卒中后神经肌肉功能耦合的多尺度特征分析及其临床应用  

Multi-scale feature analysis of neuromuscular function coupling after stroke and its clinical application

作　　者：张浩浩 毛之奇[2] 陈晓玲[3] 李天晴 刘迪 余新光 Zhang Haohao;Mao Zhiqi;Chen Xiaoling;Li Tianqing;Liu Di;Yu Xinguang(School of Medicine,Nankai University,Tianjin 300350,China;Department of Neurosurgery,the First Medical Center,PLA General Hospital,Beijing 100853,China;Key Laboratory of Measurement Technology and Instrumentation of Hebei Province,Yanshan University,Qinhuangdao 066004,China)

机构地区：[1]南开大学医学院,天津300350 [2]解放军总医院第一医学中心神经外科医学部,北京100853 [3]燕山大学河北省测试计量技术及仪器重点实验室,秦皇岛066004

出　　处：《中华神经外科杂志》2024年第4期372-377,共6页Chinese Journal of Neurosurgery

基　　金：科技创新2030——脑科学与类脑计划重大项目(2021ZD0200407)。

摘　　要：目的初步分析卒中患者神经肌肉功能耦合(FCMC)的多尺度特征,并探讨其在运动功能评估中的作用。方法前瞻性纳入2018年1—3月解放军总医院第一医学中心神经外科医学部收治的发病后右上肢偏瘫的卒中患者(n=8,卒中组)以及健康人(n=8,健康对照组)作为受试者。对受试者进行右上肢恒定握力试验,通过复杂多尺度一致性(CMSC)分析方法对同步采集的多通道脑电和肌电信号进行分析;采用一致性显著性阈值计算方法计算20个时间尺度下的显著面积指标,并采用双因素重复测量的方差分析比较卒中组与健康对照组显著面积指标的差异。采用皮尔逊相关性分析方法验证卒中组患者多尺度FCMC显著面积指标与右上肢上田敏量表评级的相关性。结果与健康对照组比较,卒中组在不同时间尺度和频率范围内的CMSC值大多较低,且CMSC高值通常出现在高频段(45~60Hz)。在<1Hz的低频率范围内,6/8的健康对照组在时间尺度10左右出现CMSC较高值,而5/8的卒中组在此处的CMSC值相对较低。双因素重复测量的方差分析结果显示,卒中组与健康对照组显著面积的差异具有统计学意义(F_(组间)=14.20,P_(组间)=0.007;F_(时间尺度)=14.35,P_(时间尺度)<0.001;F_(交互作用)=13.29,P_(交互作用)<0.001);与健康对照组比较,卒中组在时间尺度9、10、11和12上的显著面积均较低(均P<0.05)。皮尔逊相关性分析结果显示,在时间尺度分别为9(r=0.74,P=0.032)、10(r=0.62,P=0.021)及12(r=0.71,P=0.030)时,卒中组的多尺度FCMC显著面积指标与上田敏量表评级呈正相关。结论初步分析发现,卒中后存在多尺度FCMC现象,且尺度特征较健康人改变,其中特定尺度的FCMC特征指标有望应用于卒中患者运动状态的临床评估。Objective To preliminarily analyze the multi-scale characteristics of neuromuscular functional coupling(FCMC)in stroke patients and to investigate its role in motor function assessment.Methods We selected healthy individuals(n=8,healthy control group)and post-stroke patients(n=8,stroke group)with right upper limb hemiplegia who were hospitalized in the Department of Neurosurgery of the First Medical Centre of People's Liberation Army(PLA)General Hospital from January 2018 to March 2018 as the research subjects.The patients were subjected to a right upper limb constant grip strength test,and the synchronously acquired multichannel electroencephalography and electromyography signals were analyzed by complex multiscale coherence(CMSC)analysis.Significant area metrics were calculated at 20-time scales using the consistency significance threshold calculation method.Differences in significant area metrics between the stroke group and healthy control group were compared using a two-way repeated measures analysis of variance(ANOVA).Pearson's correlation analysis was used to verify the correlation between the multiscale FCMC significant area metrics and the Ueda min grade of the right upper limb in patients in the stroke group.Results In comparison with the healthy control group,the stroke group exhibited predominantly lower CMSC values across different scales and frequency ranges,and high CMSC values were mostly found in the high-frequency band(45-60 Hz).Among the healthy control group,6 out of 8 subjects had higher CMSC values around scale 10 in the low-frequency range(<1 Hz),whereas 5 out of 8 patients in the stroke group had lowerCMSC values.Two-factor repeated-measures analysis of variance showed statistically significant differences in significant areas between the stroke group and healthy controls(F_(between proups)=14.20,P_(between groups)=0.007;F_(time scale)=14.35,P_(time scale)<0.001;F_(interaction)=13.29,P_(interaction)<0.001).Significant areas on scales 9,10,11,and 12 were lower in the stroke group compared w

关 键 词：卒中 神经肌肉监测 神经电生理监测 复杂多尺度一致性 显著性面积指标 

分 类 号：R743.3[医药卫生—神经病学与精神病学]