Zhongguo cuzhong zazhi (Mar 2023)
卒中后患者上肢体感诱发电位及周围神经电生理特征分析 Analysis of Upper Limb Somatosensory Evoked Potential and Peripheral Nerve Electrophysiological Characteristics in Patients with Stroke
Abstract
目的 分析卒中后患者上肢体感诱发电位（somatosensory evoked potentials，SEP）、周围神经电生理特征与运动功能的相关性。 方法 此前瞻性研究连续纳入2018年6月—2022年3月康复科收治的亚急性期卒中患者，采用自身健患侧进行对比，进行双侧上肢SEP和周围神经电生理检查并对患侧上肢运动功能进行评分。分析患侧SEP P15、N20、P25、N13及N9潜伏期、感觉神经传导参数、运动神经传导参数与上肢运动功能等指标的相关性。 结果 本研究共纳入卒中后亚急性期偏瘫患者102例，平均（68.76±11.33）岁，男性78例。患者偏瘫侧上肢SEP P15[（16.90±1.67）ms vs.（16.27±1.50）ms，P＜0.001]、N20[（20.13±1.49）ms vs.（19.42±1.60）ms，P＜0.001]、P25[（24.39±1.75）ms vs.（23.70±1.50）ms，P＜0.001]、N13[（14.05±1.25）ms vs.（13.42±1.26）ms，P＜0.001]及N9[（9.25±0.96）ms vs.（8.80±1.40）ms， P＜0.001]的潜伏期均大于健侧；偏瘫侧上肢正中神经（指1-腕）感觉神经传导速度（sensory nerve conduction velocity，SCV）[（48.93±6.82）m/s vs.（51.26±6.40）m/s，P＜0.001]、波幅[（22.54±9.91）μv vs.（32.71±17.68）μv，P＜0.001]小于健侧；正中神经（指3-腕）SCV[（49.26±7.31）m/s vs.（52.98±5.99）m/s，P＜0.001]、波幅[（24.71±11.39）μv vs.（38.57±20.21）μv，P＜0.001]小于健侧；尺神经（指5-腕）SCV[（48.72±7.46）m/s vs.（52.01±6.82）m/s，P＜0.001]、波幅[（19.51±11.35）μv vs.（25.74±13.44）μv，P＜0.001]小于健侧；尺神经（腕-肘上）SCV[（54.53±6.06）m/s vs. （56.99±4.84）m/s，P＜0.001]、波幅[（11.37±6.04）μv vs.（14.53±7.89）μv，P＜0.001]小于健侧。偏瘫侧上肢正中神经（肘-腕）运动神经传导速度（motor nerve conduction velocity，MCV）[（54.79±4.89）m/s vs.（57.10±5.07）m/s，P＜0.001]、波幅[（8.42±3.85）μv vs.（10.00±3.72）μv，P＜0.001]小于健侧；尺神经（腕-肘上）MCV[（53.12±6.81）m/s vs.（55.01±6.35）m/s，P＜0.001]、波幅[（6.89±2.56）μv vs.（8.78±2.26）μv，P＜0.001]小于健侧。P15（r=-0.358，P＜0.001）、N20（r=-0.674，P＜0.001）、P25（r=-0.465，P＜0.001）潜伏期与Fugl-Meyer上肢运动功能评定量表（Fugl-Meyer assessment upper extremity scale，FMA-UE）评分均呈负相关；正中神经电极位置为指3-腕的波幅与FMA-UE评分呈正相关（r=0.231，P=0.026），尺神经电极位置为指5-腕（r=0.292，P=0.006），腕-肘上（r=0.391，P＜0.001）的SCV与FMA-UE评分呈正相关，电极位置为指5-腕的波幅与FMA-UE评分呈正相关（r=0.263，P=0.012），正中神经电极位置为肘-腕的MCV（r=0.220，P=0.037）、波幅（r=0.223，P=0.034）与FMA-UE评分均呈正相关，尺神经电极位置为腕-肘上的MCV（r=0.231，P=0.027）与FMA-UE评分呈正相关。 结论 卒中偏瘫患者常伴有感觉传导通路受损及偏瘫侧上肢周围神经的改变，且与患侧上肢运动功能存在一定的相关性。 Abstract: Objective To analyze the correlation between upper limb somatosensory evoked potential (SEP), peripheral nerve electrophysiological characteristics and motor function in patients with stroke. Methods Patients with subacute stroke admitted to the Department of Rehabilitation from June 2018 to March 2022 were consecutively included in this prospective study. SEP and peripheral nerve electrophysiological examination were performed on both upper limbs, which of the healthy and affected sides were compared, and motor function of the affected side was scored. The correlation of latent period of SEP P15, N20, P25, N13 and N9, sensory nerve conduction parameters, motor nerve conduction parameters of the hemiplegic upper limb and its motor function was analyzed. Results A total of 102 patients were included in this study, with an average age of (68.76±11.33) years and 78 males. The latent period of SEP P15[(16.90±1.67) ms vs.(16.27±1.50) ms, P<0.001], N20[(20.13±1.49) ms vs.(19.42±1.60) ms, P<0.001], P25[(24.39±1.75) ms vs.(23.70±1.50) ms, P<0.001], N13[(14.05±1.25) ms vs.(13.42±1.26) ms, P<0.001] and N9[(9.25±0.96) ms vs.(8.80±1.40) ms, P<0.001] of hemiplegic upper limb were greater than those of the healthy side. The sensory nerve conduction velocity (SCV) [(48.93±6.82) m/s vs.(51.26±6.40) m/s, P<0.001] and amplitude [(22.54±9.91) μv vs.(32.71±17.68) μv, P<0.001] of median nerve (finger 1-wrist) of hemiplegic upper limb were lower than those of the healthy side; median nerve (finger 3-wrist) SCV[(49.26±7.31) m/s vs.(52.98±5.99) m/s, P<0.001] and amplitude [(24.71±11.39) μv vs.(38.57±20.21) μv, P<0.001] of hemiplegic upper limb were lower than those of the healthy side. The SCV[(48.72±7.46) m/s vs.(52.01±6.82) m/s, P<0.001] and amplitude [(19.51±11.35) μv vs.(25.74±13.44) μv, P<0.001] of ulnar nerve (finger 5-wrist) of hemiplegic upper limb were lower than those of the healthy side. The SCV[(54.53±6.06) m/s vs.(56.99±4.84) m/s, P<0.001] and amplitude [(11.37±6.04) μv vs.(14.53±7.89) μv, P<0.001] of ulnar nerve (superior wrist - elbow) of hemiplegic upper limb were lower than those of the healthy side.The motor nerve conduction velocity (MCV) [(54.79±4.89) m/s vs.(57.10±5.07) m/s), P<0.001] and amplitude [(8.42±3.85) μv vs.(10.00±3.72) μv, P<0.001] of median nerve (elbow-wrist) of hemiplegic upper limb were lower than those of the healthy side; the MCV[(53.12±6.81) m/s vs.(55.01±6.35) m/s, P<0.001] and amplitude [(6.89±2.56) μv vs.(8.78±2.26) μv, P<0.001] of ulnar nerve (superior wrist-elbow) were lower than those of the healthy side. The latent period of P15 (r=-0.358, P<0.001), N20 (r=-0.674, P<0.001) and P25 (r=-0.465, P<0.001) were negatively correlated with the Fugl-Meyer assessment upper extremity scale (FMA-UE) score. The amplitude of median nerve with electrode at finger 3-wrist was positively correlated with FMA-UE score (r=0.231, P=0.026), and the SCV of ulnar nerve with electrode at finger 5-wrist (r=0.292, P=0.006) and at wrist - elbow (r=0.391, P<0.001) was positively correlated with the FMA-UE score; the amplitude of ulnar nerve with electrode at 5-wrist was positively correlated with the FMA-UE score (r=0.263, P=0.012); the MCV (r=0.22, P=0.037) and amplitude (r=0.223, P=0.034) of median nerve with electrode at elbow-wrist were positively correlated with the FMA-UE score; the MCV of ulnar nerve with electrode at superior wrist - elbow was positively correlated with the FMA-UE score (r=0.231, P=0.027) . Conclusions Stroke patients with hemiplegia are often accompanied by sensory conduction pathway injury and peripheral nerve abnormality of hemiplegic upper limb, which are correlated with motor function of the affected side upper limb.
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