2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/648693摘要：中風在全球都是導致慢性殘疾的主因，肌肉無力造成的偏癱是最常見的慢性中風後殘疾。然而，只有很少數文獻探討中風後骨骼肌肉的異常及其臨床意義。最近幾年有一些研究發現中風後肌肉結構和代謝會發生改變，中風患肢肌肉的生物特性如肌肉質量、肌肉內脂肪、纖維類型和炎症產物的表現都可能發生改變。中風會引起患肢的肌肉質量減少與肌內脂肪升高；甚至也有發現中風病人患肢肌肉的纖維類型發生改變，TNF-α mRNA 的表現也被發現在中風患肢肌肉有升高的情形。磁振造影（MRI）和磁振頻譜（MRS）技術在最近幾十年已被廣泛運用於測量各種骨骼肌的生物學特性。MRI 檢查可以很容易、重複和精確的測量肌肉的體積卻不會暴露在輻射下。在體內質子（1-H）MRS 提供了非侵入性方法測量肌內脂肪。磷（31-P）MRS 可以用來評估肌肉的能量代謝。有研究發現靜態31-P MRS可以評估肌肉纖維的分佈。而動態的31-P MRS 則可以用來測量肌肉的氧化代謝。肌肉鍛煉可能對中風後的骨骼肌有許多好處，它可以減緩因為身體活動減低的影響。強化或阻力訓練已經被證明可以提高中風患者上肢的力量和功能。我們將進行一個雙盲、多基礎點，平行設計研究，以評估強化或阻力訓練對中風患者肌肉生物特性的影響。我們的研究目的是探討中風患者接受強化或阻力訓練後，肌肉生物特性的改變和功能的改善之間的關係。<br> Abstract: Stroke is the leading cause of chronic disability worldwide. Hemiparesis resulting frommuscle weakness is the most common chronic disability after stroke. However, only fewliteratures exist on skeletal muscle abnormalities and their clinical relevance after stroke.Alterations of muscle structure and metabolism has been investigated after stroke inrecent years. Biological properties such as muscle mass, muscle fat, fiber phenotype andinflammatory product expression have been investigated in the limb muscles of strokepatients. Stroke causes reduce of lean muscle mass in the paretic side. Greater intramuscularfat related to muscle area has been found in the affected limb in stroke patient. Altered fibertype proportions has been reported in affected limbs of stroke patients. Elevation of TNF-αmRNA expression has been found in affected limb muscle of stroke patients.MRI and MRS techniques have been widely used for measuring various biologicalproperties of skeletal muscle in recent decades. MRI enables easy, repeated and accuratemeasurement of muscle volume without exposure of ionizing radiation. In vivo proton (1-H)MRS offers a non-invasive method for measuring intramuscular fat. With in vivo phosphorus(31-P) MRS, the energetic metabolism of muscle can be assessed. The resting 31-P MRS hasbeen reported to be helpful in the assessment of muscle fiber distribution. Dynamic 31P MRSusing recovery-kinetics measurement allows measurements of oxidative metabolism ofmuscle.Exercise may have many beneficial effects at the level of skeletal muscle after stroke. Itmay prevent changes associated with physical inactivity. Strength or resistance training hasbeen proved to improve upper-limb strength and function in stroke patients. We will conduct adouble-blinded, multiple-baseline, parallel design study to evaluate the effect of strength orresistance training on biological properties of affected muscle in stroke patients. The purposeof our study is to investigate the relationship between biological change and functionalimprovement in the muscle of stroke patients receiving strength or resistance training.中風肌肉磁振造影（MRI）磁振頻譜（MRS）強化或阻力訓練StrokeMuscleMRI (magnetic resonance imaging)MRS (MR spectroscopy)Strength or resistance