益髓醒神法针刺联合语言康复对卒中后失语患者脑白质微观结构的影响  

Effect of Yisui Xingshen acupuncture combined with language rehabilitation on the microstructure of white matter in patients with post stroke aphasia

作　　者：位文佩 张华[1] 常静玲[1] 李晓琳[1] 黄幸[1] 韦宇飞 WEI Wenpei;ZHANG Hua;CHANG Jingling;LI Xiaolin;HUANG Xing;WEI Yufei(Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《现代中西医结合杂志》2021年第35期3877-3883,共7页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金资助项目(81473654);北京市自然科学基金资助项目(7181005)。

摘　　要：目的研究脑卒中后与失语相关脑白质微观结构的改变及益髓醒神法针刺联合语言康复对脑白质微观结构的影响。方法选择2014年1月—2015年12月在北京中医药大学东直门医院就诊的缺血性脑卒中后失语症患者15例作为卒中失语组,选取同期与卒中失语组患者年龄、性别、利手、受教育程度相匹配的健康受试者15例作为健康组。2组受试者均进行结构磁共振成像(SMRI)及弥散张量成像(DTI)扫描,SMRI及DTI数据使用VistaSoft预处理后计算FA值,用自动纤维束量化追踪技术(AFQ)、约束球面反卷积法(CSD)生成白质纤维束,并对主要纤维束FA值进行统计分析,比较2组脑白质微观结构的差异。卒中失语组患者在入组当天及采用针刺联合语言康复训练综合治疗30 d后使用波士顿诊断性失语症检查(BDAE)分级和西方失语症成套测验(WAB)评价卒中失语组患者的语言功能,于治疗30 d后再次进行SMRI及DTI扫描,观察治疗前后BDAE分级与WAB量表评分(包括语言信息量、语言流利性、语言听觉理解、复述、命名评分)的变化,分析BDAE分级、WAB量表评分与脑白质微观结构FA值的相关性。结果与健康组比较,卒中失语组患者的左侧上纵束、弓状束、锥体束全部节段及丘脑前辐射大部分节段FA值均明显下降(P均<0.05)。卒中失语组患者治疗后的BDAE分级与WAB量表各项评分均明显高于治疗前(P均<0.05);左侧上纵束FA值与BDAE分级、WAB语言信息量评分、WAB命名评分呈正相关,右侧海马扣带束FA值与WAB语言流利性评分呈正相关,右侧钩状束FA值与WAB复述评分呈正相关。结论左侧上纵束、弓状束受损与卒中后失语患者出现语言、记忆神经功能障碍相关;卒中后失语患者治疗后的语言量表评分较治疗前升高并且与语言相关纤维束的FA值呈正相关,推测语言、记忆相关传导束微观结构改善可能为益髓醒神法针刺促进卒中后失语�Objective It is to study the changes in the microstructure of white matter related to post stroke aphasia,and to explore the effects of Yisui Xingshen acupuncture combined with language rehabilitation on the microstructure of white matter.Methods Fifteen patients with aphasia after ischemic stroke who were treated in Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from January 2014 to December 2015 were selected as the stroke aphasia group.15 healthy subjects matched in age,sex,dexterity and education at the same period were selected as the healthy group.The subjects of both groups underwent structural magnetic resonance imaging(SMRI)and diffusion tensor imaging(DTI)scans.The SMRI and DTI data were preprocessed by VistaSoft to calculate the FA value,and the automatic fiber quantification(AFQ)and constrained spherical deconvolution(CSD)were used to product white matter fiber bundles,and the FA values of the main fiber bundles were statistically analyzed,the differences in the microstructure of the white matter between the two groups were compared.The language function of the patients in the stroke aphasia group were evaluated on the day of enrollment and after comprehensively treating with acupuncture combined with language rehabilitation training for 30 days by the Boston Diagnostic Aphasia Examination(BDAE)classification and The Western Aphasia Battery(WAB).After 30 days of treatment,SMRI and DTI scans were performed again to observe the changes in BDAE classification and WAB scale scores(including language information,language fluency,language and auditory comprehension,retelling,and naming)before and after treatment,and to analyze the correlation between BDAE classification,WAB scale score and FA value of white matter microstructure.Results Compared with the healthy group,the FA values of all segments of the left upper longitudinal fasciculus,arcuate fasciculus,pyramidal fasciculus and most segments of the prethalamic radiation in the stroke aphasia group were significantly decreased(

关 键 词：卒中后失语 益髓醒神法针刺 语言康复 弥散张量成像 自动纤维束量化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]