CAJ | 학술논문

目的采用扩散张量成像技术(DTI)探讨慢性缺血性脑卒中患者,下行运动纤维束的完整性与运动预后的关系.方法收集2012年4月至2013年12月东南大学附属中大医院慢性缺血性脑卒中患者47例(卒中组);匹配健康志愿者20名(健康对照组).采集DTI数据,重建双侧下行运动纤维束,包括皮质脊髓束(CST)及辅助运动纤维束(aMF),并评估卒中组患侧与健侧CST及全部下行运动纤维束(CST+ aMF)数量,观察该值及其偏侧性指数(LI)与Fugl-Meyer上肢运动量表(FMA)的相关性.并根据下行纤维束损伤形态将卒中组分为CST+ aMF(组1),无CST及aMF(组2),CST(组3)和aMF(组4)四个亚组,观察各组FMA变化.结果卒中组患侧CST及(CST+ aMF)的数量均明显低于健康对照组(均P＜0.01,CST:26±30,CST+ aMF:37±37).组1、2、3间FMA比较差异有统计学意义(55±12、16±10、34±15,F=24.2,P＜0.01).CSTLI、(CST+ aMF)LI与FMA呈显著线性负相关(均P＜0.01,r=-0.653;r=-0.692),(CST+ aMF)LI与FMA相关性较CSTLI更显著.结论相较于CST,CST+ aMF能更好地评估卒中患者运动预后情况.在卒中患者运动功能康复过程中,要重视aMF的补偿作用,从而指导临床进行个性化的康复治疗.
목적 채용확산장량성상기술(DTI)탐토만성결혈성뇌졸중환자,하행운동섬유속적완정성여운동예후적관계.방법 수집2012년4월지2013년12월동남대학부속중대의원만성결혈성뇌졸중환자47례(졸중조);필배건강지원자20명(건강대조조).채집DTI수거,중건쌍측하행운동섬유속,포괄피질척수속(CST)급보조운동섬유속(aMF),병평고졸중조환측여건측CST급전부하행운동섬유속(CST+ aMF)수량,관찰해치급기편측성지수(LI)여Fugl-Meyer상지운동량표(FMA)적상관성.병근거하행섬유속손상형태장졸중조분위CST+ aMF(조1),무CST급aMF(조2),CST(조3)화aMF(조4)사개아조,관찰각조FMA변화.결과 졸중조환측CST급(CST+ aMF)적수량균명현저우건강대조조(균P＜0.01,CST:26±30,CST+ aMF:37±37).조1、2、3간FMA비교차이유통계학의의(55±12、16±10、34±15,F=24.2,P＜0.01).CSTLI、(CST+ aMF)LI여FMA정현저선성부상관(균P＜0.01,r=-0.653;r=-0.692),(CST+ aMF)LI여FMA상관성교CSTLI경현저.결론 상교우CST,CST+ aMF능경호지평고졸중환자운동예후정황.재졸중환자운동공능강복과정중,요중시aMF적보상작용,종이지도림상진행개성화적강복치료.
Objective To evaluate the relationship between structural integrity of descending motor tracts and motor status in patients with chronic ischemic stroke using diffusion tensor imaging (DTI).Methods From April 2012 to December 2013,47 patients with chronic ischemic strok were recruited along with 20 matched normal controls.The DTI data was acquired and preprocessed.Bilateral descending motor tracts includingcorticospinal tract (CST) and alternate motor fibers (aMF) were constructed.The descending motor tracts numberswere acquired and the relationships between laterality indices (LI) of descending motor tracts numbers and FMA were assessed.The patients were grouped into (CST + aMF) group (group1),no (CST + aMF) group (group2),CST group (group3) and aMF group (group4) according to the damage morphology of descending motor tracts.Observing the changes of each group.Results Ipsilesional CST and theentiredescending motor tracts numbers (aMF + CST) were lower in the patient group as compared to the control group(P ＜ 0.01,CST:26 ± 30,CST + aMF:37 ± 37).The FMA were statistically different between group1,2,3(55 ± 12,16 ± 10,34 ± 15,F =24.2,P ＜0.01).The LI of CST and (CST + aMF) significantly diagnosed motor impairment (P ＜ 0.01,r =-0.653;r =-0.692).Meanwhile,it is a stronger parameter when entire descending motor tracts were combined comparing to using the CST only.Conclusions The integrity of entire descending motor tracts,not merely the CST,appears to account for stroke recovery.Our results highlight the role of aMFin compensatory function,which may be used as a target in future rehabilitative treatmentsto promoting motor function recovery at the most extent.