DTI对脑梗死后康复治疗疗效的定量影像学评价

Quantitative Evaluation of DTI on Rehabilitation of Cerebral Infarction

目的利用磁共振弥散张量成像(DTI)探讨不同的康复治疗手段对脑梗死后皮质脊髓束(CST)及运动功能的影响。方法收集30例梗死时间为1-6个月的慢性脑梗死病人并随机分为A组及B组,分别对其进行常规药物治疗和非药物治疗(主要为运动疗法及作业疗法),治疗前后行常规MRI及DTI检查,分别测量脑梗死病灶及同侧大脑脚的各向异性分数(FA值),计算不同治疗手段、不同部位治疗前后FA值变化率,并与患者的脑卒中康复运动功能评分(STREAM)行Pearson相关性分析。结果 AB两组病人治疗前后在梗死灶及大脑脚的FA值均减少,差异有统计学意义(A组P=0.041及P=0.03,B组P=0.015及P=0.024);组内比较,A组及B组病人在大脑脚的FA值减少率均低于梗死灶,差异有统计学意义(P=0.001及P=0.017);组间比较,A组病人在大脑脚的FA值减少率低于B组病人(P=0.006),两组病人在梗死灶的FA值减少率无统计学差异(P=0.072);A组、B组病人在大脑脚的FA值减少率与STREAM评分均呈良好相关性(A组:r=-0.763,P=0.014;B组:r=-0.648,P=0.006)。结论康复治疗可以有效延缓或减轻脑梗死后神经纤维束的继发性损害,并且药物治疗更有利于脑梗死病人皮质脊髓束功能的重建。

Objective To investigate the effect of different treatments on corticospinal tracts(CST)after cerebral infarction with diffusion tensor imaging(DTI).Methods A total of thirty patients with chronic cerebral infarction who suffered from one to six months were collected and divided into group A and group B randomly,and they were treated with conventional drug therapy and non-drug therapy(mainly mobilization treatment and occupational therapy)respectively.Routine MRI and DTI examination were conducted and fractional anisotropy(FA)of infarcts and ipsilateral cerebral peduncles were measured before and after treatment.Calculating the change rates of FA values before and after treatments in respect to different treatments and different parts.Pearson correlation were analyzed between patients'stores of stroke rehabilitation assessment of movement(STREAM)and change rates of FA values.Results Both group A(P=0.041 and P=0.03)and group B(P=0.015 and P=0.024)could found a significant decrease of FA values after treatment in infarcts and ipsilateral cerebral peduncles.Among the groups,the FA reduction rates in cerebral peduncles of group A and B was lower than that in infarcts(P=0.001 and P=0.017).Between groups,there was no significant difference in FA reduction rate between the two groups in infarcts.(P=0.072).But the reduction rate of group A was lower than group B in cerebral peduncles(P=0.006).There was a significant negative correlation between FA reduction rates of cerebral peduncles and STREAM score in group A and group B.Conclusion Rehabilitation therapy can effectively reduce the degeneration and damage of CST after cerebral infarction.Besides,drug is more conducive to the reconstruction of CST.