脑卒中后白质完整性与上肢运动功能的关系

目的 应用扩散张量成像技术测量偏瘫患者内囊后肢的各向异性(FA)值,分析皮质脊髓束完整性与患侧上肢运动功能的关系.方法 选择17例亚急性期脑卒中后偏瘫患者,测量患侧及健侧内囊后肢FA值,并计算FA非对称比值,临床检测包括上肢运动功能指标(WMFT)及运动功能、平衡、感觉及关节功能综合评价指标(FM),利用线性相关分析FA非对称比值与患手FM 评分、WMFT 非对称比值及log WMFT之间的相关关系.结果 患手运动功能评分与内囊后肢FA非对称比值显著相关,FA非对称性比值与患手FM(R~2＝0.655,P＜0.002)呈线性负相关,与WMFT非对称性比值(R~2＝0.649,P＜0.002)、lg WMFT(R~2＝0.636,P＝0.002)以及握力非对称性比值(R~2＝0.414,P=0.02)均呈线性正相关.结论 偏瘫患者亚急性期皮质脊髓束完整性与上肢运动功能显著相关;利用扩散张量成像技术可早期监测皮质脊髓束的完整性.

Relationship between upper-extremity motor functional outcomes and the white matter integrity in patients after stroke

Objective To explore the relationship between upper-extremity motor functional outcomes and the brain white matter integrity with diffusion tensor imaging (DTI). Methods Seventeen patients with moderate upper-extremity impairment were enrolled and were assessed with the Wolf Motor Function Test (WMFT) and the upper limb portion of the Fugl-Meyer (FM) motor assessment battery. The structural integrity of the posterior limb of the internal capsule (PLIC) was assessed through examining the fractional anisotropy (FA) asymmetry between the ipsilesional and contralesional PLIC. Linear regression analysis was performed with FA asymmetry and the upper limb FM scores, WMFT asymmetry, log WMFT and grip strength asymmetry. Results FA asymmetry was strongly related to FM score (R~2=0.655, P＜0.002), WMFT asymmetry score (R~2=0.649, P＜0.002), lg WMFT (R~2＜0.636, P=0.002) and the grip asymmetry score (R~2 =0.414, P=0.02), respectively. Conclusion The clinical motor function is closely related to the white matter integrity of the internal capsule in patients 3-9 months after stroke. DTI assessment of the relative degree of white matter integrity in the internal capsule may be an useful approach to interpret motor deficits in patients with upper limb motor dysfunction and predict the motor function recovery.