大脑M1手区兴奋性与脊髓损伤后日常生活能力和神经病理性疼痛的相关性研究  

A study on the correlation between excitability of the M1 hand area and activities of daily living and neuropathic pain after spinal cord injury

作　　者：刘新禹 戴春秋 高铭 林小东 成贵卿 禄熠行 孙晓龙 袁华 LIU Xinyu;DAI Chunqiu;GAO Ming;LIN Xiaodong;CHENG Guiqing;LU Yixing;SUN Xiaolong;YUAN Hua(Department of Rehabilitation Medicine,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Department of Rehabilitation Medicine,The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army,Lanzhou 730050,China;Department of Rehabilitation Medicine,Lintong Rehabilitation and Convalescent Centre,Xi'an 710600,China)

机构地区：[1]空军军医大学西京医院康复医学科,陕西西安710032 [2]解放军联勤保障部队第九四〇医院康复医学科,甘肃兰州730050 [3]临潼康复疗养中心康复医学科,陕西西安710600

出　　处：《空军军医大学学报》2025年第3期305-311,共7页Journal of Air Force Medical University

基　　金：国家自然科学基金(82072534,82272591)。

摘　　要：目的探讨脊髓损伤(SCI)后大脑双侧初级运动皮层(M1)手区兴奋性变化,及其与日常生活能力(ADL)和神经病理性疼痛(NP)的相关性。方法纳入2022年3月至2024年3月在空军军医大学西京医院康复医学科住院的SCI患者67例(SCI组),采用单脉冲经颅磁刺激检测大脑双侧M1手区运动诱发电位(MEP)评估兴奋性;通过改良Barthel指数、脊髓独立性评定(SCIM)评估患者ADL功能;通过简化版McGill疼痛问卷2(SF-MPQ-2)评估患者NP程度。通过计算优势侧与非优势侧M1手区MEP波幅比的自然对数(LN),分析其与ADL和NP的相关性。结果与健康组相比,SCI组的双侧M1手区MEP波幅显著降低(P<0.01),潜伏期延长(P<0.01),且LN(优势侧波幅/非优势侧波幅)降低(P<0.05)。在SCI患者中,LN值与改良Barthel指数评分(r=0.250,P=0.041)、SCIM评分(r=0.263,P=0.033)及SCIM第12项室内活动评分(r=0.273,P=0.027)呈显著正相关。NP患者的LN值显著升高,且与SF-MPQ-2疼痛评分(r=0.276,P=0.047)呈显著正相关。结论SCI患者的双侧M1手区兴奋性显著降低,且兴奋性不对称程度与患者的ADL功能及NP程度密切相关。因此,大脑双侧M1手区兴奋性不对称程度可作为SCI后ADL功能及NP程度的潜在评估指标,并为未来的干预措施提供了新的靶点。Objective To investigate the changes in excitability of the bilateral primary motor cortex(M1)hand area after spinal cord injury(SCI)and its correlation with activities of daily living(ADL)and neuropathic pain(NP).Methods This study included 67 SCI patients'(SCI group)who were admitted to the Department of Rehabilitation Medicine,Xijing Hospital,Air Force Medical University from March 2022 to March 2024.Single-pulse transcranial magnetic stimulation was used to detect motor evoked potentials(MEP)in the bilateral M1 hand area to evaluate excitability.The patients' ADL function was evaluated using the modified Barthel Index and the Spinal Cord Independence Measure(SCIM),while the severity of NP was assessed using the simplified Short-Form McGill Pain Questionnaire-2(SF-MPQ-2).The natural logarithm(LN)of the ratio of MEP amplitudes in the M1 hand area from the dominant to the non-dominant side was calculated to analyze its correlation with ADL and NP.Results Compared with the healthy group,SCI group showed significantly reduced MEP amplitudes(P<0.01)and prolonged latencies in the bilateral M1 hand area(P<0.01).Additionally,the LN(dominant side amplitude/non-dominant side amplitude)was reduced(P<0.05).In SCI patients,LN values showed a significant positive correlation with the modified Barthel Index(r=0.250,P=0.041),SCIM score(r=0.263,P=0.033),and the SCIM indoor activity score(r=0.273,P=0.027).In NP patients,LN values were significantly higher and showed a positive correlation with SF-MPQ-2 pain score(r=0.276,P=0.047).Conclusion The excitability in the bilateral M1 hand area is significantly reduced in SCI patients.Furthermore,the degree of excitability asymmetry is closely related to ADL function and the severity of NP.Therefore,the degree of excitability asymmetry in the bilateral M1 hand area may serve as a potential marker for assessing ADL function and the severity of NP after SCI,and provide new targets for future intervention strategies.

关 键 词：脊髓损伤 大脑皮层兴奋性 运动诱发电位 日常生活能力 神经病理性疼痛 

分 类 号：R651.2[医药卫生—外科学]