剪切波弹性成像评估脑卒中肢体肌力变化及预后的应用价值

Application value of shear wave elastography in evaluating the changes of limb muscle strength and prognosis of stroke

目的应用实时剪切波弹性成像(SWE)评估脑卒中并下肢痉挛患者治疗前后下肢肌力的变化情况,探讨其对预后的判断价值。方法选取我院收治的脑卒中后下肢痉挛患者40例(研究组)和同期健康志愿者40例(对照组)。对照组行俯卧位和仰卧位左侧腓肠肌SWE扫查,研究组在治疗前和治疗4周后分别行俯卧位和仰卧位双侧腓肠肌SWE扫查,比较两组腓肠肌杨氏模量的差异。研究组患者治疗结束后随访1年,根据是否出现致残/死结局分为预后良好组和预后不良组,分析杨氏模量值与患者预后的关系。Logistic回归分析脑卒中患者预后不良的危险因素。结果治疗前,研究组俯卧位和仰卧位患侧腓肠肌杨氏模量值较健侧和对照组均增高,差异均有统计学意义(均P<0.05);治疗后,研究组患侧腓肠肌杨氏模量值较治疗前降低,差异均有统计学意义(P<0.05)。随访1年,研究组12例患者预后不良,致残/死率为30%(12/40)。单因素分析显示,治疗后俯卧位和仰卧位患侧腓肠肌杨氏模量值较治疗前均增高与脑卒中患者的预后有关(均P<0.05)。多因素Logistic回归分析显示,治疗后俯卧位和仰卧位腓肠肌杨氏模量值增高均为脑卒中患者预后不良的危险因素(均P<0.05)。结论SWE不仅可客观定量评估脑卒中患者下肢肌力变化情况,还能较为准确地判断患者预后,具有较好的临床应用价值。

Objective To evaluate the changes of lower limb muscle strength in stroke patients with lower extremity spasticity by real-time shear wave elastography(SWE)before and after treatment,and to explore its prognostic value.Methods A total of 40 patients with lower extremity spaticity after stroke admitted to our hospital(study group)and 40 healthy volunteers(control group)were selected.Left gastrocnemius muscle SWE scan was performed in the prone and supine position in the control group,and bilateral gastrocnemius muscle SWE scan was performed in the prone and supine position in the study group before treatment and 4 weeks after treatment,respectively,the differences in the above parameters between the two groups were compared.Patients in the study group were followed up for one year after treatment,and they were devided into good prognosis group and poor prognosis group according to whether there was disability/death outcome.The relationship between Young’s modulus and prognosis of patients was analyzed.Logistic regression was used to analyze the risk factors of poor prognosis in stroke patients.Results Before treatment,the Young’s modulus of the affected side of the study group in the prone position and supine position were higher than those of the healthy side and the control group,and the difference were statistically significant(all P<0.05).After treatment,the Young’s modulus of the affected side of the study group was lower than that before treatment,and the difference was statistically significant(P<0.05).After one year of follow-up,12 patients in the study group had poor prognosis,with a disability/fatality rate of 30%(12/40).Univariate analysis showed that Young’s modulus of gastrocnemius muscle in prone and supine positions increased after treatment compared with before treatment,which were related to the prognosis of stroke patients(all P<0.05).Multivariate Logistic regression analysis showed that increased Young’s modulus of gastrocnemius muscle in prone and supine position after treatment were risk factors for poor prognosis of stroke patients(all P<0.05).Conclusion SWE can not only assess the changes in muscle strength of the lower limbs of stroke patients objectively and quantitatively,but also accurately judge the prognosis of patients,which has better clinical application value.