摘要
目的运用血氧水平依赖功能磁共振成像(BOLD-MRI)技术探讨纹状体内囊梗死(SCI)后相关皮层功能区重组的动态变化过程及其对偏瘫上肢运动功能恢复的影响。方法选择扬州大学附属医院卒中中心自2015年6月至2017年12月收治的17例初次发病的SCI伴单侧严重上肢瘫患者为研究对象.并选取15例同期临床招募的健康志愿者为对照组。于患者发病1周内、1个月及3个月时行偏瘫侧被动手指屈伸任务下BOLD-fMRI扫描,通过SPM8软件观察不同时期脑功能区激活情况。通过Xjview软件对Bold-fMRI相应脑激活区激活进行观察并同标准脑激活区进行比较。采用简化Fugl-Mcyer量表上肢运动功能部分(FM-UL)评分对人选患者患侧上肢运动功能进行跟踪评定。结果对照组被动手指屈伸任务下主要脑激活区位于对侧SMC区及双侧SMA区。不同患者早期BOLD-fMRI感兴趣区激活特点可分为3种类型:I型患者以患侧为主,双侧SMC区及SMA区激活;1个月及3个月时健侧SMC区激活逐渐减弱.患侧SMC区激活逐渐增强。Ⅰ型患者单纯患侧SMC区及SMA区激活,1个月时表现为以健侧为主双侧SMC区及SMA区明显激活;3个月时患侧SMC区激活进一步增强,健侧减弱。Ⅲ型患者仅患侧SMC区或M1区激活,1个月时患侧SMC区激活轻度增加;3个月时患侧SMC区激活进一步增强,SMA区未见激活表现。发病初期Ⅰ型、Ⅱ型及Ⅲ型患者患肢FM-UL评分分别为(10.0±3.3)分.(10.6±5.7)分及(9.2±4.0)分,差异无统计学意义(P>0.05);发病1个月后Ⅰ型Ⅱ型及Ⅰ型患者FM-UL评分分别为(52.3±4.6).分、(36.6±2.4)分及(12.5±3.0)分,差异有统计学意义(P<0.05);发病3个月后Ⅰ型、Ⅱ型及Ⅲ型患者FM-UL评分分别为(63.7±2.9)分.(59.2±3.1)分及(13.3±5.0)分,差异有统计学意义(P<0.05)。结论颅内功能重组是一个动态的过程,患侧SMC区的早期及动态激活增强、健侧半球SMC区及双侧SMA区的早期激活在脑卒中康复进程中具有重要意义。
Objective To study the dynamic changes of cortical functional reorganization in striatocapsular infarction(SCI)by blood oxygenation level dependent-functional MR imaging(BOLD-fMRI)and its relation with recovery of motor function in the upper extremity of the hemiplegia.Methods A total of 17 patients with SCI at first onset and combined with upper extremity of the hemiplegia,admitted to our hospital from June 2015 to December 2017.were included;15 healthy volunteers recruited at the same time were selected as control group.Within 1 week of onset,and 1 and 3 months after onset,BOLD-fMRI was performed under passive finger flexion and extension task on hemiplegia side,and the activation of brain functional areas at different stages was observed by SPM8 software.The Xjview software was used to observe the activation of the corresponding brain activation areas in BOLD-fMRI and make dynamic comparison with the standard brain activation areas.The upper limb part of Fugl-Mcyer(FM-UL)scale was used to track the motor function of the upper limb.Results The activation in the control group was mainly located in the contralateral sensorimotor cortex(SMC)and bilateral supplementary motor area(SMA).The regions of interest in early BOLD-fMRI for stroke patients at early stage can be divided into 3 types.The activation in patients with type 1 was mainly at the affected side,enjoying bilateral SMC and SMA activation;1 and 3 months after onset,activation at the contralateral SMC decreased gradually,and activation at the ipsilateral SMC region gradually increased.The activation in patients with type Ⅱ was merely at the ipsilateral SMC and SMA regions;1 month after onset,bilateral SMC area and SMA area were significantly activated,mainly at the contralateral side;3 months after onset,the SMC area was further activated at the ipsilateral side and weakened at the ipsilateral side.The activation in patients with type Ⅲ was only at SMC or Ml at the ipsilateral side;1 month after onset,activation at the ipsilateral SMC area increased slightly;3 months after onset,activation at the ipsilateral SMC area further enhanced,and SMA area was without activation performance.The FM-UL scores of the affected limbs of patients with type Ⅰ,type Ⅱ and type Ⅲ at the early onst were I0.0±3.3,10.6±5.7 and 9.2±4.0.respectively,without statistical differences(P>0.05);1 month after onset,the FM-UL scores of patients with typeⅠ,type Ⅱ and type Ⅲ were 52.3±4.6.36.6±2.4 and I2.5±3.0.respectively,with significant differences(P<0.05);3 months after onset,FM-UL scores of patients with type Ⅰ,type Ⅱ and type Ⅲ were 63.7±2.9.59.2±3.1 and 13.3±5.0,respectively,with statistical differences(P<0.05).Conclusions Intracranial functional reorganization is a dynamic process.The early and dynamic activation of the affected SMC'region and the early activation of the contralateral SMC region and bilateral SMA regions arc of great significance in the process of stroke rehabilitation.
作者
周龙江
李华东
赵义
符雪涛
张新江
王苇
Zhou Longjiang;Li Huadong;Zhao Yi;Fu Xuetao;Zhang Xinjiang;Wang Wei(Medical Imaging Center,Affiliated Hospital of Yangzhou University,Yangzhou 225009,China;Department of Neurology,Affiliated Hospital of Yangzhou University,Yangzhou 225009,China;Neurosurgery Postdoctoral Workstation of Jinling Clinical Medical College,Nanjing Medical University(General Hospital of Eastern Theater Command of People’s Liberation Army))
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2021年第5期469-476,共8页
Chinese Journal of Neuromedicine
基金
江苏省博七后科研资助计划项目(2020Z117)
扬州市“十三五”科教强卫工程重点人才资助项目(ZDRC201818)。
关键词
脑卒中
功能磁共振成像
功能重组
Stroke
Functional magnetic resonance imaging
Functional reorganization