低频和高频重复经颅磁刺激对脑卒中后非流畅性失语的影响

doi:10.3969/j.issn.1006-9771.2023.03.001

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (3): 249-255.doi: 10.3969/j.issn.1006-9771.2023.03.001

• 专题非侵入式神经调控技术在康复中的应用 • 上一篇下一篇

低频和高频重复经颅磁刺激对脑卒中后非流畅性失语的影响

胡雪艳¹^,², 江晓峰³(), 山磊¹^,², 杨凌宇¹^,², 陈予东¹^,², 马琳¹^,², 刘丽旭¹^,², 张通¹^,²

1.中国康复研究中心北京博爱医院神经康复一科，北京市 100068
2.首都医科大学康复医学院，北京市 100068
3.首都医科大学公共卫生学院，北京市 100069

收稿日期:2022-12-06 修回日期:2023-03-06 出版日期:2023-03-25 发布日期:2023-04-14
通讯作者: 江晓峰 E-mail:vincejiang@163.com
作者简介:胡雪艳(1978-)，女，汉族，山东龙口市人，博士，副主任医师，主要研究方向：神经康复、神经调控。
基金资助:
1.国家自然科学基金项目(81171243);2.中国康复研究中心项目(2021ZX-16)

Effect of low frequency or high frequency repetitive transcranial magnetic stimulation on stroke patients with nonfluent aphasia

HU Xueyan¹^,², JIANG Xiaofeng³(), SHAN Lei¹^,², YANG Lingyu¹^,², CHEN Yudong¹^,², MA Lin¹^,², LIU Lixu¹^,², ZHANG Tong¹^,²

1. Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
3. School of Public Health, Capital Medical University, Beijing 100069, China

Received:2022-12-06 Revised:2023-03-06 Published:2023-03-25 Online:2023-04-14
Contact: JIANG Xiaofeng E-mail:vincejiang@163.com
Supported by:
National Natural Science Foundation of China(81171243);China Rehabilitation Research Center Project(2021ZX-16)

摘要/Abstract

摘要：

目的观察低频和高频重复经颅磁刺激(rTMS)刺激右侧大脑半球Broca区镜像区对脑卒中后非流畅性失语患者语言功能恢复的效果。

方法 2019年1月至2022年8月，北京博爱医院住院治疗的脑卒中后非流畅性失语症患者80例，随机分为对照组(n = 20)、假刺激组(n = 20)、低频组(n = 20)和高频组(n = 20)。所有患者均接受常规语言训练，在此基础上，后两组分别采用1 Hz和10 Hz rTMS刺激右侧大脑半球Broca区镜像区，假手术组接受假刺激，每天1次，每周5 d，共2周。治疗前、治疗结束时和治疗结束2个月后，分别采用中文版西方失语症成套检验(WAB)进行语言评估。

结果治疗前，4组WAB各项评分比较无显著性差异(P > 0.05)。治疗结束时和治疗结束2个月，4组WAB测试各项评分均改善(P < 0.05)。与治疗结束时比较，治疗结束2个月低频组自发言语、听理解、复述、命名和失语商(AQ)均改善(P < 0.05)，高频组复述、命名和AQ改善(P < 0.05)。治疗结束时，低频组自发言语、听理解、AQ评分高于高频组(P < 0.05)。治疗结束2个月，低频组自发言语评分高于高频组(P < 0.05)。

结论 1 Hz和10 Hz rTMS均可以改善脑卒中后非流畅性失语患者语言功能，1 Hz rTMS疗效更好。

关键词: 脑卒中, 非流畅性失语, 重复经颅磁刺激, 语言功能

Abstract:

Objective To explore the effect of low frequency or high frequency repetitive transcranial magnetic stimulation (rTMS) on right Broca's homologue in stroke patients with nonfluent aphasia.

Methods From January, 2019 to August, 2022, 80 inpatients in Beijing Bo'ai Hospital were randomly divided into control group (n = 20), sham stimulation group (n = 20), low-frequency (1 Hz) rTMS (LF-rTMS) group (n = 20) and high-frequency (10 Hz) rTMS (HF-rTMS) group (n = 20). All the patients received routine language therapy. LF-rTMS group and HF-rTMS group received ten days of rTMS (1 Hz or 10 Hz), and the sham group received ten days of sham rTMS. The Western Aphasia Battery (WAB) was used to evaluate the language function before, after treatment, and two months after treatment.

Results Before treatment, there was no significant difference in the scores of WAB among four groups (P > 0.05). All the scores improved in the four groups immediately after treatment and two months after treatment (P < 0.05). Compared with immediately after treatment, all the scores of WAB improved in LF-rTMS group (P < 0.05), and the scores of recall, name and aphasia quotient (AQ) improved in HF-rTMS group (P < 0.05) two months after treatment. Immediately after treatment, the scores of content and fluency, auditory comprehension and AQ were higher in LF-rTMS group than in HF-rTMS group (P < 0.05). Two months after treatment, the scores of content and fluency were higher in LF-rTMS group than in HF-rTMS group (P < 0.05).

Conclusion Both 1 Hz and 10 Hz rTMS could improve the language function of stroke patients with nonfluent aphasia, especially 1 Hz.

Key words: stroke, nonfluent aphasia, repetitive transcranial magnetic stimulation, language function

中图分类号:

R743.3

胡雪艳, 江晓峰, 山磊, 杨凌宇, 陈予东, 马琳, 刘丽旭, 张通. 低频和高频重复经颅磁刺激对脑卒中后非流畅性失语的影响[J]. 《中国康复理论与实践》, 2023, 29(3): 249-255.

HU Xueyan, JIANG Xiaofeng, SHAN Lei, YANG Lingyu, CHEN Yudong, MA Lin, LIU Lixu, ZHANG Tong. Effect of low frequency or high frequency repetitive transcranial magnetic stimulation on stroke patients with nonfluent aphasia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 249-255.

图/表 2

表1

表2

4组治疗前、治疗结束时和治疗结束2个月时WAB评分比较"

项目	时间	对照组(n = 18)	假刺激组(n = 17)	低频组(n = 18)	高频组(n = 18)	F值	P值
自发言语	治疗前	2.85±1.84	3.03±2.04	3.39±1.71	2.62±2.01	0.515	0.673
	治疗结束时	3.90±1.93^a,d	4.51±2.59^a,d	8.83±4.47^d	4.43±3.46^a,d	11.221	< 0.001
	治疗结束2个月	6.16±3.32^a,d	7.41±3.62^d,e	9.67±3.61^d,e	7.05±4.29^a,d	3.048	0.035
听理解	治疗前	80.61±23.59	82.47±21.81	83.68±25.56	81.67±30.54	0.211	0.888
	治疗结束时	100.72±30.88^a,d	106.82±36.32^a,d	140.50±35.97^d	118.28±41.97^a,d	4.392	0.007
	治疗结束2个月	144.67±29.36^d	140.52±31.02^d,e	160.61±45.39^d,e	158.00±37.87^d	2.507	0.066
复述	治疗前	26.55±12.82	27.94±17.16	27.83±15.73	26.77±18.71	0.153	0.927
	治疗结束时	32.05±16.47^a,b,c,d	52.23±28.25^d	57.16±20.57^d	49.67±28.46^d	4.253	0.008
	治疗结束2个月	48.83±23.06^a,b,c,d	64.11±22.06^d,e	69.72±25.42^d,e	67.94±25.83^d,e	5.565	0.002
命名	治疗前	18.27±9.49	17.70±6.66	18.88±8.66	16.56±10.97	0.655	0.582
	治疗结束时	32.16±10.15^a,d	36.01±7.04^a,d	51.61±13.03^d	36.44±10.30^d	15.070	< 0.001
	治疗结束2个月	48.67±15.14^a,d	55.35±14.42^d,e	65.11±22.34^d,e	58.05±25.29^d,e	2.977	0.038
AQ	治疗前	24.06±7.75	24.74±9.39	26.49±7.63	25.60±16.27	0.326	0.807
	治疗结束时	34.65±14.71^a,d	37.62±13.35^a,d	56.21±16.99^d	42.01±18.68^a,d	8.281	< 0.001
	治疗结束2个月	47.05±18.12^a,b,d	52.65±12.08^d,e	64.82±19.51^d,e	59.37±15.29^d,e	2.878	0.042
F值_自发言语		13.148	7.776	10.583	7.575
P值_自发言语		< 0.001	0.001	< 0.001	0.001
F值_听理解		23.357	21.817	13.229	20.730
P值_听理解		< 0.001	< 0.001	< 0.001	< 0.001
F值_复述		20.037	12.048	19.962	7.313
P值_复述		< 0.001	< 0.001	< 0.001	0.002
F值_命名		20.037	18.941	36.779	23.633
P值_命名		< 0.001	< 0.001	< 0.001	< 0.001
F值_AQ		31.489	11.616	20.740	18.941
P值_AQ		< 0.001	< 0.001	< 0.001	< 0.001

表2

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组别	n	性别(男/女)/n	年龄/岁	发病时间/d	卒中类型(脑梗死/脑出血)/n	文化程度(小学/初中及以上)/n
对照组	20	14/6	56.83±11.22	35.39±11.40	10/10	5/15
假刺激组	20	14/6	58.58±9.35	36.47±12.15	12/8	4/16
低频组	20	15/5	52.72±11.80	37.00±11.50	11/9	5/15
高频组	20	13/7	54.50±11.20	32.33±10.54	11/9	4/16
F/χ²值		1.876	0.972	0.591	0.713	1.003
P值		0.509	0.411	0.623	0.887	0.317

低频和高频重复经颅磁刺激对脑卒中后非流畅性失语的影响

Effect of low frequency or high frequency repetitive transcranial magnetic stimulation on stroke patients with nonfluent aphasia

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