Chang Won Hyuk, Park Eunhee, Lee Jungsoo, Lee Ahee, Kim Yun-Hee
From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.H.C., E.P., J.L., A.L., Y.-H.K.); and Department of Health Science and Technology (Y.-H.K.) and Department of Medical Device Management and Research (Y.-H.K.), Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.
Stroke. 2017 Jun;48(6):1457-1462. doi: 10.1161/STROKEAHA.116.015264. Epub 2017 May 11.
The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke.
A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor.
The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment <25), the number of alleles in the brain-derived neurotrophic factor genotype was also an independent predictor of upper extremity motor outcome 3 months after stroke.
Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement.
确定预测上肢运动结局的内在因素有助于制定中风康复的个性化治疗方案。本研究旨在确定亚急性中风患者上肢运动结局的预后因素，包括内在遗传因素。
共纳入97例亚急性中风患者。根据中风后3个月的Fugl-Meyer评估评分的上肢部分对上肢运动障碍进行评分。使用各种可能影响这种障碍的因素对中风后3个月的上肢运动结局进行预测建模，这些因素包括患者特征、基线上肢运动障碍、皮质脊髓束的功能和结构完整性以及脑源性神经营养因子基因型。采用多变量有序逻辑回归模型确定各因素的显著性。
所有中风患者中，中风后3个月运动结局的独立预测因素为基线上肢运动障碍、年龄、中风类型和皮质脊髓束功能完整性。然而，在基线时存在严重运动障碍的组（Fugl-Meyer评估上肢评分<25）中，脑源性神经营养因子基因型的等位基因数量也是中风后3个月上肢运动结局的独立预测因素。
对于基线运动严重受累的亚急性中风患者，脑源性神经营养因子基因型可能是上肢运动结局的一个潜在有用的预测指标。
