失匹配负波评估卒中后失语自然恢复的价值研究

Value of Mismatch Negativity for Predicting Spontaneous Recovery in Post-stroke Aphasia

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.