卒中后失语和卒中后抑郁自发脑活动改变的静息态功能磁共振成像Meta分析

doi:10.3969/j.issn.1006-9771.2025.10.005

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (10): 1143-1155.doi: 10.3969/j.issn.1006-9771.2025.10.005

卒中后失语和卒中后抑郁自发脑活动改变的静息态功能磁共振成像Meta分析

陈宇航, 杨瑜爱, 卢轩禹, 王昱航, 张蒙园, 张梓寒, 王荟荧, 常静玲()

北京中医药大学东直门医院，北京市 100700

收稿日期:2025-05-15 修回日期:2025-09-24 出版日期:2025-10-25 发布日期:2025-11-10
通讯作者: 常静玲(1970-)，女，博士，主任医师、教授，博士研究生导师，主要研究方向：中医药防治脑病的临床与神经影像研究、中医综合康复治疗方案优化与评价研究，E-mail： ear6979@163.com
作者简介:陈宇航(1994-)，男，汉族，福建古田县人，博士研究生，主要研究方向：中医药防治脑病的临床与神经影像研究。
基金资助:
1.国家自然科学基金面上项目(81973790);2.中央高水平中医医院临床科研业务费资助项目(DZMG-LJRC0016);3.北京中医药大学东直门医院科技创新专项(DZMKJCX-2024-027)

Spontaneous brain activity changes in post-stroke aphasia and post-stroke depression: a meta-analysis of resting state functional magnetic resonance imaging

CHEN Yuhang, YANG Yu'ai, LU Xuanyu, WANG Yuhang, ZHANG Mengyuan, ZHANG Zihan, WANG Huiying, CHANG Jingling()

Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China

Received:2025-05-15 Revised:2025-09-24 Published:2025-10-25 Online:2025-11-10
Contact: CHANG Jingling, E-mail: ear6979@163.com
Supported by:
National Natural Science Foundation of China (General)(81973790);Clinical Research Funding Project of Central High-level Traditional Chinese Medicine Hospital(DZMG-LJRC0016);Special Project of Science and Technology Innovation of Dongzhimen Hospital, Beijing University of Chinese Medicine(DZMKJCX-2024-027)

摘要/Abstract

摘要：

目的分析卒中后失语(PSA)和卒中后抑郁(PSD)自发脑活动各自的异常脑区以及共同的变化脑区，探索潜在的单病以及共病的病理学机制。
方法系统检索建库至2025年4月19日PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库、维普、中国生物医学文献服务系统等数据库，纳入以PSA或PSD为研究对象，以健康人为对照组，以低频波动幅度(ALFF)、分数低频波动幅度(fALFF)和局部一致性(ReHo)为结局指标的静息态功能磁共振成像研究。提取纳入文献的差异性脑区相关结果，采用SDM-PSI V6.23 beta进行神经影像Meta分析。
结果 PSA共纳入17篇文献，涉及患者339例，对照组351例；PSD共纳入5篇文献，涉及患者102例，对照组149例。PSA左侧小脑9区、右侧颞中回、右侧脑岛的自发神经功能活动高于对照组 (P < 0.05)，右侧小脑6区、左侧内侧额上回、左侧额中回、右侧前扣带与旁扣带脑回自发神经功能活动低于对照组(P < 0.05)；PSD患者右侧楔叶、右侧枕上回的自发神经功能活动高于对照组(P < 0.05)，左侧内侧额上回、左侧顶下小叶的自发神经功能活动低于对照组 (P < 0.05)。PSA和PSD在左侧内侧额上回的自发神经功能活动均低于对照组 (P < 0.05)。
结论 PSA的病理学机制可能涉及语言功能网络右侧代偿性亢进与左侧功能抑制，并伴有小脑的交叉性协同活动；PSD的发生可能与右侧枕叶网络功能亢进与左侧额顶叶网络功能抑制有关；左侧内侧额上回(MNI坐标x = 0, y = 26, z = 44)功能抑制很可能是PSA与PSD的语言-情绪整合通路，介导PSA与PSD共病的发生。

关键词: 卒中后失语, 卒中后抑郁, 静息态功能磁共振成像, 自发脑活动, Meta分析

Abstract:

Objective To analyze the respective abnormal brain regions and commonly altered brain regions of spontaneous brain activity in post-stroke aphasia (PSA) and post-stroke depression (PSD), and to explore the potential pathological mechanisms underlying single disease and comorbidity.
Methods Literatures were retrieved from PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang data, VIP and SinoMed, from establishment to April 19th, 2025. Resting-state functional magnetic resonance imaging (fMRI) studies were included if they focused on patients with PSA or PSD, with healthy controls (HC) serving as control group, and amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) were adopted as outcome indicator. Data regarding differential brain regions were extracted from the original studies, and a neuroimaging meta-analysis was conducted using SDM-PSI V6.23 beta.
Results A total of 17 articles on PSA (339 patients and 351 HC) and five articles on PSD (102 patients and 149 HC) were included. The spontaneous brain activity in the left cerebellar area 9, right middle temporal gyrus and right insula was significantly higher in PSA patients than in HC (P < 0.05), while activity in the right cerebellar area 6, left medial superior frontal gyrus (SFGmed), left middle frontal gyrus and right anterior cingulate/paracingulate gyrus was lower (P < 0.05). For PSD, spontaneous brain activity was elevated in the right cuneus gyrus and right superior occipital gyrus compared to HC (P < 0.05), while it was reduced in the left SFGmed and left inferior parietal lobe (P < 0.05). Additionally, spontaneous brain activity in the left medial superior frontal gyrus was lower in both diseases compared to HC (P < 0.05).
Conclusion The pathological mechanism of PSA may involve a pattern of right-sided compensatory hyperfunction and left-sided inhibitory damage within the language-related network, accompanied by cross-hemispheric synergistic activity of the cerebellum. The occurrence of PSD may be attributed to hyperactivity of the right occipital network, and functional inhibition involving the left inferior parietal lobe. The inhibition observed in the left SFGmed (MNI coordinates x = 0, y = 26, z = 44) likely represents the language-emotion integration hub, mediating the co-occurrence of PSA and PSD.

Key words: post-stroke aphasia, post-stroke depression, resting-state functional magnetic resonance imaging, spontaneous brain activity, meta-analysis

中图分类号:

R743.3

陈宇航, 杨瑜爱, 卢轩禹, 王昱航, 张蒙园, 张梓寒, 王荟荧, 常静玲. 卒中后失语和卒中后抑郁自发脑活动改变的静息态功能磁共振成像Meta分析[J]. 《中国康复理论与实践》, 2025, 31(10): 1143-1155.

CHEN Yuhang, YANG Yu'ai, LU Xuanyu, WANG Yuhang, ZHANG Mengyuan, ZHANG Zihan, WANG Huiying, CHANG Jingling. Spontaneous brain activity changes in post-stroke aphasia and post-stroke depression: a meta-analysis of resting state functional magnetic resonance imaging[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1143-1155.

图/表 6

图1

表1

纳入文献的基本特征和文献质量评价"

纳入文献	性别(男/ 女)/n		年龄/岁		文化程度/年		发病时间	病灶大小/cm³	诊断标准	AHRQ 评分
纳入文献	P	C	P	C	P	C	发病时间	病灶大小/cm³	诊断标准	AHRQ 评分
PSA
Guo等^[24](2019)	11/6	12/8	53.53±14.06	54.05±8.43	8.71±1.26	8.45±1.47	(9.72±5.30) d	30.60±42.23	ABC	9
Li等^[25](2023)	12/3	24/6	50.60±7.86	50.10±7.95	—	—	(8.25±7.51)个月	53.86±34.25	WAB	9
Xie等^[26](2022)	31/9	25/12	57.35±11.79	55.14±11.39	7.58±5.09	9.64±4.97	2.00(1.00,5.75)周	39.29(14.69,79.08)	ABC	8
Yang等^[27](2016)	11/6	12/8	53.53±14.06	54.05±8.43	8.71±1.26	8.45±1.47	(9.72±5.30) d	59.19±58.29	ABC	9
Yang等^[28](2016)	11/6	12/8	53.53±14.06	54.05±8.43	8.71±1.26	8.45±1.47	(9.72±5.30) d	59.19±58.29	ABC	9
Zhang等^[29](2021)	27/9	17/7	58.83±9.76	55.17±6.13	11.50±3.19	12.38±2.45	(66.19±35.19) d	3.06±3.62	WAB	9
戴燕红等^[30](2021)	9/6	10/8	56.13±7.01	53.83±5.55	10.07±2.84	9.00±2.30	(262.80±6.14) d	—	ABC	9
李闯等^[31](2022)	6/4	5/5	59.00±7.86	60.20±7.63	5.60±1.14	6.20±0.84	(5.50±1.02) d	—	ABC	8
李春星等^[32](2013)	12/8	12/8	64.50±8.00	52.30±7.80	—	—	—	—	WAB	8
李晓琳等^[33](2021)	13/2	13/2	59.87±11.53	56.73±10.29	12.07±2.87	13.40±2.59	(57.93±33.22) d	—	WAB	10
刘会茹等^[34](2014)	6/4	6/4	59.00±17.40	50.00±3.80	10.50±2.10	8.80±4.00	—	—	ABC	9
王顺娟等^[35](2020)	8/6	11/5	65.80±6.40	64.40±3.20	7.50±4.10	6.20±5.60	—	—	ABC	10
许光等^[36] (2013)	10/7	13/6	49.61±2.92	52.71±3.21	10.29±3.05	12.48±3.03	—	—	ABC	9
许光等^[37] (2014)	10/7	13/6	49.61±2.92	52.71±3.21	10.29±3.05	12.48±3.03	—	—	ABC	8
张晓彤等^[38] (2021)	15/4	12/5	48.63±7.50	45.76±7.41	—	—	—	—	WAB	8
周克贵等^[39] (2020)	8/6	11/5	65.80±6.40	64.40±3.20	7.50±4.10	6.20±5.60	—	—	ABC	10
Li等^[40] (2025)	32/14	24/16	53.41±12.47	48.79±12.87	10.83±4.24	11.85±2.69	—	—	WAB	8
PSD
Wu等^[16] (2023)	21/18	43/31	60.00±9.41	57.43±6.83	—	—	(9.92±4.92) d	0.13±0.18	DSM-V	10
Yao等^[41] (2020)	8/7	9/12	64.13±6.01	60.67±6.95	9.40±3.38	10.29±2.61	(62.87±15.73) d	1.65±1.46	HAMD	9
Yao等^[42] (2022)	8/7	9/12	64.13±6.01	60.67±6.95	9.40±3.38	10.29±2.61	(62.87±15.73) d	1.65±1.46	HAMD	9
侯晶晶等^[43](2011)	10/3	8/5	54.00±9.70	58.00±12.20	—	—	(10.8±2.8) d	—	DSM-V	8
张慧萍等^[44] (2018)	14/6	15/5	54.20±9.50	58.40±12.30	—	—	(10.9±2.8) d	—	—	8

表1

表2

纳入文献的影像特征"

纳入文献	品牌	场强	TR/ms	TE/ms	分析工具包	FWHM/mm	统计阈值	结局指标
PSA
Guo等^[24](2019)	Siemens	3.0 T	2000	30	DPABI, DynamicBC	—	Alphasim(P_校正 < 0.05)	ALFF
Li等^[25](2023)	Siemens	3.0 T	2000	30	DPARSF, SPM12	6	FWE(P_校正 < 0.05)	ReHo, ALFF
Xie等^[26](2022)	GE	3.0 T	2400	30	SPM8, DPARSF	4	FWE(P_校正 < 0.05)	ALFF
Yang等^[27](2016)	Siemens	3.0 T	2000	30	SPM8, DPARSF	8	FDR(P_校正 < 0.05)	ALFF
Yang等^[28](2016)	Siemens	3.0 T	2000	30	SPM8, DPARSF	8	FDR(P_校正 < 0.05)	ReHo
Zhang等^[29](2021)	Siemens	3.0 T	2000	30	SPM12, DPABI	6	TFCE(P_校正 < 0.05)	ALFF
戴燕红等^[30](2021)	GE	3.0 T	2100	30	DPASRSF, REST	—	Alphasim(P_校正 < 0.005)	fALFF
李闯等^[31](2022)	Siemens	3.0 T	2000	30	SPM8, DPARSF	—	—	ReHo
李春星等^[32](2013)	Siemens	3.0 T	2330	30	SPM8, DPARSF	6	Alphasim(P_校正 < 0.005)	ALFF
李晓琳等^[33](2021)	Siemens	3.0 T	2000	30	DPARSF, SPM12	—	GRF(P_校正 < 0.05)	ALFF
刘会茹等^[34](2014)	GE	3.0 T	2000	30	REST	—	Alphasim(P_校正 < 0.001)	ALFF
王顺娟等^[35](2020)	联影	3.0 T	2500	60	SPM8, DPARSF	4	Alphasim(P_校正 < 0.05)	ReHo
许光等^[36] (2013)	Philips	1.5 T	2000	50	SPM8, REST	—	Alphasim(P_校正 < 0.01)	ReHo
许光等^[37] (2014)	Philips	1.5 T	2000	50	DPARSF, REST	4	Alphasim(P_校正 < 0.01)	fALFF
张晓彤等^[38] (2021)	GE	3.0 T	2000	35	Restplus	6	P_NA < 0.05	ALFF
周克贵等^[39] (2020)	联影	3.0 T	2500	60	SPM8, DPARSF	—	Alphasim(P_校正 < 0.05)	ReHo
Li等^[40] (2025)	Siemens	3.0 T	1000	30	RESTplus, SPM12	6	FDR(P_校正 < 0.05)	ReHo, fALFF
PSD
Wu等^[16] (2023)	GE	3.0 T	2000	30	SPM12, DPABI	6	FDR(P_校正 < 0.05)	ALFF
Yao等^[41] (2020)	Siemens	3.0 T	2500	30	DPARSF, SPM12	6	FDR(P_校正 < 0.05)	ALFF
Yao等^[42] (2022)	Siemens	3.0 T	2500	30	DPARSF, SPM12	6	GRF(P_校正 < 0.05)	ReHo, fALFF
侯晶晶等^[43](2011)	Siemens	3.0 T	2000	30	SPM5, REST	8	P_不校正 < 0.01	ReHo
张慧萍等^[44] (2018)	Philips	3.0 T	—	—	—	—	P_不校正 < 0.05	ReHo

表2

图2

表3

图3

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MNI坐标(x, y, z)	AAL脑区(Brodmann分区)	团块大小/voxels	SDM-Z值	P值	I²/%
PSA > 对照组
-18, -50, -48	左侧小脑9区(NA)	1050	5.978	0.001	1.042
56, -50, 4	右侧颞中回(BA21)	435	4.592	0.001	18.489
42, -10, 6	右侧脑岛(BA48)	101	4.535	0.008	0.972
42, 6, -14	右侧脑岛(BA48)	19	4.414	0.032	0.858
PSA < 对照组
18, -68, -28	右侧小脑6区(BA19)	1822	-6.002	0.001	1.554
2, 24, 40	左侧内侧额上回(BA32)	242	-4.793	0.006	5.643
-34, 8, 60	左侧额中回(BA8)	45	-5.064	0.014	11.292
6, 32, 22	右侧前扣带与旁扣带脑回(BA32)	40	-4.234	0.030	1.224
PSD > 对照组
10, -86, 32	右侧楔叶(BA19)	265	5.014	0.001	0.209
30, -88, 30	右侧枕上回(NA)	13	4.051	0.038	9.236
PSD < 对照组
2, 38, 42	左侧内侧额上回(BA9)	954	-5.104	0.001	4.256
-2, 60, 10	左侧内侧额上回(BA10)	299	-4.514	0.001	1.419
-56, -44, 42	左侧顶下小叶(BA40)	119	-4.428	0.005	3.653
PSA < 对照组且PSD < 对照组
0, 26, 44	左侧内侧额上回(BA8)	65	-3.883	0.008	48.200

卒中后失语和卒中后抑郁自发脑活动改变的静息态功能磁共振成像Meta分析

Spontaneous brain activity changes in post-stroke aphasia and post-stroke depression: a meta-analysis of resting state functional magnetic resonance imaging

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