大脑中动脉梗死后瘫痪肢体运动单位改变及其影响因素

The loss of motor unit and it's influencing factors in patients with middle cerebral artery infarction

目的探究大脑中动脉梗死后瘫痪肢体下运动神经元运动单位的改变及其影响因素。方法纳入40例单侧新发大脑中动脉梗死患者,分为皮质-基底节组(26例)与基底节组(14例),并纳入10例健康者为对照组。入院48 h内行NIHSS评分、m RS评分、Fugl-Meyer运动功能评分评估;于发病2~4周内行上下肢神经传导检测及拇短展肌运动单位数目估计(motor unit number estimation,MUNE)检测,同时采集单个运动单位电位(single motor unit action potential,SMUAP)数据,应用SPSS20.0进行数据分析。结果瘫痪侧肢体MUNE较健侧显著下降(皮质-基底节组:95.85±26.82 vs.143.65±38.86,P<0.001;基底节组:126.71±44.13 vs.157.36±56.72,P=0.001)且SMUAP波幅及面积显著增加(P<0.05),皮质-基底节组瘫痪侧肢体MUNE较基底节组显著下降(95.85±26.82 vs.161.40±48.90,P=0.027),MUNE与NIHSS评分(r=-0.339,P=0.032)及m RS评分(r=-0.362,P=0.022)呈显著负相关,入院时NIHSS评分(β=-1.603,P=0.032,95%CI:-3.064^-0.142)与m RS评分(OR=2.885,P=0.025,95%CI:1.139~7.158)均可预测瘫痪侧MUNE下降。结论大脑中动脉梗死后瘫痪肢体可见运动单位丢失和残存的运动单位代偿,急性期NIHSS评分、m RS评分可预测瘫痪侧运动单位的丢失。

Objective To investigate the loss of motor unit and it＇s influencing factors in the lower motor neurons after middle cerebral artery infarction. Method Forty patients with first onset and unilateral middle cerebral artery infarction were divided into cortical-basal ganglia （26） and basal ganglia （14） groups and 10 healthy controls were served as control group. All included patients were scored by National Institute of Health stroke scale （NIHSS）, modified Rankin scale （mRS）, Fugl-Meyer Assessment （FMA） at 48 hours of admission. Nerve conduction study on the limb and motor unit number estimation （MUNE） on abductor pollicis brevis were performed at 2-4 weeks after onset, and the data of single motor action potential （SMUAP） were collected. SPSS 20.0 software was used to statistical analysis. Result The MUNE on were significantly lower and the amplitude and area of SMUAP were significantly increased in ipsilateral than contralateral sides （cortical-basal ganglia group： 95.85±26.82 vs. 143.65±38.86, P〈O.001; basal ganglia group： 126.71± 44.13 vs. 157.36±56.72, P=0.001）. The affected MUNE was significantly decreased in the cortex-basal ganglia than in basal ganglia groups （95.85±26.82 vs. 161.40±48.90, P=0.027）. The MUNE was negatively correlated with NIHSS score （r=-0.362, P=0.022） and mRS score （r=-0.339, P=0.032）. NIHSS score （β=-1.603, P=-0.032, 95%CI：-3.064～-0.142） and mRS score （OR=2.885, P=0.025, 95%CI：1.139-7.158） on admission could predict the loss of MUNE on the affected side. Conclusion This study reveals the loss of motor unit and the eompensation of remained motor unit on the affeeted side after middle cerebral artery infarction, NIHSS score and mRS score on admission may predict the loss of MUNE after stroke.