非侵入性脑刺激技术联合言语康复训练治疗卒中后失语症的疗效观察

关键词：卒中  失语症  非侵入性脑刺激技术  经颅直流电刺激  经颅磁刺激

Keywords:stroke  aphasia  non-invasive brain stimulation techniques  transcranial direct current stimulation  transcranial magnetic stimulation

摘要：

      摘要 目的：探讨非侵入性脑刺激技术联合言语康复训练治疗卒中后失语症的效果。 方法：选取2022年7月—2024年7月四川大学华西医院93例卒中后失语症患者，随机数字表法分3组，各31例。A组采用言语康复训练治疗，B组采用间歇性θ节律经颅磁刺激联合言语康复训练治疗，C组采用阳极经颅直流电刺激联合言语康复训练治疗，均治疗2周。比较3组治疗前后视图命名能力、语言理解专项水平、西方失语症成套测试（WAB）-失语商（AQ）、血清脑源性神经营养因子（BDNF）水平。 结果：治疗后，3组WAB-AQ、视图命名分值与反应时间、听词指图中分值与反应时间、血清BDNF均较治疗前改善（P＜0.05）；治疗后C组、B组WAB-AQ、血清BDNF水平高于A组（P＜0.05），但B组与C组WAB-AQ、血清BDNF水平比较，无显著差异（P＞0.05）；C组治疗后视图命名中高频词分值、低频词分值高于A组、B组，B组高于A组（P＜0.05）；C组治疗后视图命名中高频词反应时间、低频词反应时间短于A组、B组，B组短于A组（P＜0.05）；B组治疗后听词指图中高频词分值、低频词分值高于A组、C组，C组高于A组（P＜0.05）；B组治疗后听词指图中高频词反应时间、低频词反应时间短于A组、C组，C组短于A组（P＜0.05）。 结论：两种非侵入性脑刺激技术联合言语康复训练均能促进卒中后失语症语言功能恢复，提高血清BDNF水平，阳极经颅直流电刺激联合言语康复训练优势在于改善视图命名能力，而间歇性θ节律经颅磁刺激联合言语康复训练在语言理解能力方面改善明显，患者可根据自身具体情况选择不同非侵入性脑刺激技术。

Abstract:

      Abstract Objective：To investigate the impact of non-invasive brain stimulation in conjunction with speech and language training on the treatment of post-stroke aphasia. Method：A total of 93 patients with post-stroke aphasia in the West China Hospital of Sichuan University from July 2022 to July 2024 were selected and divided into 3 groups with 31 cases each by the random number table method. Group A was treated with speech and language training， group B was treated with intermittent θ rhythm transcranial magnetic stimulation combined with speech and language training， and group C was treated with anodal transcranial direct current stimulation combined with speech and language training for 2 weeks. The picture naming ability， specific level of language comprehension， Western Aphasia Battery （WAB） -aphasia quotient（AQ） and serum brain-derived neurotrophic factor （BDNF） levels of the three groups were compared before and after treatment. Result：After the treatment， the WAB-AQ， picture naming scores and reaction times， scores of auditory word comprehension and reaction times， as well as serum BDNF levels in all three groups were improved compared with before the treatment（P<0.05）. After the treatment， the levels of WAB-AQ and serum BDNF in groups C and B were significantly elevated compared to those in group A（P<0.05）. However， no statistically significant difference was observed in the levels of WAB-AQ and serum BDNF between groups B and C（P>0.05）. In the group C，the scores of high-frequency words and low-frequency words in the post-treatment picture naming were higher than those in the group A and group B， and the scores in the group B were higher than those in the group A（P<0.05）. After the treatment， the reaction times of high-frequency and low-frequency words in picture naming in group C were shorter than those in group A and group B，and the reaction times of group B were shorter than those in group A（P<0.05）. After the treatment， the scores of high-frequency words and low-frequency words in the auditory word comprehension of group B were higher than those of group A and group C，and the scores of group C were higher than those of group A（P<0.05）. After the treatment， the reaction times of high-frequency words and low-frequency words in the auditory word comprehension of group B were shorter than those of group A and group C，and the reaction times of group C were shorter than those of group A（P<0.05）. Conclusion：Combining either of the two non-invasive brain stimulation techniques with speech and language training can enhance the recovery of speech function in individuals with aphasia following stroke， as well as to elevate serum BDNF levels. The primary advantage of anodal transcranial direct current stimulation with speech and language training was improved picture naming ability. In contrast， intermittent θ rhythm transcranial magnetic stimulation combined with speech and language training significantly enhances language comprehension abilities. Patients are encouraged to select different non-invasive brain stimulation techniques based on their specific conditions.