基于DTI评价急性缺血性脑卒中运动功能缺损程度与肾虚髓亏证的相关性研究＊

目的 运用核磁共振弥散张量成像技术（DTI）,从皮质脊髓束损伤程度评价的角度,探讨肾虚髓亏证与急性缺血性脑卒中运动功能缺损程度相关性,丰富中风病病机及证候诊断,拓宽缺血性脑卒中的中医药防治思路,为急性缺血性脑卒中肾虚髓亏证患者运动功能损伤程度提供临床依据,强调肾虚髓亏证在急性缺血性脑卒中运动功能损伤中的重要意义。方法 纳入符合诊断标准的90例病例,根据证候分别归入肾虚髓亏组和非肾虚髓亏组,每组各45例。每组患者均给予常规西药治疗。对两组患者入院后行弥散张量成像检测,同时分别于治疗前及治疗后14天,记录两组患者NIHSS评分、改良Barthel指数量表及简化Fugl-Meyer运动功能评分量表评分,比较两组病例发病时的轻重程度及治疗前后两组病例组间的恢复差异。结果 研究显示,治疗前肾虚髓亏组在NIHSS评分方面高于非肾虚髓亏组（P<0.05）;治疗前肾虚髓亏组在改良Barthel指数量表及简化Fugl-Meyer运动功能评分方面低于非肾虚髓亏组（P<0.05）。治疗前后NIHSS评分、改良Barthel指数评分及简化Fugl-Meyer运动功能评分改善情况,非肾虚髓亏组要优于肾虚髓亏组（P<0.05）。治疗前两组患者在健侧内囊后肢及大脑脚外侧处FA值及ADC值无明显差异;肾虚髓亏组在患侧内囊后肢及大脑脚外侧处FA值及ADC值均低于非肾虚髓亏组（P<0.05）。相关性分析得出,两组患者患侧内囊后肢FA值与患者治疗前NIHSS评分呈负相关;两组患者患侧内囊后肢FA值与患者改良Barthel指数评分及简化Fugl-Meyer运动功能评分呈正相关;肾虚髓亏组患者患侧内囊后肢FA值与肾虚髓亏证中医证候评分呈负相关。结论 肾虚髓亏是急性缺血性脑卒中运动功能障碍的重要病机。研究结果显示,两组皮质脊髓束损伤程度与神经功能及运动功能损伤存在相关性,且肾虚髓亏组在皮质脊髓束的损伤程度方面与其中医证候评分呈负相关。

Study on the Correlation Between the Degree of Motor Dysfunction and the Syndrome of Kidney-marrow Deficiency in Acute Ischemic Stroke Based on DTI

Objective To explore the correlation between the kidney-marrow deficiency syndrome and motor function deficit degree of acute ischemic stroke, enrich the pathogenesis and syndrome diagnosis of stroke, and broaden the idea of traditional Chinese medicine prevention and treatment of ischemic stroke, using magnetic resonance diffusion tensor imaging (DTI) technology, from the perspective of evaluation of corticospinal tract injury, so as to provide a clinical basis for the degree of motor function injury in patients with the kidney-marrow deficiency syndrome in acute ischemic stroke, emphasizing the importance of the kidney-marrow deficiency syndrome in the motor function injury in acute ischemic stroke.Methods Ninety patients meeting the diagnostic criteria were included and classified into the kidney-marrow deficiency group and non-kidney-marrow deficiency group, with 45 cases in each group. Patients in both groups were given conventional western medicine treatment. Diffusion tensor imaging was performed for the two groups after admission, and NIHSS scores, modified Barthel index scale and simplified Fugl-Meyer motor function scale were recorded before and 14 days after treatment, respectively, to compare the severity of the onset of the two groups of patients and the difference in recovery between the two groups before and after treatment.Results The results showed that NIHSS scores in the kidney-marrow deficiency syndrome group were higher than those in the non-kidney-marrow deficiency group (P<0.05). Before treatment, the modified Barthel index scale and simplified Fugl-Meyer motor function score in the kidney-marrow deficiency syndrome group were lower than those in the non-kidney-marrow deficiency group (P<0.05). The improvement of NIHSS score, modified Barthel index score and simplified Fugl-Meyer motor function score before and after treatment was better in the non-kidney-marrow deficiency group than in the kidney-marrow deficiency syndrome group (P<0.05). It was found that there was no obvious difference in FA value and ADC value between the two groups in the posterior limb of the internal capsule on the healthy side and the lateral part of the cranial foot before treatment. The FA and ADC values in the hindlimb of the internal capsule and lateral cranial crocus of the affected side were lower in the kidney-marrow deficiency syndrome group than those in the non-kidney-marrow deficiency group (P<0.05). Correlation analysis showed that the FA value of the hindlimb of the affected side of the internal capsule was negatively correlated with the NIHSS score before treatment in both groups. The FA value of the hindlimb of the affected side of the internal capsule was positively correlated with the modified Barthel index score and the simplified Fugl-Meyer motor function score. There was a negative correlation between the FA value of the hindlimb of the internal capsule on the affected side and the TCM syndrome score of kidney deficiency and pulp deficiency group.Conclusion Deficiency of kidney-marrow is an important pathogenesis of motor dysfunction in acute ischemic stroke. The results show that the degree of corticospinal tract injury in the two groups is correlated with the neurological and motor function injuries, and there is a negative correlation between the degree of corticospinal tract injury in the kidney-marrow deficiency group and the TCM syndrome scores.