卒中后失语恢复期语言相关脑白质纤维束的偏侧化研究

关键词：卒中后失语  白质纤维束  弥散张量成像

Keywords:post-stroke aphasia  white matter fibers  diffusion tensor imaging

摘要：

      摘要 目的：采用弥散张量成像（diffusion tensor imaging， DTI）技术探讨传导束功能对卒中后失语（post-stroke aphasia， PSA）影响。 方法：纳入PSA患者14例，同时招募性别、年龄匹配的健康人18例作为对照。收集一般临床资料、西方失语成套测验（Western?aphasia?battery， WAB）结果，对两组被试进行DTI检查并分析数据，研究弓状束（arcuate fasciculus， AF）、上纵束（superior longitudinal fasciculus， SLF）、下纵束（inferior longitudinal fasciculus， ILF）损伤与PSA发生相关性。 结果：PSA患者存在优势侧AF、SLF-Ⅱ、SLF-Ⅲ、ILF损伤，纤维束的各向异性分数（fractional anisotropy， FA）、纤维数量、纤维长度皆明显下降（P＜0.05），而优势侧SLF-I、非优势侧AF、SLF-Ⅰ、SLF-Ⅱ、SLF-Ⅲ则无明显损伤（P＞0.05），失语症组非优势侧ILF纤维数量明显少于健康对照组（P＜0.05），但FA值、纤维长度未见明显下降（P＞0.05）。进一步对AF、SLF-Ⅱ、SLF-Ⅲ、ILF损伤与失语症WAB评定结果进行相关性分析，发现具体单束纤维束损伤和WAB的失语商、自发言语、听理解、复述、命名得分都无明显相关性（P＞0.05）。 结论：优势侧大脑AF、SLF-Ⅱ、SLF-Ⅲ、ILF损伤是PSA发生的重要中枢机制。

Abstract:

      Abstract Objective： To investigate the correlation between arcuate fasciculus（AF），superior longitudinal fasciculus （SLF）， inferior longitudinal fasciculus（ILF）， and post-stroke aphasia（PSA） by diffusion tensor imaging（DTI）. Method： Fourteen patients with post-stroke aphasia were included， while 18 healthy individuals with gender and age matching were recruited as controls. Western aphasia battery （WAB） and DTI were performed in two groups of participants. Result： Compared with normal healthy controls， aphasic patients had dominant side AF， SLF-Ⅱ，SLF-Ⅲ，and ILF damage，with a significant decrease in fiber FA value， fiber quantity， and fiber length（P<0.05）. However， dominant side SLF-Ⅰ， non dominant side AF， SLF-Ⅰ， SLF-Ⅱ， and SLF-Ⅲ had no significant damage（P>0.05）. The non-dominant side ILF fiber quantity of non-dominant side in the aphasic group was significantly lower than that in the healthy control group（P<0.05）.However, there were no significant decrease in the FA value and fiber length between two groups（P>0.05）. There was no significant correlation between specific single bundle fiber damage and WAB's AQ，spontaneous speech， auditory comprehension，repetition and naming scores（P>0.05）. Conclusion： The injury of AF， SLF-Ⅱ， SLF-Ⅲ， and ILF in the dominant side of the brain is an important central mechanism for the occurrence of PSA.