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病灶对侧半球的形态改变与卒中后的功能结局相关。

Morphological alterations of contralesional hemisphere relate to functional outcomes after stroke.

机构信息

School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

出版信息

Eur J Neurosci. 2023 Sep;58(5):3347-3361. doi: 10.1111/ejn.16097. Epub 2023 Jul 25.

Abstract

The present study aimed to investigate poststroke morphological alterations contralesionally and correlations with functional outcomes. Structural magnetic resonance images were obtained from 27 poststroke patients (24 males, 50.21 ± 10.97 years) and 20 healthy controls (13 males, 46.63 ± 12.18 years). Voxel-based and surface-based morphometry analysis were conducted to detect alterations of contralesional grey matter volume (GMV), cortical thickness (CT), gyrification index (GI), sulcus depth (SD), and fractal dimension (FD) in poststroke patients. Partial correlation analysis was used to explore the relationship between regions with significant structural differences and scores of clinical assessments, including Modified Barthel Index (MBI), Berg Balance Scale (BBS), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). Correction for multiplicity was conducted within each parameter and for all tests. GMV significantly decreased in the contralesional motor-related, occipital and temporal cortex, limbic system, and cerebellum lobe (P < 0.01, family-wise error [FWE] correction). Lower CT was found in the contralesional precentral and lingual gyrus (P < 0.01, FWE correction), while lower GI found in the contralesional superior temporal gyrus and insula (P < 0.01, FWE correction). There were significant correlations between GMV of contralesional lingual gyrus and MBI (P = 0.031, r = 0.441), and BBS (P = 0.047, r = 0.409) scores, and GMV of contralesional hippocampus and FMA-UE scores (P = 0.048, r = 0.408). In conclusion, stroke patients exhibited wide grey matter loss and cortical morphological changes in the contralesional hemisphere, which correlated with sensorimotor functions and the ability of daily living.

摘要

本研究旨在探讨卒中后病灶对侧的形态学改变及其与功能预后的相关性。我们对 27 名卒中患者(24 名男性,50.21±10.97 岁)和 20 名健康对照者(13 名男性,46.63±12.18 岁)进行了结构磁共振成像检查。采用基于体素和基于表面的形态计量学分析方法,检测卒中患者病灶对侧的灰质体积(GMV)、皮质厚度(CT)、脑回指数(GI)、脑沟深度(SD)和分形维数(FD)的改变。采用偏相关分析探讨了具有显著结构差异的区域与临床评估评分之间的关系,包括改良巴氏指数(MBI)、伯格平衡量表(BBS)、上肢 Fugl-Meyer 评估(FMA-UE)、简易精神状态检查(MMSE)和蒙特利尔认知评估(MoCA)。对每个参数和所有测试均进行了多重性校正。结果显示,与对侧运动相关皮质、枕叶和颞叶、边缘系统和小脑叶相比,GMV 显著降低(P<0.01,基于家族的错误[FWE]校正)。与对侧中央前回和舌回相比,CT 较低(P<0.01,FWE 校正),而与对侧颞上回和岛叶相比,GI 较低(P<0.01,FWE 校正)。病灶对侧舌回的 GMV 与 MBI(P=0.031,r=0.441)和 BBS(P=0.047,r=0.409)评分呈显著相关,病灶对侧海马的 GMV 与 FMA-UE 评分呈显著相关(P=0.048,r=0.408)。总之,卒中患者病灶对侧半球广泛存在灰质丢失和皮质形态改变,与感觉运动功能和日常生活能力相关。

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