利用PET-CT对脑卒中早期康复训练的脑皮质功能区重组研究

A study on cortex function regions reorganization by PET-CT in early rehabilitation training after stroke

目的:探讨脑卒中早期康复训练后脑功能区重组的规律。方法:发病1个月内的脑卒中偏瘫患者8例志愿者分为两组:康复治疗组6例,康复治疗时间1个半月,对照组2例(因个人经济原因未能接受康复治疗);发病初和1个月末分别进行PET-CT扫描、Fugl-Meyer评价、Barthel指数及神经功能缺损的测定。结果:8例脑卒中患者第一次扫描的健侧与患侧总均值有显著性差异(P<0.01),主要为初级运动区(M1)、后顶叶皮质(PPC)、小脑、辅助运动区(SMA)(P<0.01),治疗组与对照组无明显差异(P>0.05);两次同侧比较,健侧总均值与治疗组第二次有明显差异(P<0.05);患侧总均值与治疗组第二次有显著性差异(P<0.01)。第二次各组内两侧比较,治疗组均有显著性差异(P<0.01);对照组有明显差异(P<0.05);第二次两组间比较:健侧各功能区有明显差异(P<0.05),而两组患侧除M1无明显差异(P>0.05)外,其余各功能区有明显差异(P<0.05)。结论:卒中早期以健侧半球代偿为主导,运动相关区在皮质功能重组中异常活跃,脑卒中康复治疗后皮质激活区有向患侧半球转移的趋势,功能训练有利于皮质功能重组。

Objective：To explore the regularity of cortex function regions reorganization in stroke patients after early rehabilitation training. Method： Eight stroke patients with hemiplegia within one month were. divided into 2 groups： 6 cases in rehabilitation training group received 1 and half months training, 2 cases in control group （no training because of economy cause）. In early stage and 1 month after stroke, all patients were examined with PET-CT scanning and Fugl-Meyer,Barthel Index and lesion of brain function assessment respectively. Result：There were significant differences in general average values between affected and unaffected hemispheres in the 8 patients in the 1st PET-CT scanning （P〈0.01）,mainly in M1,PPC,cerebellum and SMA （P〈0.01）,but no significant difference between training group and control group （P〉0.05）. Comparing the 1st and 2nd scanning in the same hemisphere, there was significant difference of general average value, between unaffected side scanning and the 2nd scanning in training group （P〈0.05）, and also in affeetedside （P〈0.01）. Comparing affected and unaffected memisphere in the 2nd scanning, there were significant differences in training group （P〈0.01） and control group （P〈0.05）.In the 2nd scanning between two groups,there were significant differences in cortex function regions of unaffected hemisphere （P〈0.05）,but signifcomt differences in affected hemisphere between two groups （P〈〈0.05） except M1 （P〉0.05）. Conclusion： Unaffected hemisphere plays compensation role in early period of stroke,movement-relative regions are extremely activated in cortex function reorganization.After rehabilitation treatment,activated cortex regions show a shifting trend to affected hemisphere and function training is beneficial for cortex function reorganization.