Nozoe Masafumi, Kanai Masashi, Kubo Hiroki, Yamamoto Miho, Shimada Shinichi, Mase Kyoshi
Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan.
Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan.
J Clin Neurosci. 2020 Apr;74:141-145. doi: 10.1016/j.jocn.2020.02.020. Epub 2020 Feb 17.
Muscle wasting in patients with stroke is a factor for a poor functional outcome. However, there have been few studies on the relationships between lower limb muscle wasting during the acute phase and dependent ambulation. This study examined whether lower limb muscle wasting during the acute phase is associated with the dependent ambulation status at 3 months after stroke.
In this observational cohort study, we measured the quadriceps muscle thickness in the paretic and non-paretic limbs within 1 and 3 weeks after admission using ultrasonography in non-ambulatory patients with acute stroke. Patients were categorized into two groups based on their ambulation ability: dependent, functional ambulation category (FAC) 0-3 and independent, FAC 4-5) at 3 months after stroke.
In total, 55 patients were included and completed follow-up, and 28 patients (51%) had an ambulation status of dependent at 3 months after stroke. Significant differences in muscle wasting were observed in the non-paretic limb (-5.5% [8.7%] : -16.8% [13.6%], independent group: dependent group, respectively, P < 0.001), but not in the paretic limb (-15.0% [14.3%] : -18.7% [15.1%], P = 0.36). Even after adjusting for covariates, muscle wasting in the non-paretic limb was a significant independent predictor of dependent ambulation (adjusted odds ratio, 0.87; 95% confidence interval, 0.76-0.99, P = 0.033).
Post-stroke muscle wasting in the non-paretic lower limb during the acute phase is independently associated with dependent ambulation after stroke.
中风患者的肌肉萎缩是功能预后不良的一个因素。然而，关于急性期下肢肌肉萎缩与依赖步行之间的关系，相关研究较少。本研究旨在探讨急性期下肢肌肉萎缩是否与中风后3个月时的依赖步行状态相关。
在这项观察性队列研究中，我们对急性中风后不能行走的患者在入院后1周和3周内使用超声测量了患侧和非患侧下肢的股四头肌厚度。根据患者的步行能力将其分为两组：中风后3个月时依赖步行（功能步行分类[FAC]0 - 3）和独立步行（FAC 4 - 5）。
总共纳入55例患者并完成随访，其中28例患者（51%）在中风后3个月时处于依赖步行状态。非患侧下肢的肌肉萎缩存在显著差异（分别为-5.5%[8.7%]：-16.8%[13.6%]，独立组：依赖组，P < 0.001），但患侧下肢无显著差异（-15.0%[14.3%]：-18.7%[`15.1%]，P = 0.36）。即使在调整协变量后，非患侧下肢的肌肉萎缩仍是依赖步行的显著独立预测因素（调整后的比值比为0.87；95%置信区间为0.76 - 0.99，P = 0.033）。
急性期非患侧下肢中风后肌肉萎缩与中风后依赖步行独立相关。
