慢性脑卒中伴严重偏瘫患者经胼胝体相连皮质功能连接异常对运动恢复的影响  

Effects of abnormal functional connectivity in transcallosal cortex connecting to the corpus callosum on motor recovery in chronic stroke patients with severe hemiplegia

作　　者：刘灵[1] 孙莉敏 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] LIU Ling;SUN Limin;WANG Hewei(East China Normal University,School of Physics and Electronic Science,Shanghai,200062)

机构地区：[1]华东师范大学物理与电子科学学院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康复医学科 [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1130-1142,共13页Chinese Journal of Rehabilitation Medicine

基　　金：国家自然科学基金面上项目(81471651,32271096,81974356);国家自然科学基金青年项目(82102665);上海市科委自然科学基金面上项目(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)。

摘　　要：目的:探究慢性脑卒中重度偏瘫患者的经胼胝体连接脑区的功能连接改变及其与上肢运动功能恢复的相关性。方法:收集25例慢性脑卒中重度偏瘫患者康复干预1个月前后和32例健康受试者的静息态功能磁共振成像数据。利用自动解剖标记图谱(anmtomical automatic labeling,AAL)识别与胼胝体直接相连的32对同源皮质脑区并进行感兴趣区水平的功能连接分析,比较这些脑区的患侧半球内、健侧半球内以及半球间功能连接的组间、组内差异,并进一步将功能连接与患者上肢运动功能评分(Fugl-Meyer assessment of upper extremity,FMA-UE)进行相关性分析。结果:与健康对照组相比,卒中组康复干预前和干预后半球内总功能连接差异均不显著,而半球间总功能连接显著减弱(P<0.01,FDR校正);进一步分析发现,同源脑区比非同源脑区的半球间功能连接减弱更加明显,涉及前额叶、感觉运动区、顶叶、颞叶和枕叶。与干预前相比,卒中组干预后的患侧内侧眶回与健侧内侧额回间的功能连接显著增强(P<0.01,FDR校正)。相关性分析显示,卒中组干预前半球间总功能连接与干预前FMA-UE评分显著正相关(r=0.590;P=0.004)。有5条半球间功能连接与干预前FMA-UE评分显著正相关(P<0.05)。其中3条为同源脑区连接,涉及额下回盖部、腹侧运动前区和初级运动皮质。另外2条为非同源脑区间连接,分别是患侧外侧眶回与健侧额下回眶部之间的连接、患侧顶下小叶与健侧缘上回之间的连接。此外,卒中组康复干预前有3条非同源脑区半球间连接与FMA-UE评分变化量显著正相关(P<0.05),涉及初级运动皮质、初级感觉皮质、腹侧运动前区和颞上回。卒中组干预前后功能连接变化量与FMA-UE评分变化量无显著相关性。结论:经胼胝体相连脑区的半球间功能连接下降可能是影响慢性期脑卒中运动功能障碍持续存在的重要因素之一。感觉�Objective:To investigate the changes in functional connectivity in transcallosal cortex connecting to the corpus callosum and its relationship with upper limb motor recovery in chronic stroke patients with severe hemiplegia.Method:The resting-state functional magnetic resonance imaging(fMRI)data were collected from 25 chronic stroke with severe hemiplegia before and after one-month rehabilitation intervention,as well as from 32 healthy controls(HCs).The anatomical automatic labeling(ALL)atlas was used to identify 32 pairs of homotopic cortex regions directly connected via the corpus callosum for regions of interest(ROI)-level functional connectivity analysis.Differences in functional connectivity within the affected hemisphere,unaffected hemispheres,and between hemispheres were compared within and between groups.Furthermore,the correlation between functional connectivity and upper limb motor function scores(Fugl-Meyer assessment of upper extremity,FMA-UE)was analyzed.Result:Compared with HCs,the whole intrahemispheric functional connectivity in the stroke groups had no significant differences before and after rehabilitation intervention,while the whole interhemispheric functional connectivity was significantly reduced(P<0.01,FDR correction).Especially,the functional connectivity of homotopic regions decreased more significantly than that of interhemispheric non-homotopic regions,which involved the prefrontal,sensorimotor,parietal,temporal,and occipital lobes.For the stroke groups,functional connectivity between the ipsilesional medial orbital gyrus and contralesional medial frontal gyrus was significantly enhanced after the intervention,compared with that before the intervention(P<0.01,FDR correction).The correlation analysis showed that the whole interhemispheric functional connectivity before the intervention was significantly positively correlated with FMA-UE scores(r=0.590,P=0.004).Five interhemispheric functional connectivities were significantly positively correlated with FMA-UE scores before the interventi

关 键 词：脑卒中 静息态功能磁共振成像 功能连接 运动功能障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]