基于体素症状病变映射方法对急性脑卒中后疲劳症状的研究

Study on fatigue symptoms after acute stroke based on voxel lesion mapping

目的旨在确定急性脑卒中患者中功能性脑损伤与卒中后疲劳(PSF)的相关。方法回顾性分析2019年1月至2022年6月中国科学技术大学附属第一医院(安徽省立医院)连续收治的首次急性缺血性脑卒中患者的临床资料。卒中后疲劳评分采用疲劳严重程度量表进行评分。所有参与者均由3位高年资神经内科医师进行评估。患者均进行3.0T磁共振全脑扫描,包括弥散加权成像。人工勾画脑梗死病变区域,制作成相应图像模板。采用基于体素病变症状映射图谱(VLSM)来研究病变的位置与卒中后疲劳的发生和严重程度之间的关系。通过翻转对侧病变,也进行同样的分析,并且采用多变量逻辑回归分析来验证功能性脑损伤和PSF的相关性。结果在361例急性卒中患者中,142例(39.3%)患者在急性期被诊断为疲劳,116例(35.8%)患者在卒中后6个月随诊时被诊断为疲劳。VLSM分析显示,在6个月的随访中,右侧丘脑的聚集性病变与PSF的发生和严重程度显著相关(P<0.05)。与对侧病灶翻转分析相比,在卒中的急性期没有发现明显的聚集性疾病。翻转分析结果无统计学意义(P=0.311)。多变量逻辑回归证实,右丘脑病变负荷(OR=2.67,95%CI 1.46~4.88)是6个月PSF的预测因素。结论右侧丘脑病变增加了卒中6个月后出现卒中后疲劳症状的风险。

Objective To determine the relationship between functional brain damage and post-stroke fatigue(PSF)in patients with acute stroke.Methods The clinical data of patients with the first-ever acute ischemic stroke admitted to the First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital)from January 2019 to June 2022 were retrospectively analyzed.Post-stroke fatigue was scored using the Fatigue Severity Scale.All participants were evaluated by three senior neurologists.All patients underwent a 3.0T magnetic resonance whole brain scan,including diffusion-weighted imaging.The cerebral infarction lesion area was manually delineated,and the corresponding image template was made.Voxel-based lesion symptom mapping(VLSM)was used to investigate the relationship between lesion location and the occurrence and severity of PSF.The same analysis was performed by flipping the contralateral lesion,and multivariate logistic regression analysis was used to verify the correlation between functional brain damage and PSF.Results Among 361 patients with acute stroke,142(39.3%)patients were diagnosed with fatigue in the acute phase,and 116(35.8%)patients were diagnosed with fatigue 6 months after stroke.VLSM analysis showed that clustered lesions in the right thalamus were significantly associated with the occurrence and severity of PSF at 6-month follow-up(P<0.05).In contrast to contralateral lesion inversion analysis,no significant clustering of disease was found during the acute phase of stroke.The results of the flip analysis were not statistically significant(P=0.311).Multivariable logistic regression confirmed that right thalamic lesion burden(OR=2.67,95%CI 1.46-4.88)was an independent predictor of 6-month PSF.Conclusion Right thalamic lesions increase the risk of poststroke fatigue symptoms 6 months after stroke.