脑卒中偏瘫患者皮层下运动通路脑功能连接变化特点的fMRI研究

Altered Functional Connectivity in Subcortical Motor Pathways in Patients with Post-Stroke Hemiplegia:A fMRI Study

目的:利用静息态f MRI观察脑卒中偏瘫患者基底节核团的脑功能连接变化特点,为优化卒中后偏瘫的康复方案提供研究基础。方法:纳入脑梗死左侧肢体运动功能障碍患者21例,招募年龄、性别、文化程度相匹配的健康人20例。对所有受试者进行静息态功能核磁扫描,选取7对皮层下核团为种子点,比较患者与健康受试者种子点与全脑的功能连接度差异。结果:与健康受试者比较,患者功能连接下降主要为左侧尾状核与右侧额内侧回、颞叶、小脑后叶和尾状核,左侧额上回、顶叶和颞叶;右侧尾状核与左侧额中回、额叶、扣带回、小脑后叶、丘脑,右侧额中回;左侧壳核与右侧扣带回和丘脑;右侧壳核与左侧扣带回和丘脑;左侧丘脑与右侧额叶、颞叶和扣带回;右侧丘脑与左侧海马旁回、扣带回,右侧顶叶、楔前叶。功能连接增强主要见于右侧尾状核与右侧顶叶;右侧伏隔核与右侧苍白球;右侧苍白球与右侧顶叶和壳核;左侧苍白球与左侧枕中回。结论:处于恢复期的左侧肢体偏瘫患者双侧大脑皮质功能减弱与增强并存,皮层与基底节之间的功能连接变化呈现双侧大脑半球间减弱而半球内连接增强的规律。

Objective： To provide a research basis for optimizing rehabilitation scheme for post-stroke hemiplegia by observing altered function connectivity of the basal ganglia in patients with post-stroke hemiplegia using resting state f MRI. Methods： We recruited 21 patients with left hemiplegia and 20 healthy subjects with the age,gender and degree of culture matched. We scanned all subjects in the resting state via magnetic resonance imaging and compared the differences of the functional connectivity（ FC） between the seed points（ 7 pairs of Subcortical nuclei） and whole brain regions of the patients and healthy subjects. Results： Compared with healthy subjects,the decrease of functional connection was mainly located on the left caudate and the right medial frontal gyrus,temporal lobe,cerebellar posterior and caudal nucleus,and the left frontal gyrus,parietal lobe and temporal lobe; The right caudate nucleus and the left frontal gyrus,frontal lobe,cingulate gyrus,cerebellum posterior lobe,thalamus,and the right frontal gyrus; the left putamen and the right cingulate and thalamus; the right putamen and the left cingulate and thalamus; the left thalamus and right frontal lobe,temporal lobe and cingulate gyrus; the right thalamus and the left Parahippocampal gyrus and cingulate,right parietal lobe and precuneus. Functional connection enhancement could be seen mainly in the right caudate and right parietal lobe; right accumbens and right globus; the right globus and the right parietal lobe and putamen; the left globus and the left middle occipital gyrus. Conclusion： The decrease and enhancement in bilateral hemisphere coexisted in patients with hemiplegia who are in the left side of the recovery period. The functional connectivity between the cortex and basal ganglia decreased between bilateral cerebral hemisphere and increased within unilateral cerebral hemisphere.