低频重复经颅磁刺激对脑梗死失语的治疗作用及机制研究  

Therapeutical effect of low-frequency repetitive transcranial magnetic stimulation on cerebral infarction aphasia and its possible mechanism

作　　者：陈芳 王晓明[2] 詹成 杨玲 王寅旭[2] 孙祥荣[2] 赵晓琼[2] 黄慧[2] 胡建秀[2] 

机构地区：[1]四川攀枝花中心医院神经内科,617000 [2]川北医学院神经疾病研究所,637000

出　　处：《中华脑血管病杂志（电子版）》2012年第5期8-12,共5页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：2012年卫生部临床研究课题(1c20120709)

摘　　要：目的探讨低频重复经颅磁刺激(low-rTMS)对急性期脑梗死运动性失语的治疗作用、安全性及相关机制。方法选取左半球脑梗死后运动性失语右利手的患者24例,经ABC失语检查表评定后随机分为对照组(n=12)和治疗组(n=12)。对照组给予常规药物和语言康复治疗;治疗组在对照组治疗基础上给予low-rTMS治疗。rTMS治疗方法:频率1Hz、强度为运动阈值的80%、部位为右侧大脑半球Broca区、每序列50次脉冲、每天10个序列、序列间隔120s,共10d。两组治疗前、疗程后2周、疗程后2月和疗程后6月均行汉语ABC失语检查表语言评分评价其语言功能。两组各选取8例患者在治疗前、疗程后2周行磁共振波谱(MRS)和单光子发射计算机断层摄影(SPECT)检查,分别检测脑代谢和脑血流改变。结果①ABC评分结果:疗程后2周、疗程后2月、疗程后6月治疗组其值均高于对照组和治疗前(P<0.05)。②SPECT结果:两组治疗前和疗程后2周左额下回缺血灶明显大于对侧镜像区;疗程后2周治疗组左额下回缺血灶明显小于治疗前和对照组,其摄取值高于对照组(P<0.05)。③MRS结果:治疗前两组Broca区出现明显的倒置双乳酸(Lac)峰,N-乙酰天门冬氨酸(NAA)和NAA/肌酸(Cr)值均比对侧镜像区明显降低(均P<0.05),而胆碱(Cho)值则升高(P<0.05);疗程后2周治疗组的NAA和NAA/Cr值明显高于对照组(P<0.05);Cho值比对照组减低(P<0.05)。结论 1 Hz、rTMS对急性脑梗死失语患者有一定的康复作用;且此治疗是安全的。语言功能改善,推测可能与低频rTMS刺激健侧语言区通过远隔效应增加了局部语言区的血流量和脑代谢,抑制右侧半球的兴奋性有关。Objective Inquire into the therapeutical effect of low-frequency repetitive transcranial magnetic stimulation （rTMS） on cerebral infarction aphasia and its security and effect on cerebral blood flow. Methods Twenty-four dextromanual patients suffering from Broca＇ s aphasia （by ABC aphasia checklist assessment） post cerebral infarction （left hemisphere） were randomly divided into two groups. The control group （n = 12 ） accepted normal therapy including conventional drugs and language rehabilitation, while the treatment group （n = 12） are given low-rTMS treatment in addition to normal therapy. Low-rTMS treatment means： we give Broca area of the right side cerebrum l0 pulse sequence stimulus a day for 10 days continuously, with sequence interval of 120 s; each sequence consists of 50 pulses whose frequency equals 1 Hz; stimulus intensity equals 80% of the motor evoked potential threshold. ABC aphasia checklist assessment and analysis were taken for both groups at before the treatments as well as 2 weeks, 2 months and 6 months after the treatments. Eight patients of each group were selected to receive MR spectroscopy （MRS） and single-photon emission computed tomography （SPECT） at before treatment and 2 weeks after treatment to test brain metabolism and the cerebral blood flow change respectively. Results The ABC scores showed that the ABC rating value of treatment group at 2 weeks, 2 months and 6 months after treatment were significantly increased （ P 〈 O. 05 ） as compared with pre-treatment. The SPECT result showed that left inferior frontal lobe ischemia area of each group were significantly bigger than mirror area at before treatment and 2 weeks after the treatment ; At 2 weeks after treatment, the left frontal lobe ischemia area of patients in magnetic stimulation group were less than pre-treatment and the control group obviously and the ratio was higher than the control group （ P 〈 0.05 ）. Before treatment, MRS results showed the Broca area of left inferior frontal are

关 键 词：低频重复经颅磁刺激 脑梗死 失语 治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]