大脑脚非对称性比例与非优势半球出血性镜像卒中后语言、运动及日常生活能力变化的相关性研究

Correlation between the Asymmetry Rate of Cerebral Peduncle and Changes of Language,Motor Function and Activity of Daily Life after Hemorrhagic Mirror Stroke of Non-Dominant Hemisphere

目的探讨非优势半球出血性镜像卒中(hemorrhagic mirror stroke of non-dominant hemisphere,HMSNH)前后患者语言功能、非优势侧肢体运动功能、日常生活能力的变化,以及大脑脚非对称性比例(asymmetry rate of cerebral peduncle,ARCP)与这些变化的相关性。方法回顾性分析2017年9月—2020年6月16例HMSNH患者的临床资料,根据HMSNH后1周内最早的MRI数据测量ARCP,根据首次卒中后1周内的功能MRI数据测量双侧大脑脚层面传导束各向异性分数(fractional anisotropy,FA)。比较HMSNH发生前后失语商(aphasia quotient,AQ)、非优势侧肢体Fugl-Meyer运动功能评估量表(Fugl-Meyer assessment scale,FMA)评分、Barthel指数(Barthel index,BI)变化,分析ARCP与HMSNH后AQ、FMA评分、BI及FA值的相关性,以及ARCP与HMSNH前后AQ、FMA评分、BI差值的相关性。结果首次卒中后同侧大脑脚FA值低于对侧(0.35±0.19 vs.0.87±0.10,P<0.001),且与ARCP呈负相关(r=-0.871,P<0.001)。HMSNH前后AQ分别为77.59±7.00分、39.31±14.46分,FMA评分分别为90.38±5.16分、58.13±16.08分,BI分别为94.69±4.99分、53.75±14.89分,差异均有统计学意义(P<0.001)。ARCP与HMSNH后AQ(r=-0.739,P=0.001)、FMA评分(r=-0.807,P<0.001)、BI(r=-0.757,P<0.001)呈负相关,与HMSNH前后AQ(r=0.717,P=0.002)、FMA评分(r=0.885,P<0.001)、BI(r=0.722,P=0.002)差值呈正相关。结论ARCP与HMSNH发生后患者语言功能、非优势侧肢体运动功能、日常生活能力的变化关系密切,ARCP与HMSNH发生后上述功能评分呈负相关。

Objective To investigate the changes of language,motor function and activity of daily life before and after hemorrhagic mirror stroke of non-dominant hemisphere(HMSNH),and the correlation between the asymmetry rate of cerebral peduncle(ARCP)and the above changes.Methods The clinical data of 16 patients with HMSNH from September 2017 to June 2020 were retrospectively analyzed.The ARCP was calculated based on the data of MRI within one week of HMSNH.Fractional anisotropy(FA)of bilateral cerebral peduncle were measured according to the data of functional MRI within one week after the first stroke.The changes of aphasia quotient(AQ),Fugl-Meyer assessment(FMA)scale of limbs of non-dominant side,and Barthel index(BI)before and after HMSNH were compared,and the correlation of ARCP with the above functional changes were analyzed.Results The FA value of lesion ipsilateral cerebral peduncle was lower than that of contralateral cerebral peduncle after the first stroke(0.35±0.19 vs.0.87±0.10;t=9.587,P<0.001),and the ARCP was negatively correlated with the lesion ipsilateral FA after the first stroke(r=-0.871,P<0.001).Before and after HMSNH,AQ was 77.59±7.00 and 39.31±14.46,FMA was 90.38±5.16 and 58.13±16.08,BI was 94.69±4.99 and 53.75±14.89,respectively;and the differences of the above scores all had statistical significance(P<0.001).The ARCP were negatively correlated with AQ(r=-0.739,P=0.001),FMA(r=-0.807,P<0.001)and BI(r=-0.757,P<0.001)after HMSNH,and positively correlated with the changes of AQ(r=0.717,P=0.002),FMA(r=0.885,P<0.001)and BI(r=0.722,P=0.002)before and after HMSNH.Conclusions The ARCP was closely correlated with the changes of language,motor function and activity of daily life after the HMSNH,and ARCP was negatively correlated with the above functional scores after HMSNH.