亚急性期脑梗死患者皮层兴奋性与手功能相关性研究

Correlation between Cortical Excitability and Hand Function in Patients with Subacute Cerebral Infarction

目的:观察亚急性期脑梗死患者执行手掌抓握任务大脑运动预知过程的皮质激活特征,探讨脑梗死患者皮层兴奋性与手功能的相关关系。方法:选择2017年1月—2018年3月在中山大学附属第一医院住院治疗的亚急性期脑梗死患者25例为试验组,与试验组性别、年龄相匹配的健康中老年人25例为对照组。采用事件相关电位采集2组受试者执行提示下手掌抓握任务的脑电信号,分析运动启动前大脑皮质伴随性负波(CNV)的潜伏期和波幅;采用上肢动作研究量表(ARAT)评定试验组手功能;分析CNV波幅与ARAT评分的相关关系。结果:与对照组比较,试验组执行左手抓握任务和右手抓握任务时中央脑区CNV潜伏期均明显缩短,且中央脑区、同侧额叶及初级运动区、对侧额叶及初级运动区CNV波幅均明显增大,差异具有统计学意义(P<0.05);与试验组执行左手抓握任务时CNV潜伏期比较,右手抓握任务时CNV潜伏期无明显差别,差异无统计学意义(P>0.05),中央脑区Cz电极波幅大于对侧初级运动区C4电极波幅,差异具有统计学意义(P<0.05)。试验组执行右手抓握任务时,非损伤侧额叶、初级运动区、中央脑区的CNV波幅与ARAT呈中度相关关系(F4:r=0.510;C4:r=0.442;Fz:r=0.428);执行左手抓握任务时,非损伤侧额叶、初级运动区、中央脑区的CNV波幅与ARAT呈中度相关关系(F4:r=0.422;C4:r=0.496;Fz:r=0.446)。结论:亚急性期脑梗死患者运动预知的神经机制存在异常,大脑运动准备时间延长,非损伤侧额叶和初级运动区在运动预知过程中代偿性过度激活,大脑皮层激活程度与手功能障碍之间存在相关性。CNV可能是脑梗死患者手功能障碍严重程度的神经指标。

Objective:To observe the cortical activation characteristics of cerebral motor prediction in patients with subacute cerebral infarction in the palm grasping task,and to explore the correlation between cortical excitability and hand function in patients with cerebral infarction.Methods:A total of twenty-five patients with subacute cerebral infarction who were hospitalized in the first affiliated hospital of Sun Yat-sen University from January 2017 to March 2018 were selected as the experimental group,and twenty-five healthy individuals matched with the gender and age of the experimental group were selected as the control group.Event related potentials were used to collect the electroencephalogram signals of the two groups in the palm grasping task,and then analyzed the latencies and amplitudes of the contingent negative variation(CNV)in the cerebral cortex before motor activation.Action Research Arm Test(ARAT)was used to assess the function of hand,and the correlation between CNV amplitude and ARAT score was analyzed.Results:Compared with the control group,the CNV latencies in the midline region of the experimental group were significantly shorter during the left hand grasp and right hand grasp,and the CNV amplitude were statistically significantly increased in the midline,bilateral frontal lobe and primary motor area(M1)(P<0.05).There was no significant difference in CNV latency between left hand grasp and right hand grasp in the experimental group(P>0.05),with the CNV amplitude of Cz electrode in midline statistically significantly greater than that of C4 electrode in contralateral M1(P<0.05).There was moderate correlation between the CNV amplitude and ARAT in the non-lesioned frontal lobe,M1 and midline during right hand grasp in the experimental group(F4:r=0.510;C4:r=0.442;Fz:r=0.428).There was moderate correlation between the CNV amplitude and ARAT in the non-lesioned frontal lobe,M1 and midline during left hand grasp in the experimental group(F4:r=0.422;C4:r=0.496;Fz:r=0.446).Conclusion:The neural mechanism of motor anticipation in patients with subacute cerebral infarction is abnormal,the time of brain motor preparation is prolonged,and the non-lesioned frontal lobe and M1 are hyperactivity compensatory during motor anticipation.There was moderate correlation between the cortical excitability and hand dysfunction.Therefore,CNV may be a neural indicator of the severity of hand dysfunction in patients with cerebral infarction.