基于近红外光谱成像技术的脑卒中后偏瘫步态脑功能成像研究

Study on Brain Functional Imaging of Hemiplegic Gait after Stroke Based on Functional Near-infrared Spectroscopy CHEN Hongxin,LIN Qiang,LUO Siyi,LI Qinyi,LIN Youwei,LIAOWeihao,ZHAOBiyi,ZHENGYuxin,LANGShijuan,OU Haining,LIANGJunjie

目的:采用近红外光谱成像技术(fNIRS)动态追踪脑卒中后偏瘫病人步行时脑激活及脑网络的变化过程,探讨脑卒中后运动-认知相关脑区的脑功能机制。方法:采用横断面研究方式,纳入2020年10月—2020年12月在广州医科大学附属第五医院康复科住院的脑卒中病人10例为脑卒中组,招募10名健康老年人为对照组。对两组受试者进行步行同步fNIRS评估,比较两组受试者双侧前额叶皮质(PFC)和顶叶运动皮质(MC)含氧血红蛋白(HbO)浓度、脑功能连接(FC)情况。结果:脑卒中组患侧PFC的HbO浓度明显高于对照组非优势侧/右侧PFC(P<0.05);而脑卒中组健侧PFC的HbO浓度也明显高于对照组优势侧/左侧PFC(P<0.05)。脑卒中组患侧MC的HbO浓度明显高于对照组非优势侧/右侧MC(P<0.05);而脑卒中组健侧MC的HbO浓度高于对照组优势侧/左侧MC(P<0.05)。与对照组相比,脑卒中组双侧MC、健侧MC-健侧PFC、健侧MC-患侧PFC、患侧MC-健侧PFC和患侧MC-患侧PFC的脑功能连接明显增强(P<0.01)。结论:与健康老年人相比,脑卒中病人步行时的双侧前额叶皮质及患侧运动皮质的激活均增多,且前额叶与运动皮质间的功能连接也明显增强,提示前额叶的认知脑区在脑卒中后偏瘫病人的步行中起到了重要的代偿作用,可用于指导脑卒中病人步态康复策略的制定。

Objective:To explore the l mechanism of motion-cognition related brain regions after stroke by functional near-infrared spectroscopy(FNIRS).Methods:Ten stroke patients from Fifth Affiliated Hospital of Guangzhou Medical University as stroke group and ten healthy elders as control group were recruited,respectively.The oxygenated hemoglobin(HbO)and functional connection(FC)under fNIRS during walking were compared between the two groups in the bilateral prefrontal cortex(PFC)and parietal motor cortex(MC).Results:The HbO concentration of PFC on the affected side of the stroke group was significantly higher than that of the undominant/right PFC of the control group(P<0.05).The HbO concentration of PFC on the unaffected side of stroke group was significantly higher than that of the dominant/left PFC of control group(P<0.05).The HbO concentration of MC on the affected side of stroke group was significantly higher than that of the undominant/right MC of the control group(P<0.05).The HbO concentration of MC on the unaffected side of stroke group was significantly higher than that of the dominant/left MC of the control group(P<0.05).Compared with control group,the FC of bilateral MC,unaffected MC-unaffected PFC,unaffected MC-affected PFC,affected MC-unaffected PFC,and affected MC-affected PFC were all significantly increased in stroke group(P<0.01).Conclusion:The activation of bilateral PFC and affected MC increased,and FC between PFC and MC increased in stroke patient compared with healthy elder subjects,which indicated the important compensation role of PFC in stroke patients with hemiplegia during walking,and could help guiding gait rehabilitation strategy after stroke.