郭晋朝,王笑语,王贵玲.间歇性θ爆发式磁刺激对脑卒中后失语症患者临床疗效、脑神经递质水平及脑区功能重塑的影响[J].中华物理医学与康复杂志,2026,48(4):305-310
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| 间歇性θ爆发式磁刺激对脑卒中后失语症患者临床疗效、脑神经递质水平及脑区功能重塑的影响 |
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| DOI：10.3760/cma.j.cn421666-20250214-00135 |
| 中文关键词: 间歇性 θ 爆发式磁刺激 脑卒中后失语症 脑神经递质 脑区功能重塑 |
| 英文关键词: Theta burst stimulation Stroke Aphasia Brain neurotransmitters Brain remodeling |
| 基金项目:邢台市重点研发计划项目 (2023ZC076) |
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| 中文摘要: |
| 目的 探讨间歇性θ爆发式磁刺激（iTBS）对脑卒中后失语症（PSA）患者临床疗效、脑神经递质水平及脑区功能重塑的影响。 方法 采用随机数字表法将128例PSA患者分为对照组与观察组，每组64例。2组患者均予以常规肢体康复治疗及常规语言康复训练，观察组在此基础上增加iTBS治疗，对照组接受假iTBS治疗。治疗前及治疗4周后（治疗后），采用美国国立卫生研究院卒中量表（NIHSS）、蒙特利尔认知评估量表（MoCA）、脑卒中失语症生活质量量表（SAQOL-39）、中国康复研究中心汉语标准失语症检查（CRRCAE）、西方失语症成套测验（WAB）中的失语商（AQ）、功能性语言沟通能力量表（CFCP）评定2组患者的神经功能、认知功能、生活质量及语言功能，并检测血清中的5-羟色胺（5-HT）、去甲肾上腺素（NE）及多巴胺（dopamine, DA）水平。治疗后，比较2组患者在脑区功能重塑及低频振幅（ALFF）上的差异。 结果 与组内治疗前比较，2组患者治疗后的神经功能、认知功能、生活质量及脑神经递质水平均有所改善（P＜0.05）。与对照组比较，观察组治疗后的NIHSS评分［(7.10±0.98)分］较低，MoCA评分［(22.23±2.54)分］、SAQOL-39评分［(10.25±1.32)分］、CRRCAE评分［(32.71±4.18)分］、AQ评分［(73.24±9.21)分］、CFCP评分［(211.49±39.42)分］较高，5-HT水平［(131.52±20.14)ng/L］、NE水平［(10.19±2.17)μg/mL］、DA水平［(79.54±9.12 )ng/L］较高（P＜0.05）。观察组右侧梭状回与尾状核处的ALFF值显著高于对照组，双侧小脑 CrusⅡ区、右侧小脑 VIIb区及Ⅷ区的 ALFF 值显著低于对照组（P<0.05）。 结论 在常规肢体康复及语言康复训练的基础上，联合iTBS可有效改善PSA患者的神经功能与认知能力，提升生活质量，促进语言功能恢复，调节脑神经递质表达，增强脑功能重塑。 |
| 英文摘要: |
| Objective To demonstrate any effect of intermittent theta-burst stimulation(iTBS) on neurotransmitter levels and functional remodeling in the brain among persons with post-stroke aphasia(PSA). Methods A total of 128 persons with PSA were divided into a control group and an observation group, each of 64, using a random number table. In addition to conventional limb rehabilitation and routine language rehabilitation training, the observation group received iTBS, while the control group received sham iTBS. Before and after 4 weeks of treatment, both groups′ neurological functioning, cognition, quality of life and language use where tested using the National Institutes of Health Stroke Scale(NIHSS), the Montreal Cognitive Assessment(MoCA), Stroke Aphasia Quality of Life Scale-39(SAQOL-39), the Chinese Rehabilitation Research Center′s Standard Aphasia Examination(CRRCAE), the aphasia quotient(AQ) from the Western Aphasia Battery, and Communicative Functional Communication Profiles(CFCPs). Serum levels of 5-hydroxytryptamine(5-HT), norepinephrine(NE) and dopamine(DA) were also measured. Functional brain remodeling and the amplitudes of low-frequency fluctuations(ALFFs) were compared between the two groups. Results Significant improvement was observed in the neurological functioning and cognition of both groups, which was reflected in their life quality scores and brain neurotransmitter levels. The observation group had the lower average NIHSS score and higher average MoCA, SAQOL-39, CRRCAE, AQ and CFCP scores. That group also had significantly higher serum 5-HT, NE and DA levels after the treatment. The post-treatment ALFF values in the right fusiform gyrus and caudate nucleus were significantly higher in the observation group than in the control group, on average, while those in the bilateral cerebellar Crus Ⅱ, and the right cerebellar Ⅶb and Ⅷ regions were significantly lower. Conclusions iTBS can effectively supplement conventional limb rehabilitation and language rehabilitation training to improve neurological functioning and cognition, enhance life quality, and promote language recovery among stroke survivors with aphasia. |
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