不同吞咽时期大脑皮质激活特征：基于功能性近红外光谱技术

doi:10.3969/j.issn.1006-9771.2024.06.011

摘要/Abstract

摘要：

目的采用功能性近红外光谱技术(fNIRS)研究吞咽不同时期大脑皮质激活情况。

方法 2023年10月至12月，招募健康成年人18例，在fNIRS采集过程中执行视觉刺激、咀嚼、舌尖滑动和反复吞咽4项任务，计算覆盖额叶、顶叶和枕叶3个区域共计41个通道的皮质激活β值。

结果在口腔前期，双侧运动前区和辅助运动皮质区(PSMC)、双侧额下回、右侧视觉联合皮质(AVC)和左侧初级运动皮质(PMC)被激活(P < 0.05)。在口腔准备期，右侧额下回三角部(PTG)、右侧额极区(FPA)、右侧背外侧前额叶(DPC)、左侧初级躯体感觉皮质(PSC)、左侧PSMC、左侧PMC被激活(P < 0.05)。在口腔期和咽期的过渡期，双侧PSMC，双侧PMC被激活(P < 0.05)。在口腔期和咽期两个连续时期，双侧PSC、双侧PTG、双侧FPA、双侧眶额区、双侧PSMC、双侧DPC、双侧PMC被激活(P < 0.05)。

结论吞咽运动需要额叶、顶叶和枕叶的大脑皮质共同协调完成，不同吞咽时期主要激活的脑区具有差异性，PSMC和PMC参与大部分吞咽时期。

关键词: 吞咽, 功能性近红外光谱技术, 大脑皮质

Abstract:

Objective To explore the cerebral cortex activation in different swallowing periods using functional near-infrared spectroscopy (fNIRS).

Methods From October to December 2023, a total of 18 healthy adults were recruited to perform four tasks of visual stimulation, chewing, tongue tip sliding and repeated swallowing during fNIRS acquisition, to calculate the cortical activation β values covering a total of 41 channels in frontal, parietal and occipital lobes.

Results During the preoral period, the bilateral pre-motor and supplementary motor cortex (PSMC), bilateral inferior prefrontal gyrus, right visual association cortex (AVC), and left primary motor cortex (PMC) were significantly activated (P < 0.05). During oral preparation, the right pars triangularis (PTG), right frontal polar area (FPA), right dorsolateral prefrontal cortex (DPC), left primary somatosensory cortex (PSC), left PSMC and left PMC were significantly activated (P < 0.05). During the transition between oral and pharyngeal phases, bilateral PSMC and bilateral PMC were significantly activated (P < 0.05). Bilateral PSC, bilateral PTG, bilateral FPA, bilateral orbitofrontal area, bilateral PSMC, bilateral DPC and bilateral PMC were significantly activated during two consecutive periods of oral and pharyngeal phases (P < 0.05).

Conclusion The swallowing movement requires the coordination of the frontal, parietal and occipital cortex. The main activated brain areas are different in different swallowing stages, and the PSMC and PMC are involved in most swallowing stages.

Key words: swallow, functional near-infrared spectroscopy, cerebral cortex

中图分类号:

R338

刘佳琪, 侯闪闪, 汪鑫煜, 朱崇田, 王孝文. 不同吞咽时期大脑皮质激活特征：基于功能性近红外光谱技术[J]. 《中国康复理论与实践》, 2024, 30(6): 709-718.

LIU Jiaqi, HOU Shanshan, WANG Xinyu, ZHU Chongtian, WANG Xiaowen. Characteristics of cerebral cortex activation in different swallowing periods based on near-infrared spectroscopy[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 709-718.

图/表 11

图1

图2

图3

表1

图4

表2

图5

表3

图6

表4

图7

参考文献 36

[1]	林广勇, 黎月桃, 杨侃荣, 等. 基于功能核磁共振的中老年人吞咽任务脑功能区成像研究[J]. 临床医学工程, 2023, 30(12): 1621-1622.
	LIN G Y, LI Y T, YANG K R, et al. Study on brain functional area imaging of swallowing task of middle-aged and elderly people based on functional magnetic resonance imaging[J]. Clin Med Eng, 2023, 30(12): 1621-1622.
[2]	FRAZURE M L, BROWN A D, GREENE C L, et al. Rapid activation of esophageal mechanoreceptors alters the pharyngeal phase of swallow: evidence for inspiratory activity during swallow[J]. PLoS One, 2021, 16(4): 0248994.
[3]	武静芳, 李雪梅, 袁永学, 等. 吞咽不同黏度食物时健康成年人舌运动的超声研究[J]. 中国康复理论与实践, 2022, 28(11): 1355-1359. doi: 10.3969/j.issn.1006-9771.2022.11.016
	WU J F, LI X M, YUAN Y X, et al. Tongue movement of swallowing food with different viscosities in healthy adults: an ultrasound study[J]. Chin J Rehabil Theory Pract, 2022, 28(11): 1355-1359.
[4]	肖卫红, 吴碧玉. 脑卒中后吞咽障碍的康复研究进展[J]. 中国康复理论与实践, 2017, 23(7): 783-787. doi: 10.3969/j.issn.1006-9771.2017.07.009
	XIAO W H, WU B Y. Progression of rehabilitation for dysphagia after stroke (review)[J]. Chin J Rehabil Theory Pract, 2017, 23(7): 783-787.
[5]	雷小兰, 邱芳晖, 陈海燕. 舌三针中药棒冰刺激治疗脑卒中后吞咽障碍临床研究[J]. 新中医, 2023, 55(22): 161-165.
	LEI X L, QIU F H, CHEN H Y. Clinical study on tongue three needles combined with ice stimulation of decoction-contained popside for post-stroke dysphasia[J]. New J Tradit Chin Med, 2023, 55(22): 161-165.
[6]	WANG Y, HE Y, JIANG L, et al. Effect of transcutaneous auricular vagus nerve stimulation on post-stroke dysphagia[J]. J Neurol. 2023, 270(2): 995-1003.
[7]	吴群, 韩金星, 李慧. 早期介入冰刺激结合吞咽-摄食训练对脑梗死后吞咽障碍病人吞咽功能的影响[J]. 循证护理, 2023, 9(21): 3975-3978.
	WU Q, HAN J X, LI H. Impact of early interventional ice stimulation combined with swallowing-feeding training on swallowing function in patients with dysphagia after cerebral infarction[J]. Chin Evidence-Based Nurs, 2023, 9(21): 3975-3978.
[8]	KOBER S E, GRÖSSINGER D, WOOD G. Effects of motor imagery and visual neurofeedback on activation in the swallowing network: a real-time fMRI study[J]. Dysphagia, 2019, 34: 879-895. doi: 10.1007/s00455-019-09985-w pmid: 30771088
[9]	KAWAI T, WATANABE Y, TONOGI M, et al. Visual and auditory stimuli associated with swallowing: an fMRI study[J]. Bull Tokyo Dent Coll, 2009, 50 (4): 169-181. pmid: 20179392
[10]	朱原, 张虹. 应用fMRI探讨吞咽功能神经控制的研究概况[J]. 中华针灸电子杂志, 2021, 10(1): 18-21.
	ZHU Y, ZHANG H. Progress of neural control of swallowing function by using fMRI[J]. Chin J Acupunct Moxibust (E-ed), 2021, 10(1): 18-21.
[11]	近红外脑功能成像临床应用专家共识编写组. 近红外脑功能成像临床应用专家共识[J]. 中国老年保健医学, 2021, 19(2): 3-9.
	Expert Consensus on Clinical Application of Near-infrared Brain Functional Imaging Technology Writing Group. Expert consensus on clinical application of near-infrared brain functional imaging technology[J]. Chin J Geriatr Care, 2021, 19(2): 3-9.
[12]	FERRARI M, QUARESIMA V. A brief review on the history of human functional near-infrared spectroscopy (fNIRS) development and fields of application[J]. Neuroimage, 2012, 63(2): 921-935. doi: 10.1016/j.neuroimage.2012.03.049 pmid: 22510258
[13]	田婧, 何志杰, 杨青, 等. 基于功能性近红外光谱技术的卒中后上肢单侧任务与双侧任务的脑功能成像对比观察[J]. 中国卒中杂志, 2022, 17(4): 360-364.
	TIAN J, HE Z J, YANG Q, et al. Comparative observation of functional near-infrared brain imaging in stroke patients with unilateral upper limb training and bilateral upper limb training[J]. Chin J Stroke, 2022, 17(4): 360-364.
[14]	刘洪, 李妍妍, 罗海军, 等. 基于功能性近红外光谱血氧测量系统研究进展[J]. 重庆师范大学学报(自然科学版), 2023, 40(3): 155-163.
	LIU H, LI Y Y, LUO H J, et al. Research progress in cerebral oxygen detection system based on NIRS technology[J]. J Chongqing Norm Univ, 2023, 40(3): 155-163.
[15]	阚超杰, 郭川, 朱仕哲, 等. 老年人在认知-平衡双任务下的皮质激活特征[J]. 中国康复理论与实践, 2023, 29(10): 1189-1194. doi: 10.3969/j.issn.1006-9771.2023.10.010
	KAN C J, GUO C, ZHU S Z, et al. Characteristics of cortical activation in older adults under cognition-balance dual tasks[J]. Chin J Rehabil Theory Pract, 2023, 29(10): 1189-1194.
[16]	李晁金子, 黄富表, 杜晓霞, 等. 功能性近红外光谱技术在利手、非利手主动抓握-释放任务下脑区激活研究中的应用[J]. 中国康复理论与实践, 2021, 27(9): 1066-1071. doi: 10.3969/j.issn.1006-9771.2021.09.010
	LI C J Z, HUANG F B, DU X X, et al. Application of functional near-infrared spectroscopy in brain area activation research: dominant and non-dominant hand under active grasp-release task[J]. Chin J Rehabil Theory Pract, 2021, 27(9): 1066-1071.
[17]	SI J, YANG Y, XU L, et al. Evaluation of residual cognition in patients with disorders of consciousness based on functional near-infrared spectroscopy[J]. Neurophotonics, 2023, 10(2): 025003.
[18]	LIU H, PENG Y, LIU Z, et al. Hemodynamic signal changes and swallowing improvement of repetitive transcranial magnetic stimulation on stroke patients with dysphagia: a randomized controlled study[J]. Front Neurol, 2022, 13: 918974.
[19]	李玉华, 陈睿, 何清华. 功能性近红外光谱技术在社会互动脑机制研究中的应用[J]. 心理科学, 2018, 41(2): 305-311.
	LI Y H, CHEN R, HE Q H. The application of functional near-infrared spectroscopy in understanding the brain mechanism of social interaction[J]. J Psychol Sci, 2018, 41(2): 305-311.
[20]	KOBER S E, WOOD G. Hemodynamic signal changes during saliva and water swallowing: a near-infrared spectroscopy study[J]. J Biomed Opt, 2018, 23(1): 1-7. doi: 10.1117/1.JBO.23.1.015009 pmid: 29388413
[21]	ZHANG X, XIE H, WANG X, et al. Modulating swallowing-related functional connectivity and behavior via modified pharyngeal electrical stimulation: a functional near-infrared spectroscopy evidence[J]. Front Neurol, 2022, 13: 1006013.
[22]	邰佳慧, 李浩正, 王婷玮, 等. 基于功能性近红外光谱技术的吞咽相关任务大脑皮质功能偏侧化研究[J]. 中国康复医学杂志, 2022, 37(5): 594-599.
	TAI J H, LI H Z, WANG T W, et al. Lateralization of cerebral cortex function in swallowing related tasks: a functional near-infrared spectros-copy study[J]. Chin J Rehabil Med, 2022, 37(5): 594-599.
[23]	KOBER S E, BAUERNFEIND G, WOLLER C, et al. Hemodynamic signal changes accompanying execution and imagery of swallowing in patients with dysphagia: a multiple single-case near-infrared spectroscopy study[J]. Front Neurol, 2015, 6: 151. doi: 10.3389/fneur.2015.00151 pmid: 26217298
[24]	阳雨露, 孙蕴怡, 肖洪奇, 等. 精神疾病患者言语流畅性任务下前额叶激活特征的功能性近红外光谱成像研究[J]. 四川精神卫生, 2023, 36(3): 235-241.
	YANG Y L, SUN Y Y, XIAO H Q, et al. Study of prefrontal cortex activation characteristics of patients with psychiatric disorders in verbal fluency task using functional near-infrared spectroscopy[J]. Sichuan Ment Health, 2023, 36(3): 235-241.
[25]	张晨晨, 陈秀恩, 郑洁皎, 等. 基于功能性近红外光谱技术的不同吞咽任务态前额叶皮质功能研究[J]. 中国康复医学杂志, 2023, 38(10): 1372-1378.
	ZHANG C C, CHEN X E, ZHENG J J, et al. The study of prefrontal cortex function in different swallowing task based on functional near-infrared spectroscopy[J]. Chin J Rehabil Med, 2023, 38 (10): 1372-1378.
[26]	彭昕珂, 贾飞阳, 刘静, 等. 健康成年人反复唾液吞咽测试期间的近红外脑功能成像[J]. 中国组织工程研究, 2023, 27(32): 5103-5107.
	PENG X K, JIA F Y, LIU J, et al. Functional brain imaging using near-infrared spectroscopy during the repetitive saliva swallowing test in healthy adults[J]. Chin J Tissue Eng Res, 2023, 27 (32): 5103-5107.
[27]	李思静, 席艳玲. Broca失语患者双侧额下回与全脑功能连接的时间变异性研究[J]. 中华物理医学与康复杂志, 2023, 45(8): 688-694.
	LI S J, XI Y L. Variability in the functional connectivity of the bilateral inferior frontal gyrus with the whole brain in persons with Broca's aphasia[J]. Chin J Phys Med Rehabil, 2023, 45(8): 688-694.
[28]	KOBER S E, GRÖSSINGER D, WOOD G. Effects of motor imagery and visual neurofeedback on activation in the swallowing network: a real-time fMRI study[J]. Dysphagia, 2019, 34(6): 879-895. doi: 10.1007/s00455-019-09985-w pmid: 30771088
[29]	YEO B T, KRIENEN F M, SEPULCRE J, et al. The organization of the human cerebral cortex estimated by intrinsic functional connectivity[J]. J Neurophysiol, 2011, 106(3): 1125-1165. doi: 10.1152/jn.00338.2011 pmid: 21653723
[30]	蔡伟强, 李浩正, 朱玉连, 等. 持续短阵脉冲刺激对脑卒中偏瘫患者静息态脑功能连接模式的影响[J]. 中国康复医学杂志, 2023, 38(7): 898-903, 923.
	CAI W Q, LI H Z, ZHU Y L, et al. Effects of single-session continuous theta burst stimulation on the connectivity pattern of poststroke patients with hemiplegia[J]. Chin J Rehabil Med, 2023, 38(7): 898-903, 923.
[31]	杨文蕊, 李琰, 杨黎, 等. 帕金森病患者辅助运动区动态功能连接的静息态功能MRI[J]. 放射学实践, 2022, 37(4): 449-453.
	YANG W R, LI Y, YANG L, et al. Functional MRI study on dynamic functional connection of supplementary motor area in patients with Parkinson's disease[J]. Radiol Pract, 2022, 37(4): 449-453.
[32]	解二康, 从洋洋, 王瑜元, 等. 基于下肢康复机器人的双任务训练对脑卒中患者下肢运动及步行能力的影响[J]. 中华物理医学与康复杂志, 2024, 46(2): 112-117.
	XIE E K, CONG Y Y, WANG Y Y, et al. Improving the lower limb functioning and walking ability of stroke survivors with robot-assisted dual-task training[J]. Chin J Phys Med Rehabil, 2024, 46(2): 112-117.
[33]	OKUBO A, TSUJIMURA T, UEHA R, et al. Chewing well modulates pharyngeal bolus transit during swallowing in healthy participants[J]. [ahead of print]. Dysphagia, 2024. doi: 10.1007/s00455-024-10689-z.
[34]	窦祖林. 吞咽障碍评估与治疗[M]. 2版. 北京: 人民卫生出版社, 2017: 3-5.
	DOU Z L. Evaluation and treatment of dysphagia[M]. 2nd ed. Beijing: People's Medical Publishing House, 2017:3-5.
[35]	SÖRÖS P, INAMOTO Y, MARTIN R E. Functional brain imaging of swallowing: an activation likelihood estimation meta-analysis[J]. Hum Brain Mapp, 2009, 30(8): 2426-2439. doi: 10.1002/hbm.20680 pmid: 19107749
[36]	MA X, PENG Y, ZHONG L, et al. Hemodynamic signal changes during volitional swallowing in dysphagia patients with different unilateral hemispheric stroke and brainstem stroke: a near-infrared spectroscopy study[J]. Brain Res Bull, 2024, 207: 110880.