用基于体素的形态分析探测发育性口吃的脑灰质异常  

Gray matter abnormalities in developmental stuttering determined with voxel-based morphometry

作　　者：宋鲁平[1] 彭聃龄[2] 金真[3] 姚力[4] 宁宁[2] 郭小娟[4] 张通[1] 

机构地区：[1]首都医科大学康复医学院中国康复研究中心神经康复科,北京100068 [2]北京师范大学认知神经科学与学习国家重点实验室 [3]中国人民解放军三○六医院磁共振室 [4]北京师范大学电子系

出　　处：《中华医学杂志》2007年第41期2884-2888,共5页National Medical Journal of China

基　　金：中国博士后科学基金(中博基{2001}14);首都医学发展基金(2005-2003)

摘　　要：目的考察发育性口吃成年人是否具有异常脑结构改变,探讨其相关的神经机制。方法应用 GE Haifa 2T 高场强 MR 成像系统,对10例发育性口吃成年人和12名非口吃成年人行全脑扫描,用快速梯度回波成像序列获得三维结构图像。采用以 SPM99软件为基础的 VBM 软件包,由计算机全自动地进行数据处理,比较两组间脑局部灰质的差异。结果口吃组双侧大脑半球颞上回、颞中回、中央后回、顶下小叶和运动前回的灰质明显高于对照组(P<0.001),左、右侧半球增加的体素数分别为48 782个和60 247个;而双侧小脑后叶和延髓明显少于对照组(P<0.001),减少的体素总数为32 394个。结论发育性口吃成年人在脑组织结构上与非口吃成年人有所不同。其中,双侧小脑及延髓灰质体积减少,可能是口吃者言语运动协调障碍的主要神经解剖学基础;而双侧半球中灰质体积增加的脑区,则可能是对言语协调功能不足进行长期代偿所致的结构性变化。Objective To investigate the differences of regional grey matter volume between adults with persistent developmental stuttering and fluent speaking adults , and to determine whether stutterers have anomalous anatomy of speech-relevant brain areas that possibly affect speech fluency. Methods Highresolution magnetic resonance imaging （MRI） scanning was performed on 10 adults with developmental stuttering, aged 26 （21-35） with the onset age of 4 （3-7） and 12 age, sex, hand preference, and education-matched controls. The customized brain templates were created in order to improve spatial normalization and segmentation. Then automated preprocessing of MRI data was conducted using an optimized version of VBM, a fully automated unbiased and objective whole-brain MRI analysis technique. Results VBM analysis revealed that compared with the controls, the stuttering adults had significant clusters of locally gray matter volume increased in the superior temporal, middle temporal, precentral and postcentral gyros, and inferior parietal lobule of the bilateral hemisphere （ P 〈 0. 001 ） , the numbers of increased gray matter volume in the right and left hemispheres were 60 247 and 48 782 voxels respectively. The, Grey matter decrease was shown with an overall decreased gray matter volume of 32 394 voxels, mainly in the bilateral cerebella posterior lobe and dorsal part of medulla, especially inferior semi-lunar lobule, followed by cerebellar tonsil and bilateral medulla in comparison with the controls （P 〈 0.001 ）. Conclusion The reduction of the regional gray matter volume of bilateral cerebella and medulla is related to the neural mechanism of the controlling disorder of speech production and may be the essential cause of stuttering. Some areas with increased gray matter volume in temporal lobe, parietal lobe, and frontal lobe, may be the result of long term functional compensation for the cerebella and medulla function deficiency.

关 键 词：口吃 磁共振成像 神经机制 图像处理 计算机辅助 

分 类 号：R742.8[医药卫生—神经病学与精神病学]