| 戴燕红,王 红,罗海龙,赵 钊,黄颖安,汪睿清,邹月华,李淑青.弱活性与强连接：脑梗死后慢性期失语症的静息态脑功能研究[J].中国康复医学杂志,2021,(12):1496~1504 |
| 弱活性与强连接：脑梗死后慢性期失语症的静息态脑功能研究 点此下载全文 |
| 戴燕红 王 红 罗海龙 赵 钊 黄颖安 汪睿清 邹月华 李淑青 |
| 暨南大学附属第一医院康复科，广东省广州市，510000 |
| 基金项目：广东省基础与应用基础研究基金项目（2020A1515010578）； 广东省医学科学技术研究基金项目（A2018242）； 广东省医学科研基金项目（A2020352）； 天河区科技计划项目（医疗卫生专项)( 2018YT001） |
| DOI：10.3969/j.issn.1001-1242.2021.12.003 |
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| 摘要： |
| 摘要
目的：运用静息态功能磁共振（resting-state-functional magnetic resonance image，rs-fMRI）探讨脑梗死后慢性期重度非流利性失语症患者脑功能的变化。
方法：首先，扫描得到15例脑梗死后慢性期重度非流利性失语症患者和18例健康人对照者的静息态磁共振数据，采用DPARSF软件进行比率低频振幅（fractional amplitude of low frequency fluctuation，fALFF）分析，利用REST软件进行独立双样本t检验，得到失语症患者组fALFF信号减低的脑区，并与汉语失语成套测验评估量表（aphasia battery Chinese，ABC）各言语亚项得分及波士顿诊断性失语症测评量表（Boston diagnostic aphasia examination，BDAE）失语症严重程度做相关性分析，然后选择与失语症严重程度及言语功能评分有相关性的脑区作为感兴趣区对两组患者分别进行功能连接（functional connectivity，FC）分析并进行双样本t检验，得到失语症患者组和健康人对照组语言功能网络的差异脑区。
结果：①fALFF结果：与健康人对照组相比，失语症患者左侧额中回的fALFF信号减弱最为显著且与失语症严重程度、部分语言学评分有显著正相关（BDAE严重程度分级：r=0.524，P=0.045；流畅性：r=0.562，P=0.029；听理解：r=0.615，P=0.015；复述：r=0.523，P=0.045；命名：r=0.543，P=0.037），其他脑区均无相关性。②FC结果：以左侧额中回作为感兴趣区，失语症患者组功能连接减弱的脑区主要集中在左侧半球，而连接增强的脑区不仅位于左侧半球传统语言功能区周围（左侧颞上回、左侧眼眶部额下回），右侧半球亦可见连接增强的脑区：右侧海马、右侧颞中回、右侧岛叶、右侧扣带回中部、右侧眼眶部额下回。
结论：静息状态下，与正常对照相比，脑梗后慢性期重度失语症的脑功能活动存在以左侧额中回低功能活动水平为基础的强功能连接重组，包括周边连接以及对侧半球连接。这种语言功能区域的漂移、代偿，可为失语症的病理生理学机制的深入理解提供客观的影像学特征以指导临床诊疗工作。 |
| 关键词：失语症 静息态功能磁共振 比率低频振幅 功能连接 |
| Weak activity and strong connectivity： resting state brain function in chronic aphasia after cerebral infarction Download Fulltext |
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| The First Affiliated Hospital of Jinan University， Guangzhou ，Guangdong，510000 |
| Fund Project: |
| Abstract: |
| Abstract
Objective： To investigate the changes of brain function in patients with chronic severe non-fluent aphasia after cerebral infarction by resting functional magnetic resonance imaging.
Method： Firstly， the resting magnetic resonance data of 15 patients with chronic severe non-fluent aphasia after cerebral infarction and 18 healthy controls were scanned. The fractional amplitude of low frequency fluctuation analysis (fALFF) was used to obtain the brain areas of decreased fALFF signal in the aphasia group， and the correlation was analyzed with the scores of speech subitems of the Aphasia Battery Chinese and the severity of Boston diagnostic aphasia examination (BDAE). The relevant brain regions were selected as regions of interest to analyze the functional connections of the two groups of patients respectively and double-sample t-test was carried out to obtain the different brain regions of language functional networks between the aphasia group and the healthy control group.
Result： FALFF results： compared with the healthy control group， the fALFF signal in the left middle frontal gyrus of aphasia patients was most significantly decreased and positively correlated with the severity of aphasia and some linguistic scores (BDAE severity rating：r=0.524， P=0.045； Fluency：r=0.562， P=0.029； Listening comprehension：r=0.615， P=0.015； Retell：r=0.523， P=0.045； Naming：r=0.543， P=0.037)， there was no correlation in other brain regions. FC results： when the left middle frontal gyrus was as the region of interest， the brain areas with decreased functional connections in the aphasia group were mainly concentrated in the left hemisphere， while the areas with enhanced connections were not only located around the traditional language functional areas in the left hemisphere (left superior temporal gyrus， left orbital inferior frontal gyrus). Enhanced connectivity can also be seen in the right hemisphere：the right hippocampus， the right middle temporal gyrus， the right insular lobe， the middle cingulate gyrus and the right orbital inferior frontal gyrus.
Conclusion： In resting state， compared with the normal control， the brain functional activity of severe aphasia in the chronic phase after cerebral infarction has strong functional connectivity reorganization based on the low level of left middle frontal gyrus， including peripheral connectivity and contralateral hemisphere connectivity. In this network， there is a strong connection pattern around the traditional language functional areas of the left hemisphere and the right hemisphere. The drift and compensation of this language functional area can provide objective imaging features for in-depth understanding of the pathophysiological mechanism of aphasia to guide clinical diagnosis and treatment. |
| Keywords:aphasia resting-state-functional MRI fractional amplitude of low frequency fluctuation functional connectivity |
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