摘要
目的:探索综合淋巴消肿治疗对乳腺癌术后淋巴水肿患者脑区激活和功能连接强度的即刻影响。方法:于2022年5—10月在复旦大学附属华山医院康复医学科门诊招募乳腺癌术后淋巴水肿患者11例,进行单次综合淋巴消肿治疗,干预前后对所有患者进行上肢围度和肩关节活动度测定,并进行静息态及任务态近红外脑功能成像检测。同时招募年龄和身体质量指数匹配的健康对照10例,进行静息态及任务态近红外脑功能成像检测。结果:与健康对照组相比,乳腺癌术后淋巴水肿患者的静息态近红外脑功能成像表现出运动网络间功能连接强度普遍异常增高(P<0.05);与干预前相比,乳腺癌术后淋巴水肿患者干预后的上肢围度和肩关节活动度显著改善,差异有显著性意义(P<0.05)。在肩关节前屈运动任务中,患侧DLPFC、M1区激活显著性降低,差异有显著性意义(P<0.05)。干预后静息态脑网络中的功能连接强度广泛降低,患侧M1-健侧S1、健侧M1-患侧SAC、患侧M1-患侧SAC、健侧S1-患侧SAC、患侧DLPFC-健侧S1、患侧DLPFC-患侧M1、患侧S1-患侧SAC、健侧M1-患侧S1、患侧DLPFC-健侧M1、患侧M1-健侧M1、患侧DLPFC-患侧SAC功能连接与干预前的差异有显著性意义(P<0.05)。干预后患侧M1-健侧S1功能连接的下降与肩关节前屈活动度的改善呈高度相关,且差异有显著性意义(P<0.05)。结论:单次综合淋巴消肿治疗技术可引起乳腺癌术后淋巴水肿患者即刻的神经可塑性改变。
Objective:To explore the immediate effects of complex decongestive therapy on brain activation and functional connectivity strength in patients with postoperative lymphedema secondary to breast cancer.Method:From May to October 2022,11 patients with postoperative lymphedema secondary to breast cancer were recruited from the Rehabilitation Medicine Outpatient Clinic at Huashan Hospital Affiliated to Fudan University and received a single session of complex decongestion therapy.Upper limb circumference and shoulder joint mobility were measured before and after the intervention,and resting-state and task-state functional near-infrared spectroscopy scan were conducted.Additionally,10 healthy controls with matched age and body mass index were also recruited and underwent functional near-infrared spectroscopy scan.Result:Compared to healthy controls,patients with lymphedema after breast cancer surgery showed a general increase in functional connectivity strength of motor networks on resting-state near-infrared brain scans(P<0.05).Compared to before intervention,patients with lymphedema after breast cancer surgery showed significant improvement in upper limb circumference and shoulder joint mobility after intervention,with statistically significant differences (P<0.05). In the task of shoulder flexion, activation of the affected side DLPFC andM1 region decreased significantly, with statistically significant differences (P<0.05). After intervention, thefunctional connectivity strength of resting-state brain networks decreased widely,and the functional connectionsof affected side M1-unaffected side S1,unaffected side M1-affected side SAC,affected side M1-affected sideSAC,unaffected side S1-affected side SAC,affected side DLPFC-unaffected side S1,affected side DLPFC-affectedside M1,affected side S1-affected side SAC,unaffected side M1-affected side S1,affected side DLPFC-unaffected side M1,affected side M1-unaffected side M1,affected side DLPFC-affected side SAC had statisticallysignificant differences compared to before intervention (P<0.05). The decline of affected side M1-unaffectedside S1 functional connection after intervention was highly correlated with the improvement of shoulderflexion activity,and the difference was statistically significant (P<0.05).Conclusion:A single session of complex decongestion therapy can result in immediate changes in neural plasticityin individuals with postoperative lymphedema secondary to breast cancer.
作者
沈莉
李浩正
胡瑞萍
朱玉连
吴毅
向延卫
SHEN Li;LI Haozheng;HU Ruiping(Shanghai University of Traditional Chinese Medicine,Shanghai,201203)
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2023年第6期761-767,共7页
Chinese Journal of Rehabilitation Medicine
基金
上海市自然基金资助(21ZR1463400)
上海人工智能创新发展专项资助(2020-RGZN-02038)。
关键词
乳腺癌术后
淋巴水肿
综合淋巴消肿治疗
近红外脑功能成像
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