精细的运动皮层厚度对肌萎缩侧索硬化症患者上运动神经元损害的评价研究  

Assessment of the upper motor neuron degeneration by detailed motor homunculus cortex thickness in amyotrophic lateral sclerosis

作　　者：靳娇婷[1] 胡芳芳[1] 张秋丽[2] 张明[2] 陈乔依 李海宁[2] 秦星[1] 康丽[1] 贾蕊[1] 刘潇 党静霞[1] JIN Jiaoting;HU Fangfang;ZHANG Qiuli;ZHANG Ming;CHEN Qiaoyi;LI Haining;QIN Xing;KANG Li;JIA Rui;LIU Xiao;DANG Jingxia(Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Imaging,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Cell Biology and Genetics,School of Basic Medical Sciences,Xi’an Jiaotong University Health Science Center,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院神经内科,陕西西安710061 [2]西安交通大学第一附属医院影像科,陕西西安710061 [3]西安交通大学医学部细胞生物学与遗传学系,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2023年第5期694-700,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省2020年重点研发计划项目(No.2020SF-098,2020SF-089);陕西省自然科学基础研究计划(No.2022JQ-964)。

摘　　要：目的寻找上运动神经元(upper motor neuron,UMN)损害的证据对诊断肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)至关重要,拟通过精细的运动皮层厚度客观、敏感评价UMN损害并进行早期和精确诊断。方法纳入就诊于西安交通大学第一附属医院神经内科的ALS患者108例,同时招募健康对照90人。对所有的研究对象进行颅脑核磁共振成像(magnetic resonance imaging,MRI)扫描。纳入的ALS患者首先进行临床资料登记,然后评估延髓、颈髓、胸髓和腰骶髓4个体区是否存在UMN损害。结果ALS组双侧头面部-延髓区和上肢区的皮质厚度均较对照组明显变薄(P<0.05)。ALS组双侧下肢区皮层厚度较对照组未见明显变薄(P>0.05)。整体UMN损害阳性组的双侧头面部-延髓区和上肢区的运动皮质厚度较对照组明显变薄(P<0.05)。双侧头面部-延髓区的运动皮质厚度在相对应的延髓体区UMN损害阳性组较对照组明显变薄(P<0.05)。双侧上肢区的运动皮质厚度在相对应的上肢体区UMN损害阳性组较对照组明显变薄(P<0.05)。结论在临床工作中可以将运动皮层厚度变薄作为ALS患者UMN受累的客观标记物。Objective The involvement of upper motor neuron(UMN)degeneration is crucial to the diagnosis of amyotrophic lateral sclerosis(ALS).This study aimed to determine objective and sensitive UMN degeneration markers for an accurate and early diagnosis.Methods A total of 108 ALS patients and 90 age-and gender-matched control subjects were recruited from ALS Clinic of The First Affiliated Hospital of Xi’an Jiaotong University.The motor homunculus cortex thickness data in MRI were collected from all the participants.The clinical characteristics and UMN clinical examination of bulbar,cervical,thoracic and lumbosacral regions were collected from the ALS patients.Results Cortical thickness was significantly thinner in the ALS group than in the control group in bilateral head-face-bulbar and upper-limb areas(P<0.05).however,thinning in bilateral lower-limb areas in motor homunculus was not found(P>0.05).The cortical thickness of the global UMN positive group was significantly thinner than that of control groups in bilateral head-face-bulbar and upper-limb areas(P<0.05).The cortical thickness of the UMN positive group in the corresponding region was significantly thinner than that of control groups in bilateral head-face-bulbar and upper-limb areas(P<0.05).Conclusion The thinning of the motor homunculus cortex can be used as an objective marker of UMN involvement in ALS patients in clinical practice.

关 键 词：肌萎缩侧索硬化症 运动皮层厚度 上运动神经元损害 

分 类 号：R741[医药卫生—神经病学与精神病学]