【摘要】 目的：探究慢性脑卒中重度偏瘫患者的经胼胝体连接脑区的功能连接改变及其与上肢运动功能恢复的相关性。方法：收集25例慢性脑卒中重度偏瘫患者康复干预1个月前后和32例健康受试者的静息态功能磁共振成像数据。利用自动解剖标记图谱（anmtomical automatic labeling,AAL）识别与胼胝体直接相连的32对同源皮质脑区并进行感兴趣区水平的功能连接分析，比较这些脑区的患侧半球内、健侧半球内以及半球间功能连接的组间、组内差异，并进一步将功能连接与患者上肢运动功能评分（Fugl-Meyer assessment of upper extremity,FMA-UE）进行相关性分析。结果：与健康对照组相比，卒中组康复干预前和干预后半球内总功能连接差异均不显著，而半球间总功能连接显著减弱（P<0.01,FDR校正）；进一步分析发现，同源脑区比非同源脑区的半球间功能连接减弱更加明显，涉及前额叶、感觉运动区、顶叶、颞叶和枕叶。与干预前相比，卒中组干预后的患侧内侧眶回与健侧内侧额回间的功能连接显著增强（P<0.01,FDR校正）。相关性分析显示，卒中组干预前半球间总功能连接与干预前FMA-UE评分显著正相关（r=0.590;P=0.004）。有5条半球间功能连接与干预前FMA-UE评分显著正相关（P<0.05）。其中3条为同源脑区连接，涉及额下回盖部、腹侧运动前区和初级运动皮质。另外2条为非同源脑区间连接，分别是患侧外侧眶回与健侧额下回眶部之间的连接、患侧顶下小叶与健侧缘上回之间的连接。此外，卒中组康复干预前有3条非同源脑区半球间连接与FMA-UE评分变化量显著正相关（P<0.05），涉及初级运动皮质、初级感觉皮质、腹侧运动前区和颞上回。卒中组干预前后功能连接变化量与FMA-UE评分变化量无显著相关性。结论：经胼胝体相连脑区的半球间功能连接下降可能是影响慢性期脑卒中运动功能障碍持续存在的重要因素之一。感觉运动脑区之间以及健侧感觉运动脑区与患侧颞上回之间的跨半球功能连接与运动恢复密切相关，可用于预测慢性期脑卒中重度偏瘫患者上肢运动功能的恢复。更多还原

【Abstract】 Objective:To investigate the changes in functional connectivity in transcallosal cortex connecting to the corpus callosum and its relationship with upper limb motor recovery in chronic stroke patients with severe hemiplegia.Method:The resting-state functional magnetic resonance imaging(fMRI) data were collected from 25 chronic stroke with severe hemiplegia before and after one-month rehabilitation intervention,as well as from 32 healthy controls(HCs). The anatomical automatic labeling(ALL) atlas was used to identify 32 pairs of homotopic cortex regions directly connected via the corpus callosum for regions of interest(ROI)-level functional connectivity analysis. Differences in functional connectivity within the affected hemisphere, unaffected hemispheres, and between hemispheres were compared within and between groups. Furthermore, the correlation between functional connectivity and upper limb motor function scores(Fugl-Meyer assessment of upper extremity,FMA-UE)was analyzed.Result:Compared with HCs,the whole intrahemispheric functional connectivity in the stroke groups had no significant differences before and after rehabilitation intervention,while the whole interhemispheric functional connectivity was significantly reduced(P<0.01,FDR correction). Especially,the functional connectivity of homotopic regions decreased more significantly than that of interhemispheric non-homotopic regions,which involved the prefrontal,sensorimotor,parietal,temporal,and occipital lobes. For the stroke groups,functional connectivity between the ipsilesional medial orbital gyrus and contralesional medial frontal gyrus was significantly enhanced after the intervention, compared with that before the intervention(P<0.01,FDR correction). The correlation analysis showed that the whole interhemispheric functional connectivity before the intervention was significantly positively correlated with FMA-UE scores(r=0.590,P=0.004). Five interhemispheric functional connectivities were significantly positively correlated with FMA-UE scores before the intervention in the stroke group(P<0.05),including three interhemispheric functional connectivities between homologous regions(involving the opercular part of the inferior frontal gyrus,ventral premotor area and primary motor cortex),and the other two interhemispheric functional connectivities between non-homologous regions(involving one connectivity between the ipsilesional lateral orbital gyrus and the contralesional orbital part of the inferior frontal gyrus,and another connectivity between the ipsilesional inferior parietal lobule and the contralesional superamarginal gyrus). Additionally, three interhemispheric functional connectivities between non-homologous regions in the pre-intervention stroke group were significantly positively correlated with the change of FMA-UE scores(P<0.05),involving the primary motor cortex,primary sensory cortex,ventral premotor area and superior temporal gyrus. Compared post-with pre-intervention,there was no significant correlation between changes in functional connectivity and FMA-UE scores.Conclusion:The weakened interhemispheric functional connectivity in transcallosal cortical regions may be an important factor contributing to the persistent motor dysfunction in chronic stroke patients with severe hemiplegia. The interhemispheric functional connectivities within the sensorimotor cortex and between the ipsilesional sensorimotor cortex and the contralesional superior temporal lobe are closely related to motor recovery,possibly may be used to predict motor recovery of the upper limb in chronic stroke patients with severe hemiplegia.更多还原