早期皮层下脑梗死半球间功能连接与皮质脊髓束解剖连接在运动康复中的作用机制

Interhemispheric functional connectivity and corticospinal tract (CST) anatomical connection have been associated with the degree of poststroke motor recovery. Both of them have been shown to exhibit a dynamic evolution. However, their change patterns are different and specific in different stroke stages. Applying single index has its limitation. While, combining both of them can improve prediction effect of recovery. Our previous study demonstrated that enhanced interhemispheric functional connectivity compensates for anatomical connection damages in chronic subcortical stroke patients with good motor outcomes (Stroke, 2015). However, the intrinsic association and motor rehabilitation mechanisms of two indexes remain largely unknown in acute stroke patients. Base on the foundation of previous studies, we recruited longitudinal large sample of ischemic stroke patients with infarctions restricted to the internal capsule and neighboring regions that exhibited damage of motor function. The concrete steps including: (1) Studying the dynamic relationship between interhemispheric functional connectivity and anatomical connection damage. Clarifying the time inflection-point of interhemispheric functional connectivity starting recovery; (2) Exploring the relationship between time inflection-point of interhemispheric functional connectivity starting recovery and CST damage；(3) Studying the intrinsic association and predicted effect of two indexes in motor rehabilitation. Our study will offer theoretical basis for motor recovery, and has an important significance for rehabilitation treatment strategy.

研究表明皮层下脑梗死半球间功能连接和皮质脊髓束解剖连接是影响运动功能康复的重要因素。两者均存在动态变化，但变化模式不同且具有阶段特异性。应用单一指标存在局限性，联合应用有助于提高康复预测效果。课题组前期研究证明慢性期运动功能恢复良好的皮层下脑梗死患者脑间功能连接增强代偿解剖连接损害（Stroke, 2015）。但早期脑梗死两种指标的关系及其在运动康复中的作用机制仍然不清楚。本项目拟在前期研究基础上，采集大样本病灶位于内囊水平伴运动功能损害的脑梗死纵向数据，具体分析步骤包括：（1）探索不同康复阶段半球间功能连接与解剖连接损害的关系，明确半球间功能连接开始恢复的时间拐点；（2）揭示半球间功能连接开始恢复的时间拐点与皮质脊髓束损伤的关系；（3）探究急性期两者间关系及其对运动康复的预测作用。本项目为阐明运动功能康复机制提供理论依据，有助于康复期采取有效治疗策略。

缺血性中风是成人最常见的致残原因，以运动残疾最常见且危害最大。中风患者康复效果个体差异很大，究其原因是对中风后运动功能康复机制的认识不足。课题组在前期小样本研究基础上，通过收集大样本纵向缺血性中风患者，研究中风后人脑功能、结构及血流的改变。主要研究结果包括（1）基于效应连接的分析方法，发现了皮层下中风患者脑间效应连接的改变模式；（2）利用高精度扩散谱成像技术，明确了皮层下中风患者皮质脊髓束以及皮质红核脊髓束与运动功能康复的关系；（3）利用多模态MRI技术，明确了中风后脑结构及脑血流损害与重组的异质性；（4）利用扩散张量成像数据，发现了慢性皮层下中风患者注意功能损害的神经机制。上述成果发表和录用SCI论文8篇（影响因子8分以上2篇）。本项目为阐明运动功能康复机制提供理论依据，有助于康复期采取有效治疗策略。