弥散张量成像对重复经颅磁刺激治疗缺血性脑卒中偏瘫患者的疗效评估

目的应用弥散张量成像（DTI)评估重复经颅磁刺激（rTMS）治疗缺血性脑卒中偏瘫患者的疗效，探讨rTMS改善缺血性脑卒中患者运动功能的潜在机制。 方法选取包头市中心医院康复医学科自2020年10月至2021年12月收治的40例脑卒中患者为研究对象，按照随机数字表法分为治疗组和对照组，每组20例。所有患者均给予基础药物治疗及常规康复治疗，治疗组在此基础上增加低频（1 Hz）rTMS治疗。每周治疗5 d，总疗程为4周。所有患者均在治疗前和治疗结束时进行美国国立卫生研究院卒中量表（NIHSS）、简式Fugl-Meyer运动功能量表（FMA）、改良巴氏指数评定量表（MBI）评分，同时收集治疗前后患者DTI中感兴趣区（放射冠区、内囊后肢）的各向异性分数（FA）值并计算出相对各项异性分数（rFA）后进行比较分析。 结果经过4周治疗后，治疗组、对照组患者的NIHSS评分均较治疗前下降，FMA、MBI评分均较治疗前有所提高（P<0.05），且治疗组提高更显著（P<0.01）。DTI参数：治疗组放射冠区、内囊后肢的FA、rFA值均较治疗前有所提高（P<0.05）；对照组治疗前后放射冠区、内囊后肢的FA、rFA值差异无统计学意义（P>0.05）。相关性分析显示，治疗组病灶侧放射冠区的FA、rFA值与NIHSS评分呈负相关（P<0.05），与FMA、MBI评分呈正相关（P<0.05）；内囊后肢的FA、rFA值与MBI评分呈正相关（P<0.05），与NIHSS、FMA评分无明显相关性（P>0.05）。 结论常规康复治疗、rTMS治疗均能提高缺血性脑卒中患者的运动功能，二者结合效果更为突出。经DTI证实，传统康复治疗结合rTMS可改善神经纤维束的完整性，这可能是rTMS改善缺血性脑卒中偏瘫患者运动功能的潜在机制。

Evaluate the therapeutic efficacy by diffusion tensor imaging for ischemic stroke hemiplegia patients treated with repetitive transcranial magnetic stimulation

ObjectiveTo evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of ischemic stroke patients with hemiplegia by diffusion tensor imaging (DTI), and to explore the potential mechanism of rTMS in improving motor function in patients with ischemic stroke. MethodsForty stroke patients admitted by the Rehabilitation Medicine Department of Baotou Central Hospital from October 2020 to December 2021 were selected as the research objects, and were divided into treatment group and control group according to the random number table, with 20 patients in each group. All patients were given basic medication and conventional rehabilitation treatment, and low-frequency (1 Hz) rTMS treatment was added to the treatment group on this basis. The treatment was given 5 d per week for a total duration of 4 weeks. The National Institutes of Health stroke scale (NIHSS), the Fugl-Meyer motor function assessment (FMA), and the modified Bartholomew index (MBI) scores were collected before and after treatment. The relative fractional anisotropy scores (rFA) were calculated and then compared and analyzed. ResultsAfter 4 weeks of treatment, the NIHSS scores of patients in the treatment and control groups decreased compared with before, and the FMA and MBI scores improved compared with before receiving treatment (P<0.05), and the improvement was more significant in the treatment group (P<0.01). The DTI parameters before and after treatment, in which the FA and rFA values of the radiographic coronal area and the posterior limb of the internal capsule in the treatment group were improved compared with those before treatment (P<0.05), and the differences in FA and rFA values of the radiographic coronal area and the posterior limb of the internal capsule in the control group before and after treatment were not statistically significant (P>0.05). Correlation analysis showed that the FA and rFA values of the radiographic coronal area on the side of the lesion in the treatment group were negatively correlated with the NIHSS score (P<0.05) and positively correlated with the FMA and MBI scores (P<0.05); the FA and rFA values of the posterior limb of the internal capsule were positively correlated with the MBI score, and did not significantly correlate with the NIHSS and FMA scores (P>0.05). ConclusionConventional rehabilitation treatment and rTMS treatment can improve the motor function of patients with ischemic stroke, and the combination of the two is more effective. DTI confirmed that traditional rehabilitation therapy combined with rTMS can improve the integrity of nerve fiber bundle, which may be the potential mechanism of rTMS to improve motor function in patients with ischemic stroke hemiplegia.