脑卒后融合性脑白质高信号使平衡和步态恢复恶化：队列研究。
Recovery of balance and gait after stroke is deteriorated by confluent white matter hyperintensities: Cohort study.
机构信息
Neurorehabilitation Department, Institute of Rehabilitation, Grenoble-Alpes University Hospital, 38434 Échirolles, France; Laboratoire de psychologie et neurocognition, UMR CNRS 5105, University Grenoble-Alpes, Grenoble, France.
Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, 75013 Paris, France; Groupe d'imagerie neurofonctionnelle, institut des maladies neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, 33000 Bordeaux, France.
出版信息
Ann Phys Rehabil Med. 2022 Jan;65(1):101488. doi: 10.1016/j.rehab.2021.101488. Epub 2021 Nov 11.
BACKGROUND
White matter hyperintensities (WMHs) are well known to affect post-stroke disability, mainly by cognitive impairment. Their impact on post-stroke balance and gait disorders is unclear.
OBJECTIVES
We aimed to test the hypothesis that WMHs would independently deteriorate post-stroke balance and gait recovery.
METHODS
This study was performed in 210 individuals of the cohort Determinants of Balance Recovery After Stroke (DOBRAS), consecutively enrolled after a first-ever hemisphere stroke. Clinical data were systematically collected on day 30±3 (D30) post-stroke and at discharge from the rehabilitation ward. WMHs were searched on MRI, graded with the Fazekas scale, and dichotomized as no/mild (absence/sparse) or moderate/severe (confluent). The primary endpoint was the recovery of the single limb stance, assessed with the Postural Assessment Scale for Stroke (PASS). The secondary endpoint was the recovery of independent gait, assessed with the modified Fugl-Meyer Gait Assessment (mFMA). The adjusted hazard ratios (aHRs) of achievements of these endpoints by level of WMHs were estimated by using Cox models, accounting for other relevant clinical and imaging factors.
RESULTS
Individuals with moderate/severe WMHs (n=86, 41%) had greater balance and gait disorders and were more often fallers than others (n=124, 59%). Overall, they had worse and slower recovery of single limb stance and independent gait (P<0.001). Moderate/severe WMHs was the most detrimental factor for recovery of balance (aHR 0.46, 95% confidence interval [CI] 0.32-0.68, P<0.001) and gait (0.51, 0.35-0.74, P<0.001), along with age, stroke severity, lesion volume and disrupted corticospinal tract. With cerebral infarct, endovascular treatments had an independent positive effect, both on the recovery of balance (aHR 1.65, 95% CI 1.13-2.4, P=0.009) and gait (1.78, 1.24-2.55, P=0.002).
CONCLUSIONS
WMHs magnify balance and gait disorders after stroke and worsen their recovery. They should be better accounted for in post-stroke rehabilitation, especially to help establish a prognosis of mobility. CLINICALTRIALS.
GOV REGISTRATION
NCT03203109.
背景
脑白质高信号（WMHs）已知会影响中风后的残疾程度，主要是通过认知障碍。但其对中风后平衡和步态障碍的影响尚不清楚。
目的
我们旨在检验这样一个假设，即 WMHs 会独立地恶化中风后平衡和步态的恢复。
方法
这项研究是在 210 名首次发生半球中风的队列 Determinants of Balance Recovery After Stroke (DOBRAS) 患者中进行的，这些患者连续入选。临床数据在中风后第 30±3 天（D30）和从康复病房出院时系统地收集。在 MRI 上搜索 WMHs，并用 Fazekas 量表进行分级，并将其分为无/轻度（无/稀疏）或中度/重度（融合）。主要终点是单肢站立的恢复情况，使用姿势评估量表 for Stroke（PASS）进行评估。次要终点是独立行走的恢复情况，使用改良 Fugl-Meyer 步态评估（mFMA）进行评估。使用 Cox 模型估计 WMHs 水平对这些终点的实现的调整后的危险比（aHR），该模型考虑了其他相关的临床和影像学因素。
结果
有中度/重度 WMHs（n=86，41%）的患者平衡和步态障碍更严重，跌倒的频率也高于其他人（n=124，59%）。总的来说，他们的单肢站立和独立行走的恢复情况更差、更慢（P<0.001）。中度/重度 WMHs 是平衡恢复（aHR 0.46，95%置信区间[CI]0.32-0.68，P<0.001）和步态恢复（0.51，0.35-0.74，P<0.001）的最不利因素，与年龄、中风严重程度、病灶体积和皮质脊髓束中断有关。对于脑梗死患者，血管内治疗对平衡（aHR 1.65，95%CI 1.13-2.4，P=0.009）和步态（1.78，1.24-2.55，P=0.002）的恢复都有独立的积极影响。
结论
WMHs 会加重中风后的平衡和步态障碍，并使其恢复情况恶化。在中风后的康复中，应更好地考虑 WMHs，尤其是为了帮助建立对移动能力的预后。临床试验。
政府注册
NCT03203109。
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