王凌燕,施爱群,赵瀛,等.基于弥散张量成像分析大脑中动脉脑梗死患者吞咽障碍的回顾性研究[J].中华物理医学与康复杂志,2019,41(12):935-940
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| 基于弥散张量成像分析大脑中动脉脑梗死患者吞咽障碍的回顾性研究 |
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| DOI：DOI:10.3760/cma.j.issn.0254-1424.2019.12.014 |
| 中文关键词: 脑梗死 吞咽障碍 弥散张量成像 岛叶 大脑脚 |
| 英文关键词: Cerebral infarction Dysphagia Diffusion tensor images Insulae Cerebral peduncles |
| 基金项目:浙江省金华市科技局社会发展重点项目（2013-3-015） |
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| 中文摘要: |
| 目的 采用弥散张量成像（DTI）探究大脑中动脉脑梗死患者吞咽障碍和恢复的相关皮质下区域。 方法 纳入大脑中动脉梗死后吞咽障碍的患者10例（吞咽障碍组）和未发生吞咽障碍的大脑中动脉梗死后患者10例（非吞咽障碍组）。选取胼胝体等11个感兴趣区（ROIs），比较吞咽障碍组和非吞咽障碍组病灶侧与健侧的扩散张量参数扩散各向异性（FA）的比值rFA的差异，以及吞咽障碍组1个月和3个月吞咽障碍恢复时的rFA值的变化，并采用Spearman相关分析rFA与吞咽障碍的结局和严重度量表（DOSS）评分的关系。 结果 比较吞咽障碍组和非吞咽障碍组各ROI的rFA值后发现，吞咽障碍组岛叶的rFA值为0.73±0.16，非吞咽障碍组岛叶的rFA值为0.97±0.07，2组间比较有统计学差异（P<0.01）。比较吞咽障碍组发病1个月内和发病3个月后ROIs中扩散张量参数rFA值后，吞咽障碍组岛叶、大脑脚、小脑上脚的rFA值在发病3个月后均显著增加，且差异均有统计学意义，P<0.05）。吞咽障碍组发病1个月内的DOSS评分为（4.4±0.8）分，与发病3个月后（6.3±0.8）分比较，差异有统计学意义（P<0.05）。吞咽障碍组发病1个月内，DOSS评分与岛叶、大脑脚和小脑上脚具有显著相关性，差异均有统计学意义（P<0.05）；发病3个月后， DOSS评分仅与大脑脚具有显著的相关性，差异均统计学意义（P<0.01）。 结论 大脑中动脉脑梗死患者早期吞咽障碍程度（发病1个月内）与岛叶、大脑脚、小脑上脚相关，而晚期（发病3个月后）与大脑脚相关。 |
| 英文摘要: |
| Objective To determine the subcortical areas associated with post-stroke dysphagia and its recovery using diffusion tensor images. Methods Ten patients with middle cerebral artery lesions and dysphagia were selected into the dysphagia group, while another 10 counterparts without dysphagia were chosen for the non-dysphagia group. The ratios of diffuse anisotropy (rFAs) in eleven regions of interest (ROIs) on both the healthy and affected sides were recorded and compared between the two groups. One and 3 months later, the rFA values of the dysphagia group were again measured and the rFAs were related with dysphagia outcomes and severity using Spearman correlation analysis. Results Comparing the rFAs of the 11 ROIs between the two groups revealed significant differences between the insulae of the dysphagia group and the non-dysphagia group. Three months later the rFA values of the insulae, cerebral peduncles and superior cerebellar peduncles had increased significantly in the dysphagia group. The average dysphagia outcome and severity score of the dysphagia group was significantly lower one month after the treatment than 3 months later. Moreover, the outcome and severity score was found to be significantly correlated with the rFA values of the insulae and of the superior cerebellar peduncles one month after the treatment, but with that of the cerebral peduncles only after 3 months. Conclusion Dysphagia within one month of the onset of infarction is related to the insulae, the cerebral peduncles and the superior cerebellar peduncles. After 3 months it is associated with the cerebral peduncles. |
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