李颖,杨雅馨,袁海峰,等.弥散张量成像联合运动诱发电位在脑卒中患者上肢运动功能评估中的应用研究[J].中华物理医学与康复杂志,2025,47(1):13-18
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| 弥散张量成像联合运动诱发电位在脑卒中患者上肢运动功能评估中的应用研究 |
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| DOI：10.3760/cma.j.cn421666-20220605-00608 |
| 中文关键词: 弥散张量成像 运动诱发电位 脑卒中 上肢运动功能 预后 |
| 英文关键词: Diffusion tensor imaging Motor evoked potentials Stroke Upper limb motor function Prognosis |
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| 中文摘要: |
| 目的 观察弥散张量成像（DTI）联合运动诱发电位（MEP）在脑卒中患者上肢运动功能评估中的应用效果。 方法 选取合并上肢运动功能障碍的脑卒中患者37例，分别于发病第4周、12周、24周，采用上肢Fugl-Meyer评分（FMA-UE）、美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）、Barthel指数（BI）、偏瘫手功能分级对患者开展临床康复评定，并进行DTI和MEP检查。以MEP波形是否存在，将患者细分为MEP阳性组和MEP阴性组。分析DTI和MEP参数与FMA-UE结果之间的相关性，利用受试者工作特征（ROC）曲线评估DTI预测手功能的效果，探讨采用MEP预测手功能恢复的灵敏度和特异度，以FMA-UE为结局指标，对DTI和MEP参数进行多元线性回归分析。 结果 病后第12周、24周，患者内囊后肢各项异性分数平均值不对称指数（FAa）、大脑脚FAa与FMA-UE均呈负相关，采用内囊后肢FAa、大脑脚FAa预测患者手功能恢复至实用手水平的最佳截点分别为0.155、0.145。37例患者中，共8例患者（MEP阳性组）的MEP能被引出，且手功能全部恢复至实用手水平。采用MEP预测患者手功能恢复至实用手水平的灵敏度为80%，特异度为100%。多元线性回归分析显示，大脑脚FAa和MEP对发病第24周时患者上肢运动功能的预测准确率为77.2%（P＜0.05）。MEP阴性组中，有2例患者的手功能恢复至实用手水平，其中1例患者的FAa＜0.145，1例患者的FAa＞0.145。当MEP未能被引出时，联合DTI预测患者手功能恢复至实用手水平的灵敏度为50%，特异度为81.5%。 结论 DTI联合MEP可作为评估脑卒中患者上肢运动功能预后的生物学指标。 |
| 英文摘要: |
| Objective To observe effectiveness of combining diffusion tensor imaging (DTI) with motor evoked potentials (MEPs) in evaluating the upper limb motor functioning of stroke survivors. Methods Thirty-seven stroke survivors with upper limb motor dysfunction were selected. At the 4th, 12th and 24th week after their onset, each was were assessed using Fugl-Meyer Upper Limb (FMA-UE) scoring, the National Institutes of Health stroke scale (NIHSS), the modified Rankin Scale (mRS), the Barthel Index (BI) and hemiplegic hand function classification. DTI was also applied and MEPs were measured. The patients were divided into an MEP positive group and an MEP negative group according to the existence of the MEP waveform. The DTI and MEP parameters were correlated with the FMA-UE scores, linear regressions were evaluated and a receiver operating characteristics curve was prepared to estimate the utility of DTI in predicting hand function. The sensitivity and specificity of MEPs in predicting hand function recovery were evaluated. Results The asymmetry index (FAa) of the average anisotropy score of the posterior limb of the internal capsule and the FAa of the cerebral peduncle were both significantly correlated with the FMA-UE scores at the 12th and 24th weeks. The best cut-off points for predicting functional recovery of a patient′s hand were 0.155 for the FAa of the posterior limb of the internal capsule and 0.145 for the cerebral peduncle. Among the 37 patients, the MEPs of 8 (the MEP positive group) could be extracted, and their hand functions recovered completely. The sensitivity of the MEPs in predicting the complete recovery of hand function was 80% with 100% specificity. The linear regression analysis showed 77% prediction accuracy for the FAa and MEPs of the cerebral peduncle for upper limb motor function at the 24th week after onset. In the MEP negative group, two patients completely recovered their hand function, with one′s FAa less than 0.145, and the other′s more than 0.145. When the MEP was negative, the sensitivity of DTI in predicting the recovery of hand function was 50% with 81.5% specificity. Conclusions DTI combined with MEPs can be used as an index to evaluate the prognosis of upper limb motor function in stroke patients. |
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