间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响

doi:10.3969/j.issn.1006-9771.2023.07.014

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (7): 839-843.doi: 10.3969/j.issn.1006-9771.2023.07.014

间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响

蒋孝翠, 刘臻(), 苏清伦, 赵秦, 夏晓昧, 陆飞

南京医科大学康达学院第一附属医院（连云港市第一人民医院），江苏连云港市 222000

收稿日期:2023-02-17 修回日期:2023-06-19 出版日期:2023-07-25 发布日期:2023-08-30
通讯作者: 刘臻(1971-)，男，主任医师，主要研究方向：神经康复、骨关节康复。E-mail：18961325965@189.cn
作者简介:蒋孝翠(1990-)，女，汉族，江苏连云港市人，硕士研究生，主管康复治疗师，主要研究方向：脑卒中和脊髓损伤的功能康复，失语症、吞咽障碍的评估与治疗。
基金资助:
连云港市第一人民医院医疗技术扶持项目(BB202212)

Effect of intermittent theta burst transcranial magnetic stimulation on non-fluent aphasia after stroke

JIANG Xiaocui, LIU Zhen(), SU Qinglun, ZHAO Qin, XIA Xiaomei, LU Fei

The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China

Received:2023-02-17 Revised:2023-06-19 Published:2023-07-25 Online:2023-08-30
Contact: LIU Zhen, E-mail: 18961325965@189.cn
Supported by:
The First People's Hospital of Lianyungang Medical Technology Support Project(BB202212)

摘要/Abstract

摘要：

目的探讨间歇性theta节律经颅磁刺激(iTBS)对脑卒中后非流利性失语的治疗作用及机制。

方法 2021年8月至2022年8月，连云港市第一人民医院50例脑卒中后非流利性失语患者随机分为假刺激组(n = 25)和iTBS组(n = 25)，两组均予言语治疗，iTBS组给予iTBS，假刺激组接受假iTBS，共4周。治疗前后抽取空腹静脉血测定血清脑源性神经营养因子(BDNF)含量，采用中国康复研究中心汉语标准失语症检查量表和波士顿诊断性失语症测验进行评估。

结果假刺激组脱落2例，iTBS组脱落3例。治疗后，两组BDNF水平，听理解、复述、命名、朗读、语言功能总分均较治疗前显著改善(|t| > 5.012, P < 0.001)，iTBS组显著优于假刺激组(|t| > 3.968, P < 0.001)，iTBS组治疗有效率高于假刺激组(χ² = 8.835, P < 0.05)。

结论 iTBS可以改善脑卒中后非流利性失语患者的语言功能，可能与促进BDNF表达有关。

关键词: 脑卒中, 非流利性失语, 经颅磁刺激, 间歇性theta节律刺激, 言语

Abstract:

Objective To explore the therapeutic effect and mechanism of intermittent theta burst transcranial magnetic stimulation (iTBS) on non-fluent aphasia after stroke.

Methods From August, 2021 to August, 2022, 50 patients with non-fluent aphasia after stroke in the First People's Hospital of Lianyungang were randomly divided into sham stimulation group (n = 25) and iTBS group (n = 25). Both groups accepted speach training. iTBS group accepted iTBS, and the sham stimulation group received sham iTBS, for four weeks. The serum brain-derived neurotrophic factor (BDNF) was measured, and they were assessed by China Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination before and after treatment.

Results Two cases in the sham stimulation group and three cases in iTBS group dropped down. The BDNF level, and listen and understand, repeat, name, read aloud, and total score of CRRCAE improved in two groups after treatment (|t| > 5.012, P < 0.001); and they were better in iTBS group than in the sham stimulation group (|t| > 3.968, P < 0.001). The total effective rate was more in iTBS group than in the sham stimulation group (χ² = 8.835, P < 0.05).

Conclusion iTBS can improve speech function in patients with non-fluent aphasia after stroke, which may associate with the promotion of BDNF.

Key words: stroke, non-fluent aphasia, transcranial magnetic stimulation, intermittent theta burst stimulation, speech

中图分类号:

R743.3

蒋孝翠, 刘臻, 苏清伦, 赵秦, 夏晓昧, 陆飞. 间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响[J]. 《中国康复理论与实践》, 2023, 29(7): 839-843.

JIANG Xiaocui, LIU Zhen, SU Qinglun, ZHAO Qin, XIA Xiaomei, LU Fei. Effect of intermittent theta burst transcranial magnetic stimulation on non-fluent aphasia after stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 839-843.

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参考文献 23

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组别	n	性别(女/男)/n	年龄/岁	受教育年限/年	卒中类型 (脑梗死/脑出血)/n	病程/d	失语症类型(完全性失语/经皮质失语/Broca失语)/n
假刺激组	23	7/16	63.57±9.69	10.35±3.59	15/8	35.04±30.65	6/6/11
iTBS组	22	13/9	58.86±12.81	9.32±2.50	12/10	39.95±28.84	5/7/10
t/χ²值		3.740	1.392	1.113	0.534	-0.553	0.193
P值		0.053	0.171	0.272	0.465	0.593	0.908

组别	n	治疗前	治疗后	t值	P值
假刺激组	23	29.13±3.07	33.60±1.82	-9.324	< 0.001
iTBS组	22	29.77±3.06	39.19±1.81	-14.045	< 0.001
t值		-0.698	-10.323
P值		0.489	< 0.001

指标	假刺激组(n = 23)		iTBS组(n = 22)		假刺激组组内比较		iTBS组组内比较		两组训练前比较		两组训练后比较
指标	治疗前	治疗后	治疗前	治疗后	t值	P值	t值	P值	t值	P值	t值	P值
听理解	74.30±28.62	98.39±29.85	85.23±24.42	139.23±24.26	-8.850	< 0.001	-12.796	< 0.001	-1.374	0.176	-5.023	< 0.001
复述	51.09±19.59	89.35±21.96	59.64±20.56	133.14±27.10	-12.245	< 0.001	-11.506	< 0.001	-1.428	0.160	-5.968	< 0.001
命名	30.70±13.11	51.00±27.84	31.91±15.86	90.86±33.11	-5.012	< 0.001	-11.466	< 0.001	-0.280	0.781	-4.378	< 0.001
朗读	27.26±17.37	53.65±28.13	29.86±19.27	84.68±24.07	-6.124	< 0.001	-19.081	< 0.001	-0.476	0.636	-3.968	< 0.001
总分	271.43±90.12	417.78±112.19	310.95±69.35	628.63±97.20	-15.695	< 0.001	-21.550	< 0.001	-1.643	0.108	-6.725	< 0.001

间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响

Effect of intermittent theta burst transcranial magnetic stimulation on non-fluent aphasia after stroke

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组别	n	显效	有效	无效	总有效
假刺激组	23	7	8	8	15
iTBS组	22	10	8	4	18