重复经颅磁刺激对卒中后失语语言功能重组的影响:基于功能磁共振的研究  

Effect of Repeated Transcranial Magnetic Stimulation on Reorganization of Aphasia after Stroke: A Study Based on Functional Magnetic Resonance Imaging

作　　者：邱国荣 丘卫红[1] 邹艳[2] 冯小欢 武惠香[1] 陈兆聪 康庄[2] QIU Guo-rong1,QIU Wei-hong1,ZOU Yan2,FENG Xiao-huan1,WU Hui-xiang1,CHEN Zhao-cong1,KANG Zhuang2(1. a. Department of Rehabilitation Medicine; b. Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, Chin)

机构地区：[1]中山大学附属第三医院康复医学科,广东广州市510630 [2]中山大学附属第三医院放射科,广东广州市510630

出　　处：《中国康复理论与实践》2018年第6期686-695,共10页Chinese Journal of Rehabilitation Theory and Practice

基　　金：广东省自然科学基金项目(No.2016A030313327);广东省科技计划项目(No.2016A020215226);广州市科技计划项目(No.201607010185);国家自然科学基金青年科学基金项目(No.81401869)~~

摘　　要：目的结合功能磁共振(f MRI)技术探讨重复经颅磁刺激(r TMS)对卒中后失语语言功能重组的影响。方法 2017年1月至2018年2月,选择符合条件的卒中后失语患者6例作为实验组,选择年龄、性别相匹配的健康成人9例作为健康对照组,均于入组时进行任务态功能磁共振(task-f MRI)检查。其中4例患者在神经导航定位系统引导下标记右侧额下回三角部,予1 Hz r TMS刺激,每周5次,共2周。治疗前后进行中文版西方失语症成套检验(WAB)评估及task-f MRI检查。采用SPM 12软件对f MRI数据进行处理,比较两组脑区激活差异及体素变化,对4例病例r TMS治疗前后f MRI数据及WAB评分进行个体分析,比较其脑区激活差异、激活体素指数(AVI)及语言功能变化。结果实验组双侧大脑半球激活总体素均比健康对照组多,包括感兴趣区(ROI)双侧额中回、双侧补充运动区;非感兴趣区(n-ROI)左楔前叶、左中央后回、右海马、右旁扣带回等。实验组比健康对照组激活减少的脑区包括ROI左侧额下回三角部;n-ROI左距状裂周围皮层、左舌回、右前扣带回和旁扣带回。病例1、病例2病程较短,病灶体积较小,治疗前双侧大脑半球激活升高,AVI显示语言功能偏侧化为右侧大脑半球;治疗后双侧大脑半球激活水平均降低,但ROI的高效语言功能区如左侧额下回三角部由原来无激活变为明显激活,AVI显示语言功能偏侧化由右侧大脑半球转为左侧大脑半球,语言功能较前改善。病例3、病例4病程较长,病灶体积较大,治疗前双侧大脑半球激活均降低,AVI显示病例3语言功能偏侧化为右侧大脑半球,病例4为左侧大脑半球。治疗后两者双侧大脑半球激活均较前增加,语言功能偏侧化均为右侧大脑半球;病例3的ROI左侧额中回、右侧颞中回由治疗前无激活变为明显激活,右侧补充运动区激活增加,病例4治疗前未见ROI激活,治疗后双侧补充运动区、右�Objective To investigate the effect of repetitive transcranial magnetic stimulation（r TMS） on the brain functional reorganization of aphasia after stroke, with functional magnetic resonance imaging（f MRI）.Methods From January, 2017 to February, 2018, six eligible stroke patients with aphasia were recruited in experimental group, and nine age-gender matched healthy adults were recruited in healthy control group. Subjects in both groups received task-f MRI, and the experimental group was assessed with Chinese version of Western Aphasia Battery（WAB） examination before and after r TMS treatment. Four patients underwent r TMS at the right inferior frontal gyri pars triangularis marked by neuro-navigation-guided system, 1 Hz, five times per week for two weeks. The f MRI data were processed by SPM 12. The differences of brain activation and voxel changes between two groups were compared. The f MRI data including the differences in brain activation, voxel volume and activation voxel indices（AVI） and WAB scores were analyzed before and after r TMS.Results The cerebral hemisphere activation in the experimental group was higher than that of the healthy control group,including the regions of interest（ROI） such as bilateral supplementary motor area and middle frontal gyrus, and the non-ROI（n-ROI） such as left praecuneus, left postcentral gyrus, right hippocampus, right paracingulate cortex, etc., while the activation reduced in the areas of left pars triangularis and n-ROI such as left calcarine fissure cortex, left gyrus lingualis, the right anterior cingulate and the paracingulate cortex. Cases 1 and 2 had shorter course of disease, smaller lesion volume, and activation increased in bilateral cerebral hemispheres before treatment. AVI showed that their hemispheric dominance was right, and activation reduced in bilateral cerebral hemisphere after treatment, but the high-efficiency language function area of ROI, such as the left pars triangularis,turned from inactive to active, and the hemispheric domi

关 键 词：脑卒中 失语症 功能磁共振成像 经颅磁刺激 功能重组 

分 类 号：R743.3[医药卫生—神经病学与精神病学]