多发性硬化症患者手部功能的纵向评估。
Longitudinal assessment of hand function in individuals with multiple sclerosis.
机构信息
Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
Department of Neurology, University of Washington, Seattle, WA, USA.
出版信息
Mult Scler Relat Disord. 2019 Jul;32:107-113. doi: 10.1016/j.msard.2019.04.035. Epub 2019 May 6.
OBJECTIVE
Little is known about the frequency and severity of hand dysfunction in individuals with multiple sclerosis (MS). Hence, we sought to determine the extent that quantitative tests of hand function detect changes over time, evaluate their relationship to global disability measures, and identify predictors of hand function.
METHODS
One-hundred and forty-seven individuals with MS were included (96 women, 84 relapsing-remitting MS [RRMS]) along with 35 age-and-sex matched controls. Quantitative tests of hand function (grip strength, pinch strength, 9 hole peg test [9HPT], finger tapping) and leg strength were acquired and normalized to age and sex. Expanded Disability Status Scale (EDSS) and timed 25 foot walk were also obtained. Spearman correlations, multivariate regression models and mixed effects linear regression were used for analysis.
RESULTS
Our cohort had an EDSS of 3.6 ± 2.2 (median ± SD) and age 44.6 ± 11.9 years. Follow up time was up to 5 years. At baseline, 14/63 individuals with progressive MS (PMS) required more than twice as much time to complete the 9HPT using their dominant hand, compared to controls. Similarly, 11 individuals with PMS had less than 50% of grip strength and 6 had less than 50% of pinch strength, compared to controls. Additionally, 7 individuals with PMS were found to be at least 50% slower than controls in finger tapping. Over two years, 27/85 individuals with MS had more than 20% worsening in their 9HPT results from baseline (17 RRMS, 10 PMS) and 37/74 (20 RRMS, 17 PMS) had more than 20% worsening in their grip strength compared to baseline.
CONCLUSIONS
Hand function is commonly impaired in individuals with MS. Assessing hand dysfunction with dynamometry and the 9HPT could help improve the precision of detecting changes in hand function over time in MS, and may be more sensitive in detecting changes in PMS. These quantitative tests may be useful as outcome measures in clinical trials using neuroprotective or reparative therapies and rehabilitative interventions.
目的
多发性硬化症（MS）患者手部功能障碍的频率和严重程度知之甚少。因此，我们旨在确定定量手部功能测试在多大程度上能够随时间检测到变化，评估其与整体残疾测量指标的关系，并确定手部功能的预测因素。
方法
纳入了 147 名 MS 患者（96 名女性，84 名复发缓解型 MS [RRMS]）和 35 名年龄和性别匹配的对照者。获取并将手部功能（握力、捏力、9 孔插板测试 [9HPT]、手指敲击）和腿部力量的测试结果进行了定量检测，并进行了年龄和性别校正。还获得了扩展残疾状况量表（EDSS）和 25 英尺步行计时。采用 Spearman 相关分析、多变量回归模型和混合效应线性回归进行分析。
结果
我们的队列 EDSS 评分为 3.6±2.2（中位数±标准差），年龄为 44.6±11.9 岁。随访时间最长达 5 年。在基线时，14/63 名进展型 MS（PMS）患者使用惯用手完成 9HPT 的时间比对照组多了两倍多。同样，11 名 PMS 患者的握力不足 50%，6 名患者的捏力不足 50%，而对照组则没有。此外，7 名 PMS 患者的手指敲击速度比对照组慢至少 50%。在两年的时间里，85 名 MS 患者中有 27 名（17 名 RRMS，10 名 PMS）的 9HPT 结果较基线恶化超过 20%，74 名患者中有 37 名（20 名 RRMS，17 名 PMS）的握力较基线恶化超过 20%。
结论
手部功能在 MS 患者中普遍受损。使用测力和 9HPT 评估手部功能障碍可以帮助提高 MS 患者随时间检测手部功能变化的精确性，并且可能在检测 PMS 变化方面更为敏感。这些定量测试可能对使用神经保护或修复治疗和康复干预措施的临床试验作为结局指标有用。
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