脑皮质梗死慢性期非流利性失语症灰质体积的改变

doi:10.3969/j.issn.1006-9771.2021.00.003

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (7): 785-790.doi: 10.3969/j.issn.1006-9771.2021.00.003

脑皮质梗死慢性期非流利性失语症灰质体积的改变

戴燕红^1a,黄嘉英^1b,罗海龙^1b,汪睿清^1a,黄颖安^1a,陈卓铭^1a,王红^1a,²()

1.暨南大学附属第一医院, a. 康复科; b. 影像科, 广东广州市510000
2.暨南大学附属中西医结合医院, 广东广州市 510000

收稿日期:2021-03-16 修回日期:2021-05-12 出版日期:2021-07-25 发布日期:2021-07-28
通讯作者: 王红 E-mail:daxiaobaotwins@126.com
作者简介:戴燕红(1989-),女,汉族,广东茂名市人,硕士,医师,主要研究方向：神经康复。|王红(1966-),女,汉族,江苏南京市人,主任医师,主要研究方向：神经康复。
基金资助:
1.国家重点研发计划项目(2020YFC2005700);2.广东省基础与应用基础研究基金项目(2020A1515010578);3.广东省医学科研基金项目(A2020352)

Changes in Gray Matter Volume in Chronic Nonfluent Aphasia after Cortical Cerebral Infarction

DAI Yan-hong^1a,HUANG Jia-ying^1b,LUO Hai-long^1b,WANG Rui-qing^1a,HUANG Ying-an^1a,CHEN Zhuo-ming^1a,WANG Hong^1a,²()

1. a. Department of Rehabilitation Medicine; b. Department of Radiology, the First Affiliated Hospital of Ji'nan University, Guangzhou, Guangdong 510000, China
2. Department of Rehabilitation Medicine, Integrated Traditional Chinese and Western Medicine Hospital Affiliated of Ji'nan University, Guangzhou, Guangdong 510000, China

Received:2021-03-16 Revised:2021-05-12 Published:2021-07-25 Online:2021-07-28
Contact: WANG Hong E-mail:daxiaobaotwins@126.com
Supported by:
National Key Research and Development Project Fund(2020YFC2005700);Guangdong Basic and Applied Basic Research Fund(2020A1515010578);Guangdong Medical Research Fund(A2020352)

摘要/Abstract

摘要：

目的探讨脑皮质梗死慢性期非流利性失语症患者灰质体积的改变及其与语言功能的关系。

方法 2016年6月至2019年6月,暨南大学附属第一医院康复科脑皮质梗死慢性期非流利性失语症住院患者19例为患者组,健康人28例为对照组,分别行结构磁共振扫描,采用基于体素的形态学测量分析两组灰质体积存在差异的脑区,提取有体积差异的脑区与患者组汉语失语成套测验评估量表(ABC)部分亚项评分进行相关性分析。

结果患者组右额下回三角部、右额下回岛盖部、右角回、右内侧额上回、左岛叶、左内侧额上回灰质体积增加,右苍白球灰质体积减少。患者组左岛叶体积与复述(r = 0.665, P = 0.001)和命名(r = 0.638,P = 0.003)评分相关,右额下回三角部与听理解(r = 0.493, P = 0.031)、复述(r = 0.576, P = 0.009)和命名(r = 0.674, P = 0.001)评分相关。

结论脑皮质梗死慢性期非流利性失语症患者左岛叶、右额下回三角部体积增大,可能与语言功能相关。

关键词: 脑梗死, 失语症, 结构磁共振成像, 基于体素的形态学测量, 灰质体积

Abstract:

Objective To investigate the changes of gray matter volume in patients with chronic nonfluent aphasia after cortical cerebral infarction and the relationship between gray matter volume and language function.

Methods From June, 2016 to June, 2019, 19 patients with chronic nonfluent aphasia after cortical cerebral infarction from the First Affiliated Hospital of Ji'nan University and 28 healthy subjects (controls) were scanned with structural magnetic resonance imaging. The data were analyzed using voxel-based morphological measurement to measure the gray matter volumes of the brain regions, and the differences between patients and controls were compared. The correlation between volumes of brain regions with difference and scores of items of Aphasia Battery of Chinese (ABC) was analyzed.

Results The gray matter volumes increased in the brain regions of right inferior frontal gyrus triangle, right inferior frontal gyrus island cover, right angular gyrus, the right medial frontal gyrus, left insula, left medial frontal gyrus in the patients; while decreased in right globus pallidus. The volumes of left insular lobe correlated with the scores of repeating (r = 0.665, P = 0.001) and naming (r = 0.638, P = 0.003); and the volumes of right inferior frontal gyrus triangle correlated with the scores of hearing comprehension (r = 0.493, P = 0.031), repeating (r = 0.576, P = 0.009) and naming (r = 0.674, P = 0.001) in the patients.

Conclusion The cortex volumes of left insula and right inferior frontal gyrus triangle increase in patients with chronic nonfluent aphasia after cerebral infarction, which may play a role in the language dysfunction.

Key words: cerebral infarction, aphasia, structural magnetic resonance imaging, voxel-based morphological measurement, gray matter volume

中图分类号:

R743.32

戴燕红, 黄嘉英, 罗海龙, 汪睿清, 黄颖安, 陈卓铭, 王红. 脑皮质梗死慢性期非流利性失语症灰质体积的改变[J]. 《中国康复理论与实践》, 2021, 27(7): 785-790.

DAI Yan-hong, HUANG Jia-ying, LUO Hai-long, WANG Rui-qing, HUANG Ying-an, CHEN Zhuo-ming, WANG Hong. Changes in Gray Matter Volume in Chronic Nonfluent Aphasia after Cortical Cerebral Infarction[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 785-790.

图/表 4

表1

表2

图1

图2

参考文献 37

[1]	ARAS B, İNAL Ö, KESIKBURUN S, et al. Response to speech and language therapy according to artery involvement and lesion location in post-stroke aphasia[J]. J Stroke Cerebrovasc Dis, 2020, 29(10):105132. doi: 10.1016/j.jstrokecerebrovasdis.2020.105132
[2]	KAPOOR A. Repetitive transcranial magnetic stimulation therapy for post-stroke non-fluent aphasia: a critical review[J]. Top Stroke Rehabil, 2017, 24(7):547-553. doi: 10.1080/10749357.2017.1331417
[3]	STEFANIAK J D, HALAI A D, LAMBON RALPH M A. The neural and neurocomputational bases of recovery from post-stroke aphasia[J]. Nat Rev Neurol, 2020, 16(1):43-55. doi: 10.1038/s41582-019-0282-1
[4]	BREINING B L, SEBASTIAN R. Neuromodulation in post-stroke aphasia treatment[J]. Curr Phys Med Rehabil Rep, 2020, 8(2):44-56. doi: 10.1007/s40141-020-00257-5
[5]	NAKASHIMA A, MORIUCHI T, MITSUNAGA W, et al. Prediction of prognosis of upper extremity function following stroke-related paralysis using brain imaging[J]. J Phys Ther Sci, 2017, 29(8):1438-1443. doi: 10.1589/jpts.29.1438
[6]	TORBEY M T, BOSEL J, RHONEY D H, et al. Evidence-based guidelines for the management of large hemispheric infarction: a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro intensive Care and Emergency Medicine[J]. Neurocrit Care, 2015, 22(1):146-164. doi: 10.1007/s12028-014-0085-6
[7]	余晓凤, 陈芹, 高晴, 等. 颞叶癫痫患者语言网络基于Granger因果检验的功能磁共振特点[J]. 中华神经科杂志, 2014, 47(8):537-541.
	YU X F, CHEN Q, GAO Q, et al. Evaluating the connectivity within the language network in temporal lobe epilepsy using Granger causality analysis: a functional magnetic resonance imaging study[J]. Chin J Neurol, 2014, 47(8):537-541.
[8]	JAKAB A, MOLNÁR P P, BOGNER P, et al. Connectivity-based parcellation reveals interhemispheric differences in the insula[J]. Brain Topogr, 2012, 25(3):264-271. doi: 10.1007/s10548-011-0205-y
[9]	OH A, DUERDEN E G, PANG E W. The role of the insula in speech and language processing[J]. Brain Lang, 2014, 135:96-103. doi: 10.1016/j.bandl.2014.06.003
[10]	ARDILA A, BERNAL B, ROSSELLI M. Participation of the insula in language revisited: a meta-analytic connectivity study[J]. J Neurolinguistics, 2014, 29:31-41. doi: 10.1016/j.jneuroling.2014.02.001
[11]	NORISE C, HAMILTON R H. Non-invasive brain stimulation in the treatment of post-stroke and neurodegenerative aphasia: parallels, differences, and lessons learned[J]. Front Hum Neurosci, 2016, 10:675. doi: 10.3389/fpsyg.2019.00675
[12]	LOUGHNAN R, LORCA-PULS D L, GAJARDO-VIDAL A, et al. Generalizing post-stroke prognoses from research data to clinical data[J]. Neuroimage Clin, 2019, 24:102005. doi: 10.1016/j.nicl.2019.102005
[13]	SREEDHARAN S, CHANDRAN A, YANAMALA V R, et al. Self-regulation of language areas using real-time functional MRI in stroke patients with expressive aphasia[J]. Brain Imaging Behav, 2020, 14(5):1714-1730. doi: 10.1007/s11682-019-00106-7
[14]	HARTWIGSEN G, SAUR D, PRICE C J, et al. Perturbation of the left inferior frontal gyrus triggers adaptive plasticity in the right homologous area during speech production[J]. Proc Natl Acad Sci, 2013, 110(41):16402-16407. doi: 10.1073/pnas.1310190110
[15]	TURKELTAUB P E. Brain stimulation and the role of the right hemisphere in aphasia recovery[J]. Curr Neurol Neurosci Rep, 2015, 15(11):72. doi: 10.1007/s11910-015-0593-6
[16]	ROBSON H, ZAHN R, KEIDEL J L, et al. The anterior temporal lobes support residual comprehension in Wernicke's aphasia[J]. Brain, 2014, 137(Pt3):931-943. doi: 10.1093/brain/awt373
[17]	JOHNSON J P, MEIER E L, PAN Y, et al. Treatment-related changes in neural activation vary according to treatment response and extent of spared tissue in patients with chronic aphasia[J]. Cortex, 2019, 121:147-168. doi: 10.1016/j.cortex.2019.08.016
[18]	ABEL S, WEILLER C, HUBER W, et al. Therapy-induced brain reorganization patterns in aphasia[J]. Brain, 2015, 138(Pt 4):1097-1112. doi: 10.1093/brain/awv022
[19]	REN C, ZHANG G, XU X, et al. The effect of rTMS over the different targets on language recovery in stroke patients with global aphasia: a randomized sham-controlled study[J]. Biomed Res Int, 2019, 2019:4589056.
[20]	HARVEY D Y, PODELL J, TURKELTAUB P E, et al. Functional reorganization of right prefrontal cortex underlies sustained naming improvements in chronic aphasia via repetitive transcranial magnetic stimulation[J]. Cogn Behav Neurol, 2017, 30(4):133-144. doi: 10.1097/WNN.0000000000000141
[21]	ROSSETTI A, MALFITANO C, MALLOGGI C, et al. Phonemic fluency improved after inhibitory transcranial magnetic stimulation in a case of chronic aphasia[J]. Int J Rehabil Res, 2019, 42(1):92-95. doi: 10.1097/MRR.0000000000000322
[22]	HAGHIGHI M, MAZDEH M, RANJBAR N, et al. Further evidence of the positive influence of repetitive transcranial magnetic stimulation on speech and language in patients with aphasia after stroke: results from a double-blind intervention with sham condition[J]. Neuropsychobiology, 2017, 75(4):185-192. doi: 10.1159/000486144
[23]	邱国荣, 丘卫红, 邹艳, 等. 重复经颅磁刺激对卒中后失语语言功能重组的影响:基于功能磁共振的研究[J]. 中国康复理论与实践, 2018, 24(6):686-695.
	QIU G R, QIU W H, ZOU Y, et al. Effect of repeated transcranial magnetic stimulation on reorganization of aphasia after stroke: a study based on functional magnetic resonance imaging[J]. Chin J Rehabil Theory Pract, 2018, 24(6):686-695.
[24]	HEIKKINEN P H, PULVERMULLER F, MÄKELÄ J P, et al. Combining rTMS with intensive language-action therapy in chronic aphasia: a randomized controlled trial[J]. Front Neurosci, 2019, 12:1036. doi: 10.3389/fnins.2018.01036
[25]	AL-JANABI S, NICKELS L A, SOWMAN P F, et al. Augmenting melodic intonation therapy with non-invasive brain stimulation to treat impaired left-hemisphere function: two case studies[J]. Front Psychol, 2014, 5:37.
[26]	NARDO D, HOLLAND R, LEFF A P, et al. Less is more: neural mechanisms underlying anomia treatment in chronic aphasic patients[J]. Brain, 2017, 140(11):3039-3054. doi: 10.1093/brain/awx234
[27]	CROSSON B, RODRIGUEZ A D, COPLAND D, et al. Neuroplasticity and aphasia treatments: new approaches for an old problem[J]. J Neurol Neurosurg Psychiatry, 2019, 90(10):1147-1155. doi: 10.1136/jnnp-2018-319649
[28]	FORKEL S J, THIEBAUT DE SCHOTTEN M, DELL'ACQUA F, et al. Anatomical predictors of aphasia recovery: a tractography study of bilateral perisylvian language networks[J]. Brain, 2014, 137(Pt 7):2027-2039. doi: 10.1093/brain/awu113
[29]	PANI E, ZHENG X, WANG J, et al. Right hemisphere structures predict poststroke speech fluency[J]. Neurology, 2016, 86(17):1574-1581. doi: 10.1212/WNL.0000000000002613
[30]	HOPE T M H, LEFF A P, PREJAWA S, et al. Right hemisphere structural adaptation and changing language skills years after left hemisphere stroke[J]. Brain, 2017, 140(6):1718-1728. doi: 10.1093/brain/awx086
[31]	LUKIC S, BARBIERI E, WANG X, et al. Right hemisphere grey matter volume and language functions in stroke aphasia[J]. Neural Plast, 2017, 2017:1-14.
[32]	XING S, LACEY E H, SKIPPER-KALLAL L M, et al. Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke[J]. Brain, 2016, 139(Pt1):227-241. doi: 10.1093/brain/awv323
[33]	BRODTMANN A, PARDOE H, LI Q, et al. Changes in regional brain volume three months after stroke[J]. J Neurol Sci, 2012, 322(1-2):122-128. doi: 10.1016/j.jns.2012.07.019
[34]	GAUTHIER L V, TAUB E, MARK V W, et al. Atrophy of spared gray matter tissue predicts poorer motor recovery and rehabilitation response in chronic stroke[J]. Stroke, 2012, 43(2):453-457. doi: 10.1161/STROKEAHA.111.633255
[35]	KERR A L, CHENG S Y, JONES T A. Experience-dependent neural plasticity in the adult damaged brain[J]. J Commun Disord, 2011, 44(5):538-548.
[36]	HARTWIGSEN G, SAUR D. Neuroimaging of stroke recovery from aphasia: insights into plasticity of the human language network[J]. Neuroimage, 2019, 190:14-31. doi: 10.1016/j.neuroimage.2017.11.056
[37]	VOLZ L J, VOLLMER M, MICHELY J, et al. Time-dependent functional role of the contralesional motor cortex after stroke[J]. Neuroimage Clin, 2017, 16:165-174. doi: 10.1016/j.nicl.2017.07.024

特征	对照组 (n = 28)	患者组 (n = 19)	χ²/t/Z值	P值
性别(男/女, n)	15/13	12/7	0.426	0.514^a
年龄(岁)	54.86±4.66	55.21±5.57	0.231	0.353^b
教育程度(年)	9.46±2.36	9.55±2.68	0.242	0.821^c
病程(月)	–	8.68±2.12

脑皮质梗死慢性期非流利性失语症灰质体积的改变

Changes in Gray Matter Volume in Chronic Nonfluent Aphasia after Cortical Cerebral Infarction

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 37

相关文章 15

Metrics

本文评价

推荐阅读 0

脑区	体素数	MNI坐标			t值
脑区	体素数	X	Y	Z	t值
左岛叶	22	-36	16	0	-4.229
左内侧额上回	104	-4	16	52	-5.158
右额下回三角部	33	48	24	4	-5.046
右岛盖部额下回	11	52	12	24	-3.784
右角回	53	52	-56	36	-5.144
右内侧额上回	104	4	16	52	-5.158
右侧苍白球	22	28	-8	-4	4.718

[1]	韩凯月,刘光亮,苏文龙,唐芷晴,张皓. 智能有氧踏车训练对不同病程脑梗死患者的效果[J]. 《中国康复理论与实践》, 2022, 28(7): 822-827.
[2]	王琼芬,王风波,王科,钟永强,王娇娇. 电针风池对急性脑梗死大鼠脑星形胶质细胞和神经元的保护效果[J]. 《中国康复理论与实践》, 2021, 27(3): 302-309.
[3]	张馨予,杜小正,王金海,何文洁,王娜娜,王若州,井维尧,杨尚伟. Netrin-1对脑梗死损伤的保护和修复作用研究进展[J]. 《中国康复理论与实践》, 2021, 27(3): 316-319.
[4]	杨福霞,侯冬梅,高进云,古媚,赵波沣,曾旭梅,詹敏敏,谢敏娇,谢耀钦. 针灸治疗对脑梗死后运动功能和皮质脊髓束损伤效果的神经影像学观察[J]. 《中国康复理论与实践》, 2021, 27(11): 1312-1317.
[5]	王博,张庆苏,张皓. 朗读训练对脑卒中失读症的疗效[J]. 《中国康复理论与实践》, 2020, 26(7): 820-824.
[6]	郭琳佳,陈靖,高凤莲,张运,刘文宏. 以急性多发性脑梗死为首发表现的Trousseau综合征临床特征分析[J]. 《中国康复理论与实践》, 2020, 26(6): 730-737.
[7]	杜宇鹏,李晓东,刘文兵,刘雪云. 不同强度的经颅直流电刺激对脑梗死后吞咽障碍患者的疗效比较[J]. 《中国康复理论与实践》, 2020, 26(5): 583-587.
[8]	王雪,张淑燕. 脑梗死患者住院费用结构分析：基于结构变动度和灰色关联法[J]. 《中国康复理论与实践》, 2020, 26(1): 115-119.
[9]	陈韵佳, 陈柱, 朱燕, 单春雷. 神经调控技术在失语症治疗中的应用进展[J]. 《中国康复理论与实践》, 2019, 25(8): 930-935.
[10]	赵江莉, 毛玉瑢, 徐智勤, 陈少贞, 黄东锋. 中文版上肢动作研究量表在早期脑梗死患者中的效度[J]. 《中国康复理论与实践》, 2019, 25(8): 946-955.
[11]	何芳梅, 任春晓, 宋春霞, 高惠霞, 王晶晶. 蛋白酶体α6亚单位基因1233A/T位点多态性与脑梗死的关系[J]. 《中国康复理论与实践》, 2019, 25(8): 966-970.
[12]	徐倩, 王萍, 施伯瀚, 王健. 镜像神经元系统在失语症中的应用进展[J]. 《中国康复理论与实践》, 2019, 25(7): 771-773.
[13]	张玉峰, 陈兵, 井峰. 血栓弹力图在脑梗死预后中的价值[J]. 《中国康复理论与实践》, 2019, 25(4): 460-464.
[14]	孙伟铭, 董香丽. 工作记忆刷新训练对运动性失语症患者言语流畅性的影响[J]. 《中国康复理论与实践》, 2019, 25(2): 135-139.
[15]	李秀明, 刘罡. 脑梗死后囊腔微环境分析[J]. 《中国康复理论与实践》, 2019, 25(11): 1293-1302.