Abstract: Objective  To explore the factors influencing the poor early motor function recovery of proximal and distal upper limbs in patients with cerebral infarction.
Methods   This study prospectively enrolled patients with acute cerebral infarction accompanied by upper limb dysfunction admitted to the Department of Neurology, the First Affiliated Hospital of Fujian Medical University from November 2023 to December 2024. The Fugl-Meyer motor assessment-upper extremity (FMA-UE) was used to conduct the first and second assessments at 3-7 days and 8-12 days after onset, respectively, with an interval of≥5 days. Relevant demographic and clinical data were collected. Patients were then divided into a poor proximal recovery group (estimated total recovery value of proximal FMA-UE score, ΔFJ<2.08) and a good proximal recovery group (ΔFJ≥2.08), as well as a poor distal recovery group (estimated total recovery value of distal FMA-UE score, ΔFY<1.67) and a good distal recovery group (ΔFY≥1.67) based on the recovery outcome of upper limb motor function. Univariate analysis and multivariate analysis (binary logistic regression analysis) were performed separately for proximal and distal upper limbs to explore the influencing factors of poor early motor function recovery.
Results  A total of 81 patients with acute cerebral infarction accompanied by upper limb dysfunction were enrolled in this study, including 32 patients in the poor proximal recovery group and 49 in the good proximal recovery group, as well as 44 patients in the poor distal recovery group and 37 in the good distal recovery group. Multivariate analysis revealed that low red blood cell count (OR 0.271, 95%CI 0.083-0.877, P=0.029) and low first proximal FMA-UE assessment score (F1J) (OR 0.917, 95%CI 0.855-0.984, P=0.016) were independent risk factors for poor early motor function recovery of the proximal upper limb. Proprioceptive dysfunction (OR 8.077, 95%CI 1.325-49.250, P=0.024), low red blood cell count (OR 0.187, 95%CI 0.039-0.893, P=0.036), low F1J (OR 0.783, 95%CI 0.687-0.892, P<0.001), and low first distal FMA-UE assessment score (F1Y) (OR 0.638, 95%CI 0.469-0.868, P=0.004) were independent risk factors for poor early motor function recovery of the distal upper limb.
Conclusions  Red blood cell count and F1J may be independent influencing factors for poor early motor function recovery of the proximal upper limb in patients with cerebral infarction, while proprioceptive dysfunction, red blood cell count, F1J, and F1Y may be independent influencing factors for poor early motor function recovery of the distal upper limb.

Key words: Cerebral infarction; Motor function; Upper limb; Risk factor; Outcome prediction

摘要： 目的 探讨脑梗死患者上肢近端和远端早期运动功能恢复不良的影响因素。
方法 前瞻性纳入2023年11月—2024年12月福建医科大学附属第一医院神经内科收治的急性脑梗死伴上肢功能障碍患者，采用Fugl-Meyer运动功能评定量表上肢部分（Fugl-Meyer motor assessment-upper extremity，FMA-UE），分别于发病第3～7天和第8～12天进行间隔天数≥5 d的第1次和第2次评估，并收集相关人口统计学及临床资料。根据上肢运动功能恢复结局将患者分为近端恢复不良组（近端FMA-UE评分估计总恢复值ΔFJ<2.08）和近端恢复良好组（ΔFJ≥2.08），以及远端恢复不良组（远端FMA-UE评分估计总恢复值ΔFY<1.67）和远端恢复良好组（ΔFY≥1.67）。分别针对上肢近端和远端进行单因素分析及多因素分析（二元logistic回归分析），以探讨各自运动功能恢复不良的影响因素。
结果 本研究共纳入81例急性脑梗死伴上肢功能障碍患者，其中近端恢复不良组32例、近端恢复良好组49例；远端恢复不良组44例、远端恢复良好组37例。多因素分析结果显示，低红细胞计数（OR 0.271，95%CI 0.083～0.877，P=0.029）、低上肢近端第1次FMA-UE评分（F1J）（OR 0.917，95%CI 0.855～0.984，P=0.016）是上肢近端早期运动功能恢复不良的独立危险因素；本体感觉障碍（OR 8.077，95%CI 1.325～49.250，P=0.024）、低红细胞计数（OR 0.187，95%CI 0.039～0.893，P=0.036）、低F1J（OR 0.783，95%CI 0.687～0.892，P<0.001）或低上肢远端第1次FMA-UE评分（F1Y）（OR 0.638，95%CI 0.469～0.868，P=0.004）是上肢远端早期运动功能恢复不良的独立危险因素。
结论 红细胞计数、F1J可能是脑梗死患者上肢近端早期运动功能恢复不良的独立影响因素，本体感觉障碍、红细胞计数、F1J或F1Y可能是其远端早期运动功能恢复不良的独立影响因素。

关键词: 脑梗死; 运动功能; 上肢; 危险因素; 结局预测