摘要
目的:探讨经颅磁刺激(TMS)诱导伸指肌的运动诱发电位(EDC-MEPs)联合临床评估(SAFE)的方法对脑梗死后3个月上肢运动功能恢复的预测价值。方法:纳入2020年1月至2021年6月于温州市中医院康复科3住院的脑梗死患者76例。所有患者均在入院后接受Fugl-Meyer上肢运动功能评定、SAFE评估及TMS评估,在脑梗死后3个月时再次接受Fugl-Meyer上肢运动功能评定。根据评估内容,建立三种预测方法(SAFE、EDC-MEPs和SAFE联合EDC-MEPs)。采用多因素Logistic回归分析确定上肢功能恢复的预测因素,用ROC曲线评价预测方法的效能。结果:多因素Logistic分析显示,SAFE、EDC-MEPs和SAFE联合EDC-MEPs的结果对上肢功能恢复的影响差异有统计学意义(P<0.05)。SAFE的ROC曲线下面积(AUC)为0.795(SE=0.059,95%CI=0.680~0.910),EDC-MEPs的AUC为0.729(SE=0.067,95%CI=0.599~0.860),SAFE联合EDC-MEPs的AUC可提高到0.824(SE=0.056,95%CI=0.715~0.934),与EDC-MEPs相比,差异有统计学意义(Z=2.398,P<0.05)。结论:经TMS联合SAFE用于预测脑梗死后偏瘫上肢功能恢复具有较高价值。
Objective:To investigate the predictive value of transcranial magnetic stimulation(TMS)-induced motor evoked potentials(EDC-MEPs)of extensor muscles combined with clinical evaluation(SAFE)in the recovery of upper limb motor function 3 months after cerebral infarction.Methods:Totally 76 patients with cerebral infarction hospitalized in the Rehabilitation Department of Wenzhou Hospital of Traditional Chinese Medicine from January 2020 to June 2021 were enrolled in this study.All patients received Fugl-Meyer upper limb motor function assessment,SAFE assessment and TMS assessment upon admission,and again 3 months after cerebral infarction.Three prediction methods(SAFE,EDC-MEPs and SAFE combined with EDC-MEPs)were established according to the assessment content.Multi-factor logistic regression analysis was used to determine the predictors of upper limb functional recovery,and the efficacy of prediction methods was evaluated by ROC curves.Results:Multi-factorial analysis showed statistical difference among SAFE,EDC-MEPs and SAFE combined with EDC-MEPsin the effect on functional recovery of the upper limb(P<0.05).The area under the ROC curve(AUC)for SAFE was 0.795(SE=0.059,95%CI=0.680-0.910)and for EDC-MEPs it was 0.729(SE=0.067,95%CI=0.599-0.860),but SAFE combined with EDC-MEPs it was increased to 0.824(SE=0.056,95%CI=0.715-0.934),showing significant difference compared with EDC-MEPs(Z=2.398,P<0.05).Conclusion:Transcranial magnetic stimulation combined with clinical assessment is of higher value in predicting functional recovery of hemiplegic upper limbs after cerebral infarction.
作者
潘录录
郑贺彬
张艳艳
程志清
潘蓉蓉
章国伟
支英豪
PAN Lulu;ZHENG Hebin;ZHANG Yanyan;CHENG Zhiqing;PAN Rongrong;ZHANG Guowei;ZHI Yinghao(Department of Rehabilitation 3,Wenzhou Hospital of Traditional Chinese Medicine,Zhejiang University of Traditional Chinese Medicine,Wenzhou 325015,China)
出处
《温州医科大学学报》
2022年第2期139-143,共5页
Journal of Wenzhou Medical University
基金
温州市基础性科研项目(Y20190362)
浙江省基础公益研究计划项目(LGF20H170001)。
关键词
脑梗死
运动功能
经颅磁刺激
预测价值
cerebral infarction
motor function
transcranial magnetic stimulation
predictive value
