基于局部一致性方法探讨低频重复经颅磁刺激改善脑卒中后非流利性失语症患者听理解功能及机制

关键词：重复经颅磁刺激  失语症  听理解  局部一致性  功能连接

Keywords:repetitive transcranial magnetic stimulation  aphasia  auditory comprehension  regional homogeneity  functional connectivity

摘要：

      摘要 目的：基于局部一致性(regional homogeneity， ReHo)方法探讨低频重复经颅磁刺激对脑卒中后非流利性失语症患者听理解的治疗效果及其作用机制。 方法：根据纳入及排除标准纳入60例脑卒中后非流利性失语症患者，随机分为治疗组(rTMS组)和假刺激组(S-rTMS组)，采用西方失语症成套测验(汉化版)听理解维度和简式Token测验分别于治疗前后对两组患者进行听理解功能评定。对纳入的部分患者分别于治疗前后进行静息态功能磁共振扫描，采用ReHo方法对扫描后的图像数据进行统计分析。 结果：治疗前后对比，rTMS组患者WAB听理解维度及简式Token测验得分均有显著提高，且改善幅度较S-rTMS组患者显著增高。治疗前后两组患者静息态功能磁共振结果为：ReHo分析发现rTMS组患者右侧半球多个脑区ReHo值下降，功能连接发现部分颞叶大脑感兴趣区(region of interest， ROI)的功能连接增强。 结论：低频重复经颅磁刺激(repetitive transcranial magnetic stimulation， rTMS)联合常规言语训练可通过抑制右侧半球颞顶叶多个脑区激活从而改善脑卒中后非流利性失语症患者的听理解功能。

Abstract:

      Abstract Objective： Based on the regional homogeneity(ReHo) method to explore the therapeutic effect and mechanism of low-frequency repetitive transcranial magnetic stimulation on the auditory comprehension of patients with non-fluent aphasia after stroke. Method： According to the inclusion and exclusion criteria， 60 patients with non-fluent aphasia after stroke were included and randomly divided into treatment group (rTMS group) and sham stimulation group (S-rTMS group). The WAB (Chinese version) auditory comprehension dimension and short-form Token Test were used to evaluate the auditory comprehension function of patients before and after treatment in the two groups. Part of the enrolled patients underwent resting-state functional magnetic resonance scans before and after treatment， and the ReHo method was used to perform statistical analysis on the scanned image data. Result： Before and after the treatment， the WAB auditory comprehension dimension and the short-form Token Test score of the patients in the rTMS group were significantly improved， and the improvement was significantly higher than that of the patients in the S-rTMS group. The results of resting functional MRI of the patients before and after treatment in two groups were： the ReHo value of multiple brain regions in the right hemisphere of the rTMS group decreased， functional connectivity analysis found that the functional connectivity of some region of interest(ROI) in the left temporal lobe with other brain regions was enhanced. Conclusion：Low-frequency repetitive transcranial magnetic stimulation(rTMS) combined with conventional speech training can improve the auditory comprehension of patients with non-fluent aphasia after stroke by inhibiting the activation of multiple brain regions in the temporal and parietal lobes of the right hemisphere.