失匹配负波评估卒中后失语自然恢复的价值研究
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摘要
目的了解失匹配负波(MMN)评估卒中后失语(PSA)自然恢复的临床价值及特点。方法选取2015年1月—2017年1月广东省第二人民医院神经内科收治的PSA患者27例为PSA组,另选取同期本院体检健康志愿者30例为对照组。PSA组分别于基线,卒中后2周、1个月、2个月、3个月进行西部失语症成套测验(WAB)、汉密尔顿抑郁量表17项版(HAMD-17)评估,并进行MMN检测。对照组同时接受HAMD-17及MMN检测。结果 PSA组基线,卒中后2周、1个月、2个月、3个月自发语言、听理解、复述、命名、失语商评分比较,差异均有统计学意义(F=5.60、7.58、9.60、5.05、3.75,P<0.05)。对照组与PSA组基线,卒中后2周、1个月、2个月、3个月MMN潜伏期和波幅比较,差异均有统计学意义(F=2.48、1.84,P<0.05)。结论卒中后2周、1个月、2个月、3个月失语症存在自然恢复,不同语言维度恢复时间有所差别,失语商在卒中后2个月提高明显,PSA的康复治疗可于早期介入。MMN对PSA的严重程度及自然恢复的评估有指导作用。
Objective To investigate the clinical value and features of mismatch negativity(MMN) in evaluating spontaneous recovery of post-stroke aphasia(PSA). Methods The enrolled participants were all from Guangdong Second Provincial General Hospital,including 27 cases of PSA receiving inpatient treatment in Department of Neurology(PSA group) from January 2015 to January 2017,and 30 health volunteers(control group) underwent physical examination during the same period. We used Western Aphasia Battery(WAB) to measure the aphasia status,and Hamilton Rating Scale for Depression-17 Item(HAM-D17) to evaluate the depression status,and MMN to investigate auditory discrimination and sensory memory at baseline,2 weeks,1 month,2 months,3 months after stroke,respectively in the PSA group. The controls only underwent HAMD-17 survey and MMN test once. Results Significant differences existed between the 5 average measurement scores in each of the 4 linguistic skills(spontaneous speech,auditory comprehension,repetition,naming) and aphasia quotient covered by WAB of the PSA group(F=5.60,7.58,9.60,5.05,3.75,all P<0.05). Compared with the mean MMN amplitude and latency of the controls,PSA group demonstrated significant different mean MMN amplitude(F=2.48,P<0.05) and latency(F=1.84,P<0.05). Conclusion PSA will recover spontaneously at 2 weeks,1 month,2 months and 3 months after stroke. The time of spontaneous recovery of different linguistic dimensions is different. The aphasia quotient increases significantly at 2 months after stroke. The rehabilitation treatment of PSA should be carried out as early as possible. MMN test can provide assistance for the evaluation of the severity of aphasia and recovery of PSA.
Objective To investigate the clinical value and features of mismatch negativity(MMN) in evaluating spontaneous recovery of post-stroke aphasia(PSA). Methods The enrolled participants were all from Guangdong Second Provincial General Hospital,including 27 cases of PSA receiving inpatient treatment in Department of Neurology(PSA group) from January 2015 to January 2017,and 30 health volunteers(control group) underwent physical examination during the same period. We used Western Aphasia Battery(WAB) to measure the aphasia status,and Hamilton Rating Scale for Depression-17 Item(HAM-D17) to evaluate the depression status,and MMN to investigate auditory discrimination and sensory memory at baseline,2 weeks,1 month,2 months,3 months after stroke,respectively in the PSA group. The controls only underwent HAMD-17 survey and MMN test once. Results Significant differences existed between the 5 average measurement scores in each of the 4 linguistic skills(spontaneous speech,auditory comprehension,repetition,naming) and aphasia quotient covered by WAB of the PSA group(F=5.60,7.58,9.60,5.05,3.75,all P<0.05). Compared with the mean MMN amplitude and latency of the controls,PSA group demonstrated significant different mean MMN amplitude(F=2.48,P<0.05) and latency(F=1.84,P<0.05). Conclusion PSA will recover spontaneously at 2 weeks,1 month,2 months and 3 months after stroke. The time of spontaneous recovery of different linguistic dimensions is different. The aphasia quotient increases significantly at 2 months after stroke. The rehabilitation treatment of PSA should be carried out as early as possible. MMN test can provide assistance for the evaluation of the severity of aphasia and recovery of PSA.
引文
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[3]顾爱明,郭如雅,付伟达.急性脑卒中后脑诱发电位失匹配负波的变化观察[J].中国实用神经疾病杂志,2008,11(2):39-40.DOI:10.3969/j.issn.1673-5110.2008.02.017.GU A M,GUO R Y,FU W D.Changes of mismatch negativity in patients after acute cerebral apoplexy[J].Chinese Journal of Practical Nervous Diseases,2008,11(2):39-40.DOI:10.3969/j.issn.1673-5110.2008.02.017.
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[6]中华神经科学会,中华神经外科学会.各类脑血管疾病的诊断要点[J].中华神经科杂志,1996,29(6):379.Chinese Society of Neurology,Chinese Neurosurgical Society.Diagnostic points of cerebrovascular diseases[J].Chinese Journal of Neurology,1996,29(6):379.
[7]BAKHEIT A M,CARRINGTON S,GRIFFITHS S,et al.High scores on the Western Aphasia Battery correlate with good functional communication skills(as measured with the Communicative Effectiveness Index)in aphasic stroke patients[J].Disabil Rehabil,2005,27(6):287-291.DOI:10.1080/09638280400009006.
[8]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.DOI:10.3760/cma.j.issn.1006-7876.2015.04.002.Neurology Branch of Chinese Medical Association,Cerebrovascular Group of Neurology Branch of Chinese Medical Association.Guidelines for the diagnosis and treatment of acute ischemic stroke in China 2014[J].Chinese Journal of Neurology,2015,48(4):246-257.DOI:10.3760/cma.j.issn.1006-7876.2015.04.002.
[9]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,48(4):258-273.DOI:10.3760/cma.j.issn.1006-7876.2015.04.003.Neurology Branch of Chinese Medical Association,Cerebrovascular Group of Neurology Branch of Chinese Medical Association.Guidelines for secondary prevention of ischemic stroke and transient ischemic attack in China 2014[J].Chinese Journal of Neurology,2015,48(4):258-273.DOI:10.3760/cma.j.issn.1006-7876.2015.04.003.
[10]OGREZEANU V,VOINESCU I,MIHAILESCU L,et al.“Spontaneous”recovery in aphasics after single ischaemic stroke[J].Rom J Neurol Psychiatry,1994,32(2):77-90.
[11]LASKA A C,HELLBLOM A,MURRAY V,et al.Aphasia in acute stroke and relation to outcome[J].J Intern Med,2001,249(5):413-422.DOI:10.1046/j.1365-2796.2001.00812.x.
[12]周丽,叶静.脑卒中失语症的预后及其影响因素的分析[J].中国医药指南,2013,11(19):22-23.DOI:10.15912/j.cnki.gocm.2013.19.552.ZHOU L,YE J.Analysis on aphasia after stroke,prognosis and other related ingredients[J].Guide of China Medicine,2013,11(19):22-23.DOI:10.15912/j.cnki.gocm.2013.19.552.
[13]吴小琴,刘晓加,邢一兰,等.多奈哌齐治疗早期卒中后失语:随机对照研究[J].国际脑血管病杂志,2013,21(2):81-85.DOI:10.3760/cma.j.issn.1673-4165.2013.02.001.WU X Q,LIU X J,XING Y L,et al.Donepezil in the treatment of early post-stroke aphasia:a randomized controlled trial[J].International Journal of Cerebrovascular Diseases,2013,21(2):81-85.DOI:10.3760/cma.j.issn.1673-4165.2013.02.001.
[14]CROSSON B,MCGREGOR K M,NOCERA J R,et al.The relevance of aging-related changes in brain function to rehabilitation in aging-related disease[J].Front Hum Neurosci,2015,9:307.DOI:10.3389/fnhum.2015.00307.
[15]王智樱,苗玲,陈莺.脑卒中后失语症患者自然恢复的相关因素分析[J].卒中与神经疾病,2009,16(2):94-97.DOI:10.3969/j.issn.1007-0478.2009.02.008.WANG Z Y,MIAO L,CHEN Y.Relative factor analysis of the spontaneous recovery in poststroke aphasia patients[J].Stroke and Nervous Diseases,2009,16(2):94-97.DOI:10.3969/j.issn.1007-0478.2009.02.008.
[16]HAMILTON R H,CHRYSIKOU E G,COSLETT B.Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation[J].Brain Lang,2011,118(1/2):40-50.DOI:10.1016/j.bandl.2011.02.005.
[17]ALLENDORFER J B,KISSELA B M,HOLLAND S K,et al.Different patterns of language activation in post-stroke aphasia are detected by overt and covert versions of the verb generation f MRI task[J].Med Sci Monit,2012,18(3):CR135-147.DOI:10.12659/MSM.882518.
[18]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(Pt7):2027-2039.DOI:10.1093/brain/awu113.
[19]武惠香,丘卫红,康庄,等.脑卒中后运动性失语发生机制的功能磁共振成像研究[J].中华物理医学与康复杂志,2014,36(6):407-412.DOI:10.3760/cma.j.issn.0254-1424.2014.06.002.WU H X,QIU W H,KANG Z,et al.Blood oxygen level and the pathogenic mechanism of expressive aphasia after stroke[J].Chinese Journal of Physical Medicine and Rehabilitation,2014,36(6):407-412.DOI:10.3760/cma.j.issn.0254-1424.2014.06.002.
[20]李春星,李华,周仪,等.静息态功能磁共振成像技术对右侧小脑参与语言功能的应用研究[J].国际放射医学核医学杂志,2014,38(4):211-215.DOI:10.3760/cma.j.issn.1673-4114.2014.04.001.LI C X,LI H,ZHOU Y,et al.Analysis of the mechanism of right cerebellum in language using resting state functional magnetic resonance imaging[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(4):211-215.DOI:10.3760/cma.j.issn.1673-4114.2014.04.001.
[21]MOHR B,DIFRANCESCO S,HARRINGTON K,et al.Changes of right-hemispheric activation after constraint-induced,intensive language action therapy in chronic aphasia:f MRI evidence from auditory semantic processing[J].Front Hum Neurosci,2014,8:919.DOI:10.3389/fnhum.2014.00919.
[22]张权,陈静,何雅娜,等.脑梗死运动性失语后静息态功能MRI功能连接的初步研究[J].中华放射学杂志,2014,48(6):457-461.DOI:10.3760/cma.j.issn.1005-1201.2014.06.005.ZHANG Q,CHEN J,HE Y N,et al.Resting-state functional connectivity in post-stroke expressive aphasia:a preliminary study[J].Chinese Journal of Radiology,2014,48(6):457-461.DOI:10.3760/cma.j.issn.1005-1201.2014.06.005.
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