^(99m)Tc-ECD脑血流灌注显像在脑卒中患者上肢功能训练疗效评估中的价值

Value of ^(99m)Tc-ECD Cerebral Blood Flow Perfusion Imaging on Evaluating the Effects of Upper Extremities Training of Stroke Patients

【目的】探讨^(99m)Tc-ECD脑血流灌注显像在脑卒中偏瘫性上肢功能障碍患者上肢功能训练中的应用价值。【方法】52例符合入组标准的脑卒中上肢功能障碍的患者,均进行4周的上肢功能康复训练。在康复训练前后均进行FMA-UE、MAS-UE、MBI评分和^(99m)Tc-ECD脑血流灌注显像,勾画脑缺血病灶的感兴趣区,计算其缺血的半定量值。比较康复训练前后患者临床评分的变化及脑缺血病灶血流灌注的变化,并进行两者的相关分析。【结果】经过4周的康复训练,36例上肢功能改善的患者量化表评分明显得到提高,FMA评分从19.7±6.1提高到31.5±9.0(P<0.05),MAS评分从2.1±1.4提高到4.9±4.1(P<0.05),MBI评分从53.4±26.6提高到80.9±14.1(P<0.05)。脑卒中病灶血流灌注的半定量值较康复训练前得到改善,从0.48±0.23提高到0.82±0.37(P<0.05)。16例上肢功能改善不明显的患者量表评分变化不明显,FMA评分从14.6±7.5变为15.1±6.1(P>0.05),MAS评分从1.8±1.2提高到1.9±1.6(P>0.05),MBI评分从37.5±22.8变为42.3±15.4(P>0.05),脑卒中病灶血流灌注半定量值从0.26±0.19提高到0.28±0.20(P>0.05)。52例患者脑卒中病灶血流灌注的改变与量表评分存在正相关(r值分别为0.702、0.571、0.689)。^(99m)Tc-ECD脑血流灌注显像可准确评估康复训练前后脑卒中病灶血流灌注的变化情况,且这些变化与康复训练疗效存在正相关的关系。【结论】^(99m)Tc-ECD脑血流灌注显像在评估脑卒中上肢功能障碍患者的康复训练疗效中具有重要价值。

【Objective】 To investigate the clinical value of ^99mTc-ECD cerebral blood flow perfusion imaging on evaluating upper extremities training of stroke patients. 【Methods】 Fifty-two stroke patients were enrolled in this study. Before and after rehabilitative training,^99mTc-ECD cerebral blood flow perfusion imaging was performed, and ROI of ischemic lesion and semi-quantitative value were acquired. FMA, MAS and MBI were used as outcome measures. Then the semi-quantitative value with scores of FMA, MAS and MBI were compared. 【Results】 After 4 weeks rehabilitative training, scores of 36 function improved patients increased from 19.7 ±6.1 to 31.5 ± 9.0（FMA, P〈0.05）, 2.1 ± 1.4 to 4.9 ± 4.1（MAS, P〈0.05）, and 53.4 ± 26.6 to 80.9 ± 14.1（MBI, P〈0.05）.The semi-quantitative value increased from 0.48 ± 0.23 to 0.82 ± 0.37（P〈0.05）. Scores of 16 unimproved patients changed from14.6 ± 7.5 to 15.1 ± 6.1（FMA, P〉0.05）, 1.8 ± 1.2 to 1.9 ± 1.6（MAS, P〉0.05）, and 37.5 ± 22.8 to 42.3 ± 15.4（MBI, P〉0.05）. The semi-quantitative value changed from 0.26 ± 0.19 to 0.28 ± 0.20. There is positive correlation between the semi-quantitative value and scores of FMA-UE, MAS-UE and MBI.^99mTc-ECD cerebral blood flow perfusion imaging can evaluate changes of the cerebral flow perfusion of ischemic lesion accurately, and the changes are positive correlated with changes of FMA, MAS and MBI. 【Conclusion】 There is important value of^99mTc-ECD cerebral blood flow perfusion imaging on evaluating rehabilitative effects of upper extremities training for stroke patients.