Koyama Tetsuo, Uchiyama Yuki, Domen Kazuhisa
Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan.
Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Prog Rehabil Med. 2020 Apr 3;5:20200006. doi: 10.2490/prm.20200006. eCollection 2020.
Diffusion tensor fractional anisotropy (FA) in the corticospinal tracts has been used to assess the long-term outcome in stroke patients. Patient age and the type of stroke may also affect outcomes. In this study, we investigated the associations of age, type of stroke, and FA in the ipsilesional and contralesional cerebral peduncles with stroke outcomes.
This study involved 80 patients with stroke (40 hemorrhagic, 40 ischemic) that we had investigated previously. Diffusion tensor FA images were obtained between 14 and 21 days post-stroke. FA values in the ipsilesional and contralesional cerebral peduncles were extracted and their ratio (rFA) was calculated. Outcome was assessed using the Brunnstrom stage, the motor component of the Functional Independence Measure (FIM-motor) at discharge, and the length of stay until discharge from rehabilitation. Using forward stepwise multivariate regression, we assessed the associations of rFA, contralesional FA, age, and type of stroke with outcome measures.
rFA and contralesional FA were included in the final model for the Brunnstrom stage in the upper limbs. There was a strong association between hemorrhagic stroke and poorer lower extremity function. rFA, contralesional FA, and age were included in the final model for FIM-motor and length of stay. The effect of rFA on all outcome measures was stronger than that of contralesional FA. The effect of age on FIM-motor was as strong as that of rFA.
Neural damage in the corticospinal tracts (indicated by rFA) had the strongest effect on outcome measures, whereas the level of disability (measured by FIM-motor) was associated with a broader range of factors, including age.
皮质脊髓束的扩散张量分数各向异性（FA）已被用于评估中风患者的长期预后。患者年龄和中风类型也可能影响预后。在本研究中，我们调查了年龄、中风类型以及患侧和健侧大脑脚的FA与中风预后之间的关联。
本研究纳入了我们之前研究过的80例中风患者（40例出血性中风，40例缺血性中风）。在中风后14至21天之间获取扩散张量FA图像。提取患侧和健侧大脑脚的FA值并计算其比值（rFA）。使用Brunnstrom分期、出院时功能独立性测量的运动部分（FIM运动）以及康复出院前的住院时间来评估预后。通过向前逐步多元回归，我们评估了rFA、健侧FA、年龄和中风类型与预后指标之间的关联。
rFA和健侧FA被纳入上肢Brunnstrom分期的最终模型。出血性中风与较差的下肢功能之间存在密切关联。rFA、健侧FA和年龄被纳入FIM运动和住院时间的最终模型。rFA对所有预后指标的影响均强于健侧FA。年龄对FIM运动的影响与rFA相当。
皮质脊髓束的神经损伤（以rFA表示）对预后指标的影响最强，而残疾程度（以FIM运动衡量）与更广泛的因素相关，包括年龄。
