脑白质高信号患者平衡障碍特点分析
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摘要
目的总结脑白质高信号患者平衡障碍特征。方法纳入2018年9-12月确诊的82例脑白质高信号患者,采用Fazekas分级评价脑白质高信号程度,Berg平衡量表(BBS)评价平衡功能,平衡测试仪测定静态平衡功能和稳定极限;Spearman秩相关分析探讨Fazekas分级与BBS评分(总评分、静态平衡功能评分、动态平衡功能评分)和平衡测试仪参数(重心摆动周长、面积和速度,X轴和Y轴标准差,稳定极限)之间的相关性。结果 BBS总评分(rs=-0.322,P=0.027;rs=-0.414,P=0.004)和动态平衡功能评分(rs=-0.368,P=0.011;rs=-0.440,P=0.002)与Fazekas分级侧脑室旁白质高信号和脑深部白质高信号均呈负相关。平衡测试仪各项参数中重心摆动周长(rs=0.239,P=0.030)和重心摆动速度(rs=0.240,P=0.030)仅与Fazekas分级侧脑室旁白质高信号呈正相关,重心摆动面积(rs=0.345,P=0.001;rs=0.340,P=0.002)、X轴标准差(rs=0.302,P=0.006;rs=0.260,P=0.018)、Y轴标准差(rs=0.248,P=0.025;rs=0.253,P=0.022)与Fazekas分级侧脑室旁白质高信号和脑深部白质高信号呈正相关;而稳定极限与Fazekas分级侧脑室旁白质高信号(rs=-0.258,P=0.019)和脑深部白质高信号(rs=-0.224,P=0.043)呈负相关。稳定极限与BBS总评分(rs=0.572,P=0.000)和功能性前伸测验(FRT)评分(rs=0.560,P=0.000)呈正相关。结论侧脑室旁白质高信号可能是导致脑白质高信号患者平衡障碍的影响因素之一;重度脑白质高信号患者静态稳定性、动态平衡功能、稳定极限和姿势稳定性明显下降,存在较高的跌倒风险;FRT测验可作为急诊或床旁评价患者主动姿势控制能力和跌倒风险的简捷方法。
Objective To explore the features of balance disorders in patients with white matter hyperintensity(WMH).Methods The clinical data of 82 patients with WMH from September 2018 to December 2018 were collected.Fazekas scale was used to evaluate the level of WMH.Berg Balance Scale(BBS)and visual-feedback balance test-training monitor were used to assessed the performance of balance.Results Fazekas classification periventricular WMH(PWMH)and deep WMH(DWMH)had negative correlation with BBS total score(rs=-0.322,P=0.027; rs=-0.414,P=0.004)and dynamic balance function scores(rs=-0.368,P = 0.011; rs=-0.440,P= 0.002).About the parameters of the balance monitor,the center of gravity sway circumference(rs=0.239,P=0.030)and the center of gravity sway speed(rs=0.240.P = 0.030)were only positively correlated with the PWMH,center of gravity sway area(rs= 0.345,P =0.001; rs=0.340,P=0.002),X-axis standard deviation(r =0.302,P=0.006; rs=0.260,P=0.018),Y-axis standard deviation(rs=0.248,P=0.025; rs=0.253,P=0.022)were positively correlated with DWMH and PWMH; PWMH(rs=-0.258,P=0.019)and DWMH(rs=0.224,P=0.043),were negatively correlated with stability limit.BBS total score(rs=0.572,P=0.000)and functional reach test(FRT,rs=0.560,P=0.000)were positively correlated with stability limit.Conclusions PWMH may be one of the factors influencing the balance disorder in patients with WMH.The static stability,dynamic balance function,stability limit and posture stability of the patients with severe WMH are seriously degraded,there is a high risk of falling.FRT test can be used as a simple fast emergency or bedside evaluation of patients' active posture control and fall risk.
Objective To explore the features of balance disorders in patients with white matter hyperintensity(WMH).Methods The clinical data of 82 patients with WMH from September 2018 to December 2018 were collected.Fazekas scale was used to evaluate the level of WMH.Berg Balance Scale(BBS)and visual-feedback balance test-training monitor were used to assessed the performance of balance.Results Fazekas classification periventricular WMH(PWMH)and deep WMH(DWMH)had negative correlation with BBS total score(rs=-0.322,P=0.027; rs=-0.414,P=0.004)and dynamic balance function scores(rs=-0.368,P = 0.011; rs=-0.440,P= 0.002).About the parameters of the balance monitor,the center of gravity sway circumference(rs=0.239,P=0.030)and the center of gravity sway speed(rs=0.240.P = 0.030)were only positively correlated with the PWMH,center of gravity sway area(rs= 0.345,P =0.001; rs=0.340,P=0.002),X-axis standard deviation(r =0.302,P=0.006; rs=0.260,P=0.018),Y-axis standard deviation(rs=0.248,P=0.025; rs=0.253,P=0.022)were positively correlated with DWMH and PWMH; PWMH(rs=-0.258,P=0.019)and DWMH(rs=0.224,P=0.043),were negatively correlated with stability limit.BBS total score(rs=0.572,P=0.000)and functional reach test(FRT,rs=0.560,P=0.000)were positively correlated with stability limit.Conclusions PWMH may be one of the factors influencing the balance disorder in patients with WMH.The static stability,dynamic balance function,stability limit and posture stability of the patients with severe WMH are seriously degraded,there is a high risk of falling.FRT test can be used as a simple fast emergency or bedside evaluation of patients' active posture control and fall risk.
引文
[1]Zhang ZQ.Research progress of pathophysiological concepts in small vessel disase[J].Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi,2016,16:757-761.[张在强.脑小血管病病理生理学概念研究进展[J].中国现代神经疾病杂志,2016,16:757-761.]
[2]Schmidt R,Berghold A,Jokinen H.,Gouw AA,van der Flier WM,Barkhof F,Scheltens P,Petrovic K,Madureira S,Verdelho A,Ferro JM,Waldemar G,Wallin A,Wahlund L,Poggesi A,Pantoni L,Inzitari D,Fazekas F,Erkinjuntti T;LADIS Study Group.White matter lesion progression in LADIS:frequency,clinical effects,and sample size calculations[J].Stroke,2012,43:2643-2647.
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[4]Pantoni L.Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges[J].Lancet Neurol,2010, 9:689-701.
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[7]Baezner H,Blahak C,Poggesi A,Pantoni L,Inzitari D,Chabriat H,Erkinjuntti T,Fazekas F,Ferro JM,Langhorne P,O'Brien J,Scheltens P,Visser MC,Wahlund LO,Waldemar G,Wallin A,Hennerici MG; LADIS Study Group.Association of gait and balance disorders with age-related white matter changes:the LADIS study[J].Neurology,2008,70:935-942.
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[9]Jin DM,Yan TB,Tan WJ.Reliability of balance performance monilor in the assessment of balance function[J].Zhongguo Kong Fu Yi Xue Za Zhi,2002,34:203-205.[金冬梅,燕铁斌,谭文杰.平衡测试仪的信度效度研究[J].中国康复医学杂志,2002,34:203-205.]
[10]Fazekas F,Chawluk JB,Alavi A,Hurtig HI,Zimmerman RA.MR signal abnormalities at 1.5T in Alzheimer's dementia and normal aging[J].AJR Am J Roentgenol,1987,8:421-426.
[11]Xu JF,Wang JS,Zong HY,He CQ.The test-retest reliability of limits of stability measurement in health young adults[J].Zhonghua Wu Li Yi Xue Yu Kang Fu Za Zhi,2012,34:265-267.[许惊飞,王劲松,宗慧燕,何成奇.健康年轻人的稳定极限重测信度研究[J].中华物理医学与康复杂志,2012,34:265-267.]
[12]Zhang SZ,Zhao CJ.Quantitative analysis of posturogr aphic parameters[J].Zhonghua Er Ke Xue Za Zhi,2006,4:25 8-261.[张素珍,赵承君.静态平衡功能定量分析[J].中华耳科学杂志,2006,4:258-261.]
[13]Holbein MA, Redfern MS.Functional stability limits while holding locals in various positions[J].Int J Ind Ergon,1997,19:387-395.
[14]Clark S,Rose DJ.Evaluation of dynamic balance among community-dwelling older adult fallers:a generalizability study of the limits of stability test[J].Arch Phys Med Rehabil,2001,82:468-474.
[15]Duncan PW,Weiner DK,Chandler J,Studenski S.Functional reach:a new clinical measure of balance[J].J Gerontol,1990,45:192-197.
[16]Cao L,Yang G.Practical value of the functional reach test in elderly[J].Zhongguo Lao Nian Xue Za Zhi,2014,34:4399-4400.[曹玲,杨光.老年人功能性前伸测试法的实用价值[J].中国老年学杂志,2014,34:4399-4400.]
[17]Reijmer YD,Fotiadis P,Martinez-Ramirez S,Salat DH,Schultz A,Shoamanesh A,Ayres AM,Vashkevich A,Rosas D,Schwab K,Leemans A,Biessels GJ,Rosand J,Johnson KA,Viswanathan A,Gurol ME,Greenberg SM.Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy[J].Brain,2015,138:179-188.
[18]Raines S,Madows L,Lynch-Ellerington M.Bobath concept:theory and clinical practice in neurological rehabilitation[M].UK:Willey-Blackwell,2009:117-120.
[2]Schmidt R,Berghold A,Jokinen H.,Gouw AA,van der Flier WM,Barkhof F,Scheltens P,Petrovic K,Madureira S,Verdelho A,Ferro JM,Waldemar G,Wallin A,Wahlund L,Poggesi A,Pantoni L,Inzitari D,Fazekas F,Erkinjuntti T;LADIS Study Group.White matter lesion progression in LADIS:frequency,clinical effects,and sample size calculations[J].Stroke,2012,43:2643-2647.
[3]Jia JD,Yue WD.Research progress of c.erebral small vessel disease[J]. Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi,2015,15:98-102.[贾俊栋,岳卫东.脑小血管病研究进展[J].中国现代神经疾病杂志,2015,15:98-102.]
[4]Pantoni L.Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges[J].Lancet Neurol,2010, 9:689-701.
[5]Baezner H,Hennerici M.From trepidant abasia to motor network failure:gait disorders as a consequence of subcortical vascular encephalopathy(SVE):review of historical and contemporary concepts[J].J Neurol Sci,2005,229/230:81-88.
[6]de Laat KF,van Norden AG,Gons RA.Gail in elderly with cerebral small vessel disease[J].Stroke,2010,41:1652-1658.
[7]Baezner H,Blahak C,Poggesi A,Pantoni L,Inzitari D,Chabriat H,Erkinjuntti T,Fazekas F,Ferro JM,Langhorne P,O'Brien J,Scheltens P,Visser MC,Wahlund LO,Waldemar G,Wallin A,Hennerici MG; LADIS Study Group.Association of gait and balance disorders with age-related white matter changes:the LADIS study[J].Neurology,2008,70:935-942.
[8]Alghadir AH,Al-Eisa ES,Anwer S,Sarkar B.Reliability,validity,and responsiveness of three scales for measuring balance in patients with chronic stroke[J].BMC Neurol,2018,18:141.
[9]Jin DM,Yan TB,Tan WJ.Reliability of balance performance monilor in the assessment of balance function[J].Zhongguo Kong Fu Yi Xue Za Zhi,2002,34:203-205.[金冬梅,燕铁斌,谭文杰.平衡测试仪的信度效度研究[J].中国康复医学杂志,2002,34:203-205.]
[10]Fazekas F,Chawluk JB,Alavi A,Hurtig HI,Zimmerman RA.MR signal abnormalities at 1.5T in Alzheimer's dementia and normal aging[J].AJR Am J Roentgenol,1987,8:421-426.
[11]Xu JF,Wang JS,Zong HY,He CQ.The test-retest reliability of limits of stability measurement in health young adults[J].Zhonghua Wu Li Yi Xue Yu Kang Fu Za Zhi,2012,34:265-267.[许惊飞,王劲松,宗慧燕,何成奇.健康年轻人的稳定极限重测信度研究[J].中华物理医学与康复杂志,2012,34:265-267.]
[12]Zhang SZ,Zhao CJ.Quantitative analysis of posturogr aphic parameters[J].Zhonghua Er Ke Xue Za Zhi,2006,4:25 8-261.[张素珍,赵承君.静态平衡功能定量分析[J].中华耳科学杂志,2006,4:258-261.]
[13]Holbein MA, Redfern MS.Functional stability limits while holding locals in various positions[J].Int J Ind Ergon,1997,19:387-395.
[14]Clark S,Rose DJ.Evaluation of dynamic balance among community-dwelling older adult fallers:a generalizability study of the limits of stability test[J].Arch Phys Med Rehabil,2001,82:468-474.
[15]Duncan PW,Weiner DK,Chandler J,Studenski S.Functional reach:a new clinical measure of balance[J].J Gerontol,1990,45:192-197.
[16]Cao L,Yang G.Practical value of the functional reach test in elderly[J].Zhongguo Lao Nian Xue Za Zhi,2014,34:4399-4400.[曹玲,杨光.老年人功能性前伸测试法的实用价值[J].中国老年学杂志,2014,34:4399-4400.]
[17]Reijmer YD,Fotiadis P,Martinez-Ramirez S,Salat DH,Schultz A,Shoamanesh A,Ayres AM,Vashkevich A,Rosas D,Schwab K,Leemans A,Biessels GJ,Rosand J,Johnson KA,Viswanathan A,Gurol ME,Greenberg SM.Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy[J].Brain,2015,138:179-188.
[18]Raines S,Madows L,Lynch-Ellerington M.Bobath concept:theory and clinical practice in neurological rehabilitation[M].UK:Willey-Blackwell,2009:117-120.