慢性脑卒中重度偏瘫患者功能恢复的感觉运动皮质重组模式研究  

The reorganization patterns of the sensorimotor cortex during motor recovery in chronic stroke with se⁃vere hemiplegia

作　　者：李倩文 孙莉敏[2] 王鹤玮 宁瑞鹏[1] 尹大志 余秋蓉 李哲宇 沈逸凡 袁彧健 马天宇 卢杉 刘志超 范明霞[1] LI Qianwen;SUN Limin;WANG Hewei(East China Normal University,Shanghai,200062)

机构地区：[1]华东师范大学上海市磁共振重点实验室,上海市200062 [2]复旦大学附属华山医院 [3]华东师范大学心理与认知科学学院 [4]上海市长宁区精神卫生中心 [5]上海交通大学医学院附属瑞金医院放射科 [6]上海交通大学医学院医学技术学院

出　　处：《中国康复医学杂志》2024年第8期1111-1121,共11页Chinese Journal of Rehabilitation Medicine

基　　金：国家自然科学基金面上项目(81471651,32271096,81974356);上海市科委自然基金面上项目(23ZR1408500);上海市科委“扬帆计划”基金项目(21YF1404600);上海市卫生健康系统重点扶持学科建设项目(2023ZDFC0304);国家自然科学青年基金项目(82102665)。

摘　　要：目的:探究慢性脑卒中重度偏瘫患者感觉运动皮质(sensorimotor cortex,SMC)的重组模式及其与上肢运动功能恢复的关系。方法:收集34例慢性脑卒中重度偏瘫患者在4周康复干预前后执行患手被动握拳任务及29例健康人执行单手被动握拳任务的功能磁共振成像数据。比较脑卒中组在康复干预前后SMC的激活差异和偏侧指数(the lateralization index,LI)变化,与上肢运动功能评分(Fugl-Meyer Assessment of Upper Extremity,FMA-UE)进行相关性分析。结果:健康对照组执行单手被动握拳任务时主要表现为对侧脑SMC激活,脑卒中组患手对侧脑SMC的激活变化可分为三种模式:募集、集中和无激活。其中募集模式表现为康复干预后对侧脑SMC激活较干预前增加;集中模式表现为干预后对侧脑SMC激活较干预前减少;无激活模式表现为干预前后对侧脑SMC均无激活。募集组的LI在干预后趋近健康对照组,集中组的LI在干预后偏离并且显著高于健康对照组(P<0.01)。上述三组患者在康复干预后FMA-UE评分均显著增加(P<0.01),而募集组和集中组在康复干预前、后FMA-UE及FMA-UE绝对变化值均不存在显著差异。集中组对侧脑SMC激活的相对变化量与FMA-UE相对变化量显著负相关(r=﹣0.662,P=0.014)。结论:慢性脑卒中重度偏瘫患者在上肢运动功能恢复过程中SMC存在不同重组模式,尤其是SMC募集激活和集中激活的现象,表明慢性脑卒中重度偏瘫患者的运动功能恢复不依赖于单一的皮质功能重组模式。Objective:To investigate the reorganization patterns of sensorimotor cortex(SMC)and their relationship with upper limb motor function recovery in chronic stroke with severe hemiplegia.Method:Functional magnetic resonance imaging(fMRI)data were collected from 34 chronic stroke patients with severe hemiplegia who performed the passive fist clutch task with the affected hand before and after four weeks of rehabilitation.Additionally,data were collected from 29 healthy controls(HCs)who executed the passive fist clutch task with unilateral hand.Differences in activation of SMC and the lateralization index(LI)before and after the rehabilitation intervention were compared in the stroke group,and the correlation analysis was conducted with the Fugl-Meyer Assessment of Upper Extremity(FMA-UE).Result:In the healthy control group,the passive handgrip task predominantly activated the contralateral SMC.In the stroke group,changes in contralateral SMC activation during the affected hand task were classified into three patterns:recruitment,focusing,and no activation.The recruitment pattern showed that the activation of contralateral SMC increased after the intervention compared with that before the intervention.The focusing pattern showed that the activation of contralateral SMC decreased after the intervention compared with that before the intervention.The no activation pattern showed that there was no activation of contralateral SMC before and after the intervention.The LI in the recruitment group was similar to the HCs after the intervention,and the LI in the focusing group deviated from the HCs and was significantly higher than that of the HCs after the intervention(P<0.01).The FMA-UE scores of the three activation pattern groups were significantly increased after the intervention(P<0.01),while there were no significant differences both in the absolute values and absolute change values of FMA-UE and FMA-UE scores before and after the intervention between the recruitment group and the focusing group.In addition,there was a s

关 键 词：脑卒中 功能磁共振成像 感觉运动皮质 重度偏瘫 

分 类 号：R473.3[医药卫生—护理学] R493[医药卫生—临床医学]