正常成人与伴吞咽障碍的急性脑梗死患者吞咽相关脑功能区激活机制的血氧水平依赖功能磁共振研究  

On the activation mechanism of swallowing-related brain functional areas via blood oxygenation level dependent-functional magnetic resonance imaging between normal adults and acute cerebral infarction patients with dysphagia

作　　者：邬刚[1] 郭艳吉 崔树兰 涂坤[1] 马鹏程[2] 李妍平[1] 吴海燕[3] Wu Gang;Guo Yanji;Cui Shulan;Tu Kun;Ma Pengcheng;Li Yanping;Wu Haiyan(Department of Neurology,Yan’an Hospital Affiliated to Kunming Medical University;Department of Radiology,Yan’an Hospital Affiliated to Kunming Medical University;Department of Cardiology,The First People's Hospital of Yunnan Province)

机构地区：[1]昆明医科大学附属延安医院神经内科,昆明650051 [2]昆明医科大学附属延安医院影像科,昆明650051 [3]云南省第一人民医院心内科,昆明650051

出　　处：《重庆医科大学学报》2022年第7期802-810,共9页Journal of Chongqing Medical University

基　　金：云南省高层次卫生健康技术人才医学学科后备人才计划资助项目(编号:H-2018060);云南省科技厅-昆明医科大学联合专项资助项目(编号:2019FE001(-292)、202101AY070001-210);昆明市卫生科技人才培养项目暨“十百千”工程培养计划资助项目[编号:2020-SW(后备)-10];昆明市卫生健康委员会卫生科研课题资助项目(编号:2021-03-07-003)。

摘　　要：目的:运用血氧水平依赖功能磁共振(blood oxygenation level dependent-functional magnetic resonance imaging,BOLDfMRI)技术对伴吞咽功能障碍的急性脑梗死患者和正常成人在吞咽活动时相应的脑功能区域激活特点进行研究,探索急性脑梗死患者吞咽功能障碍恢复过程中相关的脑功能区域调控方式。方法:选取2018年7月至2021年7月在昆明医科大学附属延安医院住院的伴吞咽障碍的急性脑梗死患者150例和正常成人100例,对其进行BOLD-fMRI扫描,记录两者在吞咽活动时相关脑功能区域的激活体积和强度,并对比两者间的差异。结果:共收集病例组150例,其中右侧脑梗死组患者50例,男29例,女21例,平均年龄(56.22±7.33)岁;左侧脑梗死组患者100例,男61例,女39例,平均年龄(58.07±6.84)岁;对照组100例,男57例,女43例,平均年龄(53.56±11.41)岁。对照组吞咽活动时激活的相关脑功能区域特点显示:两侧初级运动皮层中枢(BA4区)、运动前区/辅助运动区(BA6/8区)、缘上回(BA40区)、岛叶(BA13区)、颞上回(BA22区)、扣带回皮层(BA24区)、额叶内侧面(BA32区)、延髓、脑桥、基底核团、丘脑、小脑及左侧颞极(BA38区)和右侧颞横回(BA41区)等脑功能区激活体积和强度增加,左侧BA4区、BA40区、小脑激活体积较右侧大,差异有统计学意义(P<0.05);左右两侧脑区的激活强度差异无统计学意义(P>0.05)。右侧脑梗死病例组患者BOLD-fMRI扫描各脑区激活体积显示:右侧BA4区、BA6/8区激活体积较对照组减小,左侧BA6/8区、BA4区激活体积较对照组增大,双侧后扣带回皮层的BA23和顶叶内侧面BA31区体积较对照组增大,左侧视觉中枢的BA18/19和BA41区皮层激活体积较对照组增大,差异有统计学意义。右侧BA4区、BA6/8区、BA40区、BA13区激活强度较对照组降低,差异有统计学意义。左侧脑梗死病例组患者BOLD-fMRI扫描各脑区激活体积显示:左侧BA4区、BA6/8区的激活体积�Objective:To study the activation characteristics of swallowing-related brain functional areas of acute cerebral infarction()genation level dependent-functional magnetic resonance imaging(BOLD-fMRI),and to explore the regulation way of relevantbrain functional areas during dysphagia recovery of ACI patients.Methods:One hundred and fifty ACI patients with dysphagia,whowere hospitalized in Yan’an Hospital Affiliated to Kunming Medi-cal University from July 2018 to July 2021,and 100 normal adultswere selected in the study and received BOLD-fMRI.The activa-tion volume and intensity of relevant brain functional areas duringswallowing activities were recorded and the differences between them were compared.Results:Among the 150 ACI patients with dysphagia collected during the study,50 cases[29 males and 21females,averaged at(56.22±7.33)years]old)were classified into the right ACI group,and 100 cases[61 males and 39 females,averaged at(58.07±6.84)years old]were classified into the left ACI group.There were 100 normal adults[57 males and 43 females,averaged at(53.56±11.41)years old]in the control group.Characteristics of relevant brain functional areas activated during swallow-ing activities in the control group showed that increased activation volume and intensity were observed for brain functional areas includ-ing bilateral primary motor cortex center(BA4),premotor area/supplementary motor area(BA6/8),supramarginal gyrus(BA40),insu-lar lobe insular(BA13),superior temporal gyrus(BA22),cingulate cortex(BA24),frontal medial surface(BA32),medulla oblongata,pons,basal ganglia,thalamus and cerebellum as well as left temporal pole(BA38)and right Heschl’s gyrus(BA41),etc.,and the acti-vation volumes of BA4,BA40 and cerebellum were significantly larger in the left than in the right(P<0.05);there was no significantdifference in activation intensity between the left and right brain areas(P>0.05).The activation volume of each brain area of the rightACI group suggested by BOLD-fMRI showed that the activation volumes of the ri

关 键 词：吞咽 急性脑梗死 血氧水平依赖功能磁共振 脑功能区 偏侧性 

分 类 号：R741[医药卫生—神经病学与精神病学]