高频rTMS对出血性脑卒中患者认知功能障碍疗效的rs-fMRI研究  

Resting state fMRI study on therapeutic effect of rTMS for cognitive dysfunction in patients with hemorrhagic stroke

作　　者：王晓[1] 刘金岭 王栋[2] Wang Xiao;Liu Jinling;Wang Dong(Department of Radiology,the Affiliated Nanyang Second General Hospital,Xinxiang Medical University,Nanyang 473012,China)

机构地区：[1]新乡医学院附属南阳市第二人民医院影像科,河南南阳473012 [2]新乡医学院附属南阳市第二人民医院神经外科,河南南阳473012

出　　处：《中国康复》2021年第8期451-455,共5页Chinese Journal of Rehabilitation

基　　金：国家重点研发计划项目(2017YFC0111900);河南省医学科技攻关计划联合共建项目(LHGJ20191469)。

摘　　要：目的:通过静息态功能磁共振成像(rs-fMRI)技术分析高频重复经颅磁刺激(rTMS)对出血性脑卒中患者认知功能障碍疗效的研究。方法:120例出血性脑卒中患者,随机分为研究组与对照组各60例。2组均给予常规药物治疗、认知功能康复训练,研究组加用高频rTMS刺激左额叶背外侧区域。采用蒙特利尔认知评估量表(MoCA)、简易智能精神状态检查量表(MMSE)评估患者的认知功能,并进行rs-fMRI扫描。结果:治疗4周后,2组患者MoCA及MMSE评分均较治疗前升高(均P<0.01),且研究组患者明显高于对照组(P<0.01)。与对照组患者相比,研究组患者与背外侧左额叶功能连接增强的脑区包括额中回及下回、楔前叶、颞下回等,分数低频振幅值升高的脑区包括额下回、海马旁回、颞上回等,局部一致性值升高的脑区包括:扣带回、缘上回、楔前叶等。治疗4周后,2组患者分数低频振幅值、局部一致性值较前升高,且研究组患者明显高于对照组(P<0.05)。结论:高频rTMS能够有效改善出血性脑卒中患者的认知功能,rs-fMRI分析得出的认知观察区域(左额叶背外侧)功能连接变化及相关脑区代偿变化证实了患者认知功能的改善。Objective:To analyze the efficacy of high-frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of cognitive dysfunction in patients with hemorrhagic stroke through resting-state functional magnetic resonance imaging(rs-fMRI)technology.Methods:A total of 120 patients with hemorrhagic stroke were randomly divided into study group and control group.In the control group,60 patients received conventional medical treatment,cognitive function rehabilitation training and high-frequency rTMS false stimulation,and in the study group,60 patients received conventional medical treatment,cognitive function rehabilitation training and high-frequency rTMS stimulation of the left frontal dorsolateral area.The cognitive function was assessed by Montreal Cognitive Assessment Scale(MoCA)and mini mental state examination(MMSE),and RS fMRI was performed.Results:After 4 weeks of treatment,MOCA score and MMSE score in the two groups were significantly higher than those before treatment,and those in the study group were significantly higher than in the control group(P<0.01).The brain areas with enhanced functional connectivity of dorsolateral left frontal lobe in the study group included the middle frontal gyrus and inferior gyrus,precuneus lobe,inferior temporal gyrus,etc.;The brain regions with higher fractional low frequency amplitude value included inferior frontal gyrus,parahippocampal gyrus,superior temporal gyrus,and the brain regions with increased local consistency value included cingulate gyrus,superior marginal gyrus,and precuneus.After 4 weeks of treatment,the fractional low frequency amplitude and local consistency in the two groups were significantly higher than those before treatment,and those in the study group were sig nificant-ly higher than in the control group(P<0.05).Conclusion:High-frequency rTMS can effectively improve the cognitive function of patients with hemorrhagic stroke.The functional connectivity changes in the cognitive observation area(the left dorsolateral frontal lobe)and the com

关 键 词：出血性脑卒中 认知功能障碍 重复经颅磁刺激 静息态fMRI 

分 类 号：R49[医药卫生—康复医学] R743.3[医药卫生—临床医学]