义(P>0.05)。组1患者对应的3次FM-UL评分为(10.0±3.3)分、(52.3±4.6)分、(63.7±2.9)分,组2患者对应的3次FM-UL评分为(10.6±5.7)分、(36.6±2.4)分、(59.2±3.1)分,组3患者对应的3次FM-UL评分为(9.2±4.0)分、(12.5±3.Objective To explore the value and significance of sensorimotor cortex(SMC)in the recovery of upper limb motor function after cerebral infarction in the striatum with blood oxygenation level dependent functional magnetic resonance imaging(BOLD-fMRI).Methods A total of 17 patients with primary onset of striatal intracapsular infarction(SCI)with unilateral severe upper limb paralysis,who were strictly screened from the Department of Neurology,Affiliated Hospital of Yangzhou University from June 2015 to December 2017,were selected as research subjects,and 15 healthy volunteers were selected as controls.BOLD-fMRI under the passive finger extension(FE)task on the hemiplegic side was performed within one week,one month and three months after the onset of the disease.The activation of SMC was observed by SPM8 software.The activation of corresponding brain activation areas in BOLD-fMRI was observed by Xjview software and compared with the standard brain activation areas dynamically.The upper limb section of the Fugl-Meyer Scale(FM-UL)was used to track the motor function of the upper limb.The upper limb motor function of the selected patients was evaluated before functional magnetic resonance imaging(fMRI)scanning,at one month and three months after onset of the disease.Results In the controls,fMRI showed that the main brain activation areas were located in the contralateral SMC and bilateral supplementary motor area.According to the activation time course of the affected side SMC and the comparison results with the standard brain activation area,the study patients were divided into three groups:group 1(six patients),in which the activation intensity of SMC was stronger than that of standard brain activation area in the early stage of onset;group 2(five patients),in which the activation intensity of SMC in the affected side was stronger than that in the standard brain activation area at one month after onset;group 3(six patients),in which the activation intensity of SMC in the affected side increased gradually in three mo

关 键 词：卒中 磁共振成像 感觉运动区 功能重组 

分 类 号：R743.3[医药卫生—神经病学与精神病学]