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目的采用磁共振弥散张量成像(diffusion tensor imanging,DTI)动态观察脑桥梗死后,远离梗死灶的延髓及小脑中脚神经纤维华勒变性及其对患者神经功能恢复的影响。方法选择单侧脑桥梗死患者14例,以及年龄性别相匹配的健康志愿者14名作对照组。分别在发病第1、4、12周进行 DTI 检测,并行美国国立卫生研究院卒中评分(National Institutes of Health stroke scale,NIHSS)、简式 Fugl-Meyer 运动功能评分(Fugl-Meyer motor scale,FM)、共济失调评分(ataxia rating scale,ARS)和Barthel 生活指数(Baahel index,BI)评分。结果与对照组比较,患者梗死灶同侧延髓及双侧小脑中脚的部分弥散各向异性值(fractional anisotropy,FA)从第1周至第12周逐渐减少(延髓梗死同侧 FA值:第1周0.43±0.01;第4周0.37±0.02;第12周0.30±0.02,小脑中脚梗死同侧 FA 值:第1周0.50±0.02;第4周0.43±0.02;第12周0.35±0.04,小脑中脚梗死对侧 FA 值:第1周0.54±0.02;第4周0.52±0.03;第12周0.47±0.04,t=1.92～28.56,均 P<0.05),而平均弥散量(meandiffusivity,MD)的变化差异却无统计学意义(P>0.05)。在观察期间,患者梗死灶同侧延髓及双侧小脑中脚的 FA 值减少的百分数绝对值与同期 NIHSS 及 BI 变化的百分数绝对值呈负相关(P<0.05)。结论局灶性脑桥梗死后,同侧延髓及双侧小脑中脚神经纤维的华勒变性持续存在,并且可能阻碍患者神经功能的恢复。
OBJECTIVE: To investigate the effects of diffuse tensor imagination (DTI) on Werner’s degeneration of the medulla oblongata and the medial cerebellar nerve fibers far away from the infarct and its effect on the recovery of neurological function after pontine infarction. Methods Fourteen patients with unilateral pontine infarction and 14 healthy volunteers matched with age and sex were selected as the control group. DTI test was performed on the 1st, 4th, 12th week respectively, and the NIH STIs, Fugl-Meyer motor scale (FM) , Ataxia rating scale (ARS) and Barthel’s index of life (Baahel index, BI). Results Compared with the control group, fractional anisotropy (FA) of the ipsilateral medulla oblongata and bilateral middle cerebellar peduncles gradually decreased from the first week to the twelfth week (ipsilateral FA: 1 Week 0.43 ± 0.01; Week 4 0.37 ± 0.02; Week 12 0.30 ± 0.02, Cerebellar midribal infarction ipsilateral FA values: Week 1 0.50 ± 0.02; Week 4 0.43 ± 0.02; Week 12 0.35 ± 0.04, Cerebellum The mean contralateral FA value in the middle leg was 0.54 ± 0.02 in the first week, 0.52 ± 0.03 in the fourth week, 0.47 ± 0.04 in the 12th week, t = 1.92 ~ 28.56, all P <0.05) The difference was not statistically significant (P> 0.05). During the observation period, the absolute percentage reduction of FA values in the medullary medulla oblongata and bilateral cerebellum in the ipsilateral infarcts of patients was negatively correlated with the absolute percentage change of NIHSS and BI in the same period (P <0.05). Conclusion After Focal cerebral pontine infarction, the Wallerian degeneration in the medial medulla oblongata and bilateral middle cerebellar nerve fibers persists and may hinder the recovery of neurological function in patients.