重复经颅磁刺激联合重复外周磁刺激对脑出血患者上肢运动功能的效果:基于静息态功能磁共振成像的随机对照试验  

Effect of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper extremities motor function in patients with cerebral hemorrhage:a randomized controlled trial based on resting state-functional magenet

作　　者：罗红 徐丽 LUO Hong;XU Li(Department of Rehabilitation Medicine,Sichuan Academy of Medical Sciences,Sichuan Provincial People's Hospital,Chengdu,Sichuan 610072,China)

机构地区：[1]四川省医学科学院,四川省人民医院康复科,四川成都市610072

出　　处：《中国康复理论与实践》2024年第9期1060-1068,共9页Chinese Journal of Rehabilitation Theory and Practice

基　　金：四川省卫健委普及应用课题(No.21PJ079);四川省干保委普及经用课题(No.川干研2023-202);四川省中医药管理局科学技术研究专项(No.2021MS132)。

摘　　要：目的 通过功能核磁共振成像(fMRI)技术观察重复经颅磁刺激(rTMS)联合重复外周磁刺激(rPMS)对脑出血患者上肢运动功能的效果及其对脑功能重塑的机制。方法 2020年9月至2021年11月,四川省人民医院40例脑出血患者随机分为中枢组(n=13)、外周组(n=13)和联合组(n=14)。各组均接受常规药物治疗和康复治疗。在此基础上,中枢组给予健侧大脑M1区1 Hz低频rTMS治疗,外周组给予患侧上肢Erb点5 Hz高频rPMS治疗,联合组给予rTMS联合rPMS治疗,连续3周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Barthel指数(MBI)进行评定;同时采用3.0 T全身磁共振成像系统进行静息态fMRI(rs-fMRI)扫描,观察M1区与全脑其他脑区功能连接变化。对联合组治疗前后功能连接有显著性差异脑区的功能连接强度(FCS)与其FMA-UE评分差值进行相关性分析。结果 各组FMA-UE和MBI评分的组内效应(F> 106.646,P <0.001)、组间效应(F> 4.296,P <0.001)和交互效应(F> 9.583,P <0.001)均显著,且联合组最优(P <0.05)。治疗后联合组与感兴趣区(ROI) 1 (左/患侧M1区)功能连接增强的脑区主要有右侧中央后回、左侧颞上回,减弱的脑区主要包括左侧额上回、右侧小脑后叶;与ROI2 (右/健侧M1区)功能连接增强的脑区主要包括左侧中央前回、左侧楔前叶、左侧额下回,减弱的脑区主要包括左侧枕中回、右侧脑岛。与外周组相比,联合组未见与ROI1功能连接增强的脑区,功能连接减弱脑区为左侧枕中回;未见与ROI2功能连接增强的脑区,功能连接减弱脑区为左侧楔前叶、左侧丘脑。与中枢组相比,联合组与ROI1功能连接增强的脑区主要包括右侧中央后回、右侧缘上回,功能连接减弱的脑区主要有左侧小脑后叶、右侧丘脑;与ROI2功能连接增强的脑区主要包括左侧中央后回、右侧额上回,功能连接减弱的脑区主要有左侧额下回、右侧小脑后叶。联合组治疗前后Objective To observe effect of repetitive transcranial magnetic stimulation(rTMS) combined with repetitive peripheral magnetic stimulation(rPMS) on upper extremities motor function in patients with cerebral hemorrhage,and its mechanism of brain function remodeling using functional magenetic resonance imaging(fMRI).Methods From September,2020 to November,2021,40 patients with cerebral hemorrhage were randomly divided into central group(n = 13),peripheral group(n = 13) and combination group(n = 14).All patients received routine medication and physical therapy.The central group received low-frequency rTMS at 1 Hz in M1 area of the contralateral brain,the peripheral group received rPMS in the Erb's point of affected side,and the the combination group received rTMS combined with rPMS,for three weeks.They were assessed with Fulg-Meyer AssessmentUpper Extremities(FMA-UE) and modified Barthel index(MBI) before and after treatment,respectively.At the same time,resting-state fMRI(rs-fMRI) scanning was performed by using 3.0 T whole-body magnetic resonance imaging system,and the changes of functional connection between M1 area and other brain areas of the whole brain were observed.Spearman correlation analysis was used to explore the correlation between functional connectivity strength(FCS) differences in brain regions and FMA-UE score differences before and after treatment in the combination group.Results The intra-group effect(F > 106.646,P < 0.001),inter-group effect(F > 4.296,P < 0.001) and interaction effect(F > 9.583,P < 0.001) were significant in the scores of FMA-UE and MBI among groups,while the combination group was the best.After treatment,the functional connectivity(FC) to regins of intrest(ROI) 1(left/affected M1 area) enhanced in the right posterior central gyrus and the left superior temporal gyrus,and reduced in the left superior frontal gyrus and the right posterior cerebellum.The FC to ROI2(right/unaffected M1 area) enhanced in the left anterior central gyrus,the left anterior cuneiform lobe and the left i

关 键 词：脑卒中 重复经颅磁刺激 重复外周磁刺激 静息态功能核磁共振成像 上肢 运动功能 随机对照试验 

分 类 号：R743.3[医药卫生—神经病学与精神病学]