弥散张量成像评估脑卒中后吞咽障碍与皮质延髓束的相关性  

Correlation between corticobulbar tract and dysphagia after stroke:assessed by diffusion tensor imaging

作　　者：舒琳睿 孙道东[2] 周婷[2] 储浩然[2] 程红亮[2] 蒋雷雷 陈幸生[2] SHU Linrui;SUN Daodong;ZHOU Ting;CHU Haoran;CHENG Hongliang;JIANG Leilei;CHEN Xingsheng(Anhui University of Chinese Medicine,Hefei 230000,China;The Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230000,China)

机构地区：[1]安徽中医药大学,安徽合肥230000 [2]安徽中医药大学第二附属医院,安徽合肥230000

出　　处：《中国实用神经疾病杂志》2023年第6期693-698,共6页Chinese Journal of Practical Nervous Diseases

基　　金：安徽省针灸临床医学研究中心开放项目(编号:2021zjzx05);安徽省第十三批115产业创新团队“针药结合防治脑病创新团队”项目(编号:皖人才办[2020]4号);广德张氏芒针疗法流派工作室(编号:皖中医药发展秘[2021]30号)。

摘　　要：目的 基于弥散张量成像(DTI)探究脑卒中后吞咽障碍与皮质延髓束的关系。方法 选取31例脑卒中后吞咽障碍患者,按照洼田饮水试验(WST)分级将患者分为A组(14例,洼田饮水试验2级)和B组(17例,洼田饮水试验3~5级),入组后评定2组患者WST和标准吞咽功能评分(SSA),利用DTI分别测量2组半卵圆中心、额叶下部、胼胝体体部、胼胝体膝部、尾状核头部、内囊膝部、丘脑、岛叶、杏仁体、中脑、脑桥、延髓的FA值,弥散张量纤维束成像(DTT)评估2组治疗前后皮质延髓束的损伤程度。结果A组半卵圆中心、额叶皮层下部、内囊膝部、胼胝体膝部、胼胝体体部的FA值低于B组,差异均有统计学意义(P<0.05)。Pearson线性相关分析提示半卵圆中心、额叶皮层下部、胼胝体膝部、胼胝体体部、内囊膝部的FA值与WST评分呈负相关(r=—0.531,P<0.05;r=—0.594,P<0.05;r=—0.679,P<0.05;r=—0.387,P<0.05;r=—0.757,P<0.05)。受试者工作特征(ROC)曲线提示额叶皮层下部FA值、内囊膝部FA值对卒中后吞咽障碍有预测作用,最佳截断值分别为0.357、0.344。结论 脑卒中患者吞咽障碍程度与皮质延髓束的缺损密切相关。Objective To explore the relationship between swallowing disorder after stroke and corticomedul-lary tract based on diffusion tensor imaging(DTI).Methods Thirty-one patients with dysphagia after stroke were selected and divided into group A(14 patients,grade 2 in Water swallow test)and group B(17 patients,grade 3-5 in Water swallow test)according to the classification of Water swallow test(WST).After enrollment,WST and stan-dard swallowing function score(SSA)were measured in the two groups,and DTI was used to measure the semi oval center,lower frontal lobe FA values of corpus callosum,knee of corpus callosum,head of caudate nucleus,knee of internal capsule,thalamus,insula,amygdala,midbrain,pons,medulla oblongata,and diffusion tensor tractography(DTT)were used to evaluate the damage degree of cortical medullary tract before and after treatment in the two groups.Results The FA values of the semi oval center,the lower part of the frontal cortex,the knee of the internal capsule,the knee of the corpus callo⁃sum,and the body of the corpus callosum in group A were lower than those in group B(P<0.05).Pearson linear correlation analysis showed that FA values in the center of semi oval,the lower part of frontal cortex,the knee of corpus callosum,the corpus callosum,and the knee of internal capsule were negatively correlated with WST scores(r=—0.531,P<0.05;r=—0.594,P<0.05;r=—0.679,P<0.05;r=—0.387,P<0.05;r=—0.757,P<0.05).ROC curve showed that FA value in the lower part of frontal cortex and FA value in the knee of internal capsule could predict dysphagia after stroke,and the best cutoff values were 0.357 and 0.344,respectively.Conclusion The degree of dysphagia in patients with stroke is closely related to the defect of corticomedullary tract.

关 键 词：脑卒中 弥散张量成像 假性延髓性麻痹 吞咽障碍 脑白质 

分 类 号：R743.3[医药卫生—神经病学与精神病学]