脑卒中患者腹部肌肉厚度与平衡功能的相关性研究及预测分析

关键词：脑卒中  腹肌厚度  肌骨超声  平衡功能  相关性分析

Keywords:stroke  abdominal muscle thickness  musculoskeletal ultrasound  balance function  correlation analysis

摘要：

      摘要 目的：探究脑卒中患者腹肌形态学参数与平衡功能指标的相关性，阐明腹肌在平衡功能中的作用机制，为优化脑卒中后平衡障碍的康复评估体系及干预策略提供循证依据。 方法：选取2024年3—12月山东中医药大学附属医院康复中心收治的脑卒中患者60例。使用肌骨超声诊断系统定量测量腹外斜肌（EO）、腹内斜肌（IO）及腹横肌（TrA）的肌纤维厚度，采用平衡测试系统采集患者睁眼、闭眼双足站立时的重心摆动参数，包括运动椭圆面积和轨迹长度。采用相关性分析评估腹肌厚度比（患侧/健侧）及增厚率（收缩/放松）与平衡参数的相关性，并通过受试者工作特征曲线分析各腹肌参数的预测效能。 结果：脑卒中患者存在双侧腹肌厚度不对称现象，亚急性期患者腹肌厚度比显著低于慢性期（P<0.05），但增厚率更高（P<0.05）。腹肌厚度比和增厚率与睁眼、闭眼状态下的运动椭圆面积及运动长度均呈显著负相关（r=﹣0.273—﹣0.807，P<0.05）。预测模型分析表明，腹横肌（TrA）增厚率的预测效能较好（AUC=0.797），腹内斜肌（IO）与TrA增厚率联合预测效能最高（AUC=0.835）。 结论：脑卒中患者存在双侧腹肌厚度不对称性，且与病程有关。腹肌厚度参数与平衡功能呈负相关，TrA和IO增厚率可作为评估脑卒中患者平衡功能的有效预测指标，肌骨超声可以作为脑卒中患者腹部肌肉厚度的定量评估工具。

Abstract:

      Abstract Objective： To explore the correlation between abdominal muscle morphological parameters and balance function indexes in stroke patients， and to elucidate the mechanism of core muscle groups in postural control， so as to provide evidence-based basis for optimizing the rehabilitation assessment system and intervention strategies for balance disorders after stroke. Method： A total of 60 stroke patients admitted to the Rehabilitation Center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from March to December 2024 were selected. The musculoskeletal ultrasound diagnostic system was used to quantitatively measure the muscle fiber thickness of the external abdominal oblique muscle （EO）， internal oblique muscle （IO） and transverse abdominis muscle （TrA）， and the balance test system was used to collect the center of gravity swing parameters of the patient's standing on both feet with eyes open and closed， including the area of the motion ellipse and the length of the trajectory. Correlation analysis was used to evaluate the correlation between abdominal muscle thickness ratio （affected side/unaffected side） and thickening rate （contraction/relaxation） and balance parameters， and the predictive performance of each abdominal muscle parameter was analyzed by receiver operating characteristic curve （ROC）. Result： Bilateral abdominal muscle thickness asymmetry was observed in stroke patients， and the abdominal muscle thickness ratio in patients in the subacute stage was significantly lower than that in the chronic phase （P<0.05）， but the thickening rate was higher （P<0.05）. The abdominal muscle thickness ratio and thickening rate were significantly negatively correlated with the motion elliptical area and exercise length in the open and closed states （r=﹣0.273—﹣0.807， P<0.05）. The prediction model analysis showed that the prediction efficiency of transverse abdominis（TrA） muscle thickening rate was the best （AUC=0.797）， while the combined prediction efficiency of internal oblique（IO） muscle and TrA thickening rate was the highest （AUC=0.835）. Conclusion： Bilateral abdominal muscle thickness asymmetry occurs in stroke patients and is related to the course of the disease. Abdominal muscle thickness parameters were negatively correlated with balance function， and the thickening rate of TrA and IO could be used as effective predictors to evaluate the balance function of stroke patients， and musculoskeletal ultrasound could be used as a quantitative evaluation tool for abdominal muscle thickness in stroke patients.