弥散张量纤维束成像技术在脑梗死患者运动功能康复中的临床研究

Application of diffusion tensor tractography in clinical rehabilitation of motor function in ischemic stroke patients

目的通过弥散张量纤维束成像技术分析脑梗死患者皮质脊髓束损伤。方法选择脑梗死患者37例,在发病3d内完成常规磁共振弥散张量成像扫描,使用MRI自带软件勾画患者双侧皮质脊髓束。根据皮质脊髓束损伤程度分为Ⅰ级10例,Ⅱ级12例,Ⅲ级15例。比较皮质脊髓束不同损伤程度患者一般临床资料及美国国立卫生研究院卒中量表(NIHSS)评分,随访6个月,使用Fugl-Meyer评分(FMS)评估患者运动功能恢复状况及影响FMS的危险因素。结果Ⅲ级皮质脊髓束损伤患者入院NIHSS评分明显高于Ⅰ级、Ⅱ级患者(P<0.05)。Ⅰ级运动功能恢复最好,评分最高,Ⅲ级最差,评分最低。与入院时比较,Ⅰ级、Ⅱ级、Ⅲ级皮质脊髓束损伤患者6个月FMS明显改善[(90.00±4.30)分vs(85.00±4.50)分,(78.40±3.80)分vs(73.00±3.90)分,(72.50±3.80)分vs(67.00±4.00)分,P<0.01]。多因素线性回归分析显示,皮质脊髓束损伤程度、脑白质病变等级及入院NIHSS评分是影响运动功能评分的相关因素(P<0.01)。结论弥散张量纤维束成像技术可以评估脑梗死患者皮质脊髓束的损伤程度;皮质脊髓束的损伤程度是影响脑梗死患者运动功能恢复的重要因素。

Objective To analyze the damage of corticospinal tract in ischemic stroke patients with diffusion tensor tractography（DTT）.Methods Thirty-seven ischemic stroke patients who underwent routine MRI scanning and DTT within 3 days after their disease onset.Their bilateral corticospinal tracts were plotted using MRI software.The patients were divided into grade Ⅰ group（n=10）,gradeⅡ group（n=12）,and gradeⅢ group（n=15）according to the severity of their corticospinal tract damage.Their general clinical data and NIHSS score were recrded.The patients were followed up for 6 months,during which the recovery of their motor function was assessed according to the Fugl-Meyer score（FMS）and the risk factors for FMS were analyzed.ResultsThe NIHSS score on admission was significantly higher in gradeⅢ group than in gradeⅠ group and gradeⅡ group（P〈0.05）.The recovery of motor function was significantly better and the NIHSS score was significant higher in gradeⅠ group than in gradeⅢ group.The FMS was significantly higher in gradeⅠ,ⅡandⅢ groups after 6 months of treatment than on admission（P〈0.01）.Multivariate linear regression analysis showed that corticospinal tract damage,white matter lesion and NIHSS score on admission were the independent risk factors for the recovery of motor function（P〈0.01）.Conclusion DTT can assess the damage of corticospinal tract in ischemic stroke patients.The damage of corticospinal tract is an important risk factor for the recovery of motor function in ischemic stroke patients.