重复经颅磁刺激对急性脑梗死后吞咽障碍的影响及与其功能磁共振成像变化的关系

Effect of repetitive transcranial magnetic stimulation on dysphagia after acute cerebral infarction and its relationship with fMRI changes

目的探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗急性脑梗死后吞咽障碍中功能磁共振成像(functional magnetic resonance imaging,fMRI)相关指标的变化及关系。方法选取2018年6月至2019年6月于我院神经内科住院的急性脑梗死后吞咽障碍的患者共40例,随机分为2组,分别为rTMS组和假刺激组,分析两组患者干预前和干预后的低频振幅(amplitude of low frequency fluctuation,ALFF)值的变化,采用临床吞咽困难量表(clinical dysphagia scale,CDS)、吞咽困难预后和严重程度量表(dysphagia prognosis and severity scale,DOSS)评估其吞咽功能变化,同时分析CDS和DOSS评分与ALFF值变化的关系。结果两组患者干预前的CDS和DOSS评分对比差异无统计学意义(P>0.05),干预后rTMS组的CDS评分低于假刺激组,且DOSS评分高于假刺激组,差异有统计学意义(P<0.05)。干预后rTMS组较假刺激组患者ALFF增强的脑区包括双侧尾状核、双侧豆状核和双侧额上回(P<0.05),且双侧尾状核、豆状核和额上回的ALFF变化与CDS评分和DOSS评分变化存在相关性(P<0.05)。结论rTMS治疗急性脑梗死吞咽障碍的患者可以促进大脑双侧尾状核、豆状核和额上回连接功能增强和激活。

Objective To investigate the changes and relationship of fMRI related indicators in patients with dysphagia after acute cerebral infarction treated with repetitive transcranial magnetic stimulation(rTMS).Methods A total of 40 patients with dysphagia after acute cerebral infarction admitted to our hospital from June 2018 to June 2019 were randomly divided into two groups:rTMS group and sham stimulation group.The changes of ALF values of the fMRI before and after intervention were analyzed.The clinical dysphagia scale(CDS),dyspha⁃gia prognosis and severity scale(DOSS)were used to assess changes of swallowing function.The correlation of CDS and DOSS scores and ALFF were analyzed.Results There was no significant difference in CDS and DOSS scores between the two groups before intervention(P>0.05).The CDS score of the rTMS group was significantly lower than that of the sham stimulation group,and the DOSS score was significantly higher than the sham stimula⁃tion group after intervention(P<0.05).The brain area of ALFF enhanced in patients with stroke after rTMS inter⁃vention compared with the sham-stimulated group included bilateral caudate nucleus,bilateral lenticular nucleus and bilateral superior gyrus(P<0.05).There was a significant correlation between ALFF changes in bilateral cau⁃date nucleus,lenticular nucleus and suprafrontal gyrus and changes in CDS score and DOSS score(P<0.05).Conclusion rTMS can promote the enhancement and activation of bilateral caudate nucleus,lenticular nucleus and supra-frontal connections in acute cerebral infarction patients with dysphagia.