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脑白质高信号患者数字化笔迹分析特征的 临床研究
夏翠俏  谢鸿阳  赵弘轶  丁玉  夏振西  黄勇华  
0
()
摘要:
目的 通过数字化书写及绘画任务,探讨脑白质高信号(WMH)患者是否存在特征性上肢 运动障碍。方法 选择 2020 年 4 月至 2021 年 4 月在解放军总医院第七医学中心神经内科住院的 82 例 WMH 患者为研究对象,根据 Fazekas 评分对患者的 WMH 程度进行分组,分为低负荷组(n=42)、中负荷组 (n=20)、高负荷组(n=20)。使用 WACOM 触控屏及电子笔进行书写及绘画测试,采用 MovAlyzeR 软件对 运动学参数进行记录和处理。比较 3 组患者签名时的速度、压力、平均曲折度;书写“正”字第 3、4 笔的 压力、速度;书写“永”字的垂直大小及水平大小;绘画阿基米德螺旋时的平均标准化急动度(ANJ)及子 运动和,分析WMH不同程度与书写及绘画参数的差异。采用Spearman相关分析患者WMH程度与书写、 绘画参数之间的相关性。结果 低负荷、中负荷、高负荷组患者签名平均曲折度、签名速度、书写“正” 字第 4 笔速度比较[0.2(0.1,0.4)比 0.3(0.2,0.4)比 0.4(0.2,0.6)、1.6(1.4,2.3)cm/s 比 1.5(1.2,2.0)cm/s 比 1.2(1.1,1.6)cm/s、1.4(1.2,1.8)cm/s 比 1.3(0.9,1.7)cm/s 比 0.9(0.8,1.4)cm/s],差异有统计学意义(Z=9.571、 10.726、12.478;P< 0.01);书写“永”字的垂直大小比较[(1 611.3±405.0)cm 比(1 474.1±512.8)cm 比 (1 286.8±470.1)cm],差异有统计学意义(F=3.580,P< 0.05);描绘阿基米德螺旋时的 ANJ、子运动和比 较[30.9(22.2,51.3)比 44.6(23.2,80.8)比 52.8(31.2,100.8)、8.0(2.5,11.5)个比 11.0(5.0,17.0)个比 12.0(9.3, 15.8)个],差异有统计学意义(Z=7.636、7.792;P<0.05)。相关性分析显示,WMH程度与签名平均曲折度、 螺旋ANJ、螺旋子运动和呈正相关(r=0.366、0.301、0.300; P<0.01),与签名速度、书写“正”字第4笔速度、 “永”字垂直大小呈负相关(r=-0.307、-0.307、-0.287;P< 0.01)。结论 随脑白质病变严重程度的增加, 患者书写及绘画显著恶化,且书写障碍主要存在于垂直方向。
关键词:  脑白质病变  脑小血管病  数字化分析  书写  绘画
DOI:10.3969/j.issn.1009-6574.2022.06.003
基金项目:吴阶平医学基金会临床科研专项项目(320.6750.18456)
Clinical research of digital handwriting analysis characteristics in patients with cerebral white matter hyperintensities
Xia Cuiqiao,Xie Hongyang,Zhao Hongyi,Ding Yu,Xia Zhenxi,,Huang Yonghua
()
Abstract:
Objective To explore whether patients with white matter hyperintensity (WMH) have characteristic dyskinesia through simple digital writing and painting tasks. Methods A total of 82 WMH patients hospitalized in the Department of Neurology of the Seventh Medical Center of PLA General Hospital from April 2020 to April 2021 were enrolled. All patients were divided into low load group (n=42), medium load group (n=20) and high load group (n=20) according to the scores of Fazekas. WACOM touch screen and electronic pen were used for writing and painting test, and MovAlyzeR software was used to record and process kinematic parameters. The speed, pressure and average tortuosity of the three groups were compared; The pressure and speed of the third and fourth strokes of the Chinese character " 正 "; Write the vertical and horizontal size of the Chinese character " 永 "; The average normalized jerk (ANJ) and sub motion sum when painting Archimedes spiral, and analyze the differences between WMH and writing and painting parameters. Spearman correlation was used to analyze the correlation between WMH degree and writing and painting parameters. Results There were significant differences in the average tortuosity of signature, the speed of signature and the speed of writing the fourth stroke of " 正 " in low load, medium load and high load groups [0.2 (0.1, 0.4) vs 0.3 (0.2, 0.4) vs 0.4 (0.2, 0.6); 1.6 (1.4,2.3) cm/s vs 1.5 (1.2, 2.0) cm/s vs 1.2 (1.1, 1.6) cm/s; 1.4 (1.2,1.8)cm/s vs 1.3 (0.9, 1.7)cm/s vs 0.9 (0.8, 1.4)cm/s] (Z=9.571, 10.726, 12.478; P< 0.01). The difference of vertical size of " 永 " among the three groups [(1 611.3±405.0)cm vs (1 474.1±512.8)cm vs (1 286.8±470.1)cm] were statistically significant (F=3.580,P< 0.05). The difference of ANJ and sub motion sum when painting Archimedes spiral among the three groups [30.9 (22.2, 51.3) vs 44.6 (23.2, 80.8) vs 52.8 (31.2, 100.8); 8.0 (2.5, 11.5) vs 11.0 (5.0, 17.0) vs 12.0 (9.3, 15.8)] were statistically significant (Z=7.636, 7.792; P < 0.05). The correlation analysis showed that the degree of WMH was positively correlated with the average tortuosity of signature, spiral ANJ, spiral sub motion (r=0.366, 0.301,0.300;P< 0.01), and negatively correlated with the speed of signature, the speed of writing the fourth stroke of " 正 " character and the vertical size of " 永 " character (r= -0.307,-0.307,-0.287;P< 0.01). Conclusions With the increasing severity of WNH, writing and painting deteriorated significantly, and writing disorders mainly exist in the vertical direction.
Key words:  White matter hyperintensities  Cerebral small vessel disease  Digital analysis  Writing  Painting

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