脑小血管病患者运动功能及影像特征与运动诱发电位的相关性研究

Correlation of Motor Disturbance and Imaging Characteristics with Motor Evoked Potentials in Patients with Cerebral Small Vessel Disease

目的探讨脑小血管病(cerebral small vessel disease,CSVD)患者运动功能及影像特征与经颅磁刺激运动诱发电位(transcranial magnetic stimulation induced motor evoked potentials,TMS-MEP)的相关性。方法回顾性分析深圳市人民医院神经内科2018年1月-2019年8月住院的符合CSVD诊断标准且已行TMS-MEP检查的患者。记录患者的性别、年龄和血管危险因素等临床资料及MEP相关电生理数据,包括中枢运动传导时间(central motor conduction time,CMCT)和静息运动阈值(resting motor threshold,RMT)。评估并量化CSVD的影像学特征,包括近期皮质下小梗死(recent small subcortical infarct,RSSI)、腔隙、扩大的血管周围间隙、脑白质高信号、脑微出血和脑萎缩。根据是否有肌力减退分为症状半球组和非症状半球组。比较两组间的影像学特征及MEP特征,分析CSVD影像特征与MEP的相关性。结果研究共纳入202例CSVD患者,共404侧大脑半球。平均年龄64.0±10.6岁,男性135例(66.8%)。症状半球组77侧(19.1%),非症状半球组327侧(80.9%)。症状半球组中CMCT(P=0.005)和RMT(P<0.001)高于非症状半球组。症状半球组RSSI数目多于非症状半球组(P<0.001)。RSSI与CMCT(r=0.512,P=0.043)及RMT(r=0.730,P<0.001)正相关。脑白质高信号、腔隙、扩大的血管周围间隙、微出血及脑萎缩与CMCT、RMT均无相关性。结论 RSSI与CMCT、RMT正相关,RSSI可能是导致CSVD相关运动障碍的主要影像学特征。

Objective To investigate the correlation of motor disturbance and imaging characteristics with transcranial magnetic stimulation motor evoked potentials(TMS-MEP) in patients with cerebral small vessel disease(CSVD).Methods A retrospective analysis was performed on CSVD patients who had undergone TMS-MEP and were hospitalized in Department of Neurology of Shenzhen People’s Hospital from January 2018 to August 2019. Baseline data were collected. MEP related electrophysiological data included central motor conduction time(CMCT) and resting motor threshold(RMT). Assess and quantify the imaging characteristics of CSVD, including recent small subcortical infarct(RSSI), lacuna of presumed vascular origin, white matter hyperintensity(WMH) of presumed vascular origin, enlarged perivascular space(ePVS), cerebral microbleed(CMB) and brain atrophy. All patients were divided into symptomatic hemisphere(SH) group and asymptomatic hemisphere(ASH) group based on the presence or absence of muscle weakness. The MRI imaging characteristics and MEP features between the two groups were compared. The correlation between CSVD MRI imaging characteristic and MEP was analyzed.Results A total of 202 CSVD patients including 404 hemispheres were enrolled, with an average age of 64.0±10.6 years old and 135 males(66.8%). 77 hemispheres(19.1%) in SH group and 327 ones(80.9%) in ASH group. CMCT and RMT in SH group were higher than that in ASH group(P=0.005 and P<0.001, respectively). The number of RSSI in SH group was more than that in ASH group(P<0.001). RSSI was positively correlated with CMCT(r=0.512, P=0.043) and RMT(r=0.730, P<0.001). CMCT and RMT had no correlation with lacuna, WMH, ePVS, CMB and brain atrophy.Conclusions RSSI was positively correlated with CMCT and RMT. RSSI may be involved in the motor disturbance due to CSVD.