大脑脚非对称性比例对卒中后失语患者非优势半球语言代偿能力的评估价值分析

Value of asymmetry rate of the cerebral peduncle for assessing compensatory ability of non-dominant hemisphere in patients with post-stroke aphasia

目的分析大脑脚非对称性比例(ARCP)对卒中后失语(PSA)患者非优势半球语言代偿能力的评估价值。方法回顾性分析33例伴有PSA的二次卒中患者临床资料,根据二次卒中半球与首次卒中半球是否同侧分为对侧卒中组(17例)与同侧卒中组(16例)。收集患者首次卒中后1周内失语商(AQ_(postFS))、首次卒中1年后至二次卒中前失语商(AQ_(preRS))、二次卒中后1周内失语商(AQ_(postRS)),计算二次卒中前失语商变化∆AQ1(AQ_(preRS)-AQ_(postFS))、二次卒中后失语商变化∆AQ2(AQ_(preRS)-AQ_(postRS));根据二次卒中后1周内最早的磁共振影像测量并计算ARCP。比较两组ARCP、AQ_(postFS)、AQ_(preRS)、AQ_(postRS)、∆AQ1、∆AQ2;Pearson相关分析评估ARCP与∆AQ1、∆AQ2、AQ_(preRS)、AQ_(postRS)的相关性;将ARCP=1.5作为定量标准,比较两组中ARCP≥1.5的患者及<1.5患者的∆AQ2。结果对侧卒中组AQ_(postRS)低于同侧卒中组,∆AQ2高于同侧卒中组(P均<0.05);两组ARCP、AQ_(postFS)、AQ_(preRS)、∆AQ1差异无统计学意义。对侧卒中组∆AQ1、∆AQ2与ARCP呈正相关,AQ_(postRS)与ARCP呈负相关(P均<0.01),AQ_(preRS)与ARCP无相关性。同侧卒中组∆AQ1、AQ_(postRS)与ARCP呈正相关,∆AQ2与ARCP呈负相关(P均<0.01)。对侧卒中组ARCP≥1.5患者∆AQ2高于ARCP<1.5患者,同侧卒中组ARCP≥1.5患者∆AQ2低于ARCP<1.5患者(P均<0.05)。结论ARCP越高的PSA患者非优势半球代偿作用越大,ARCP对评估优势半球卒中后非优势半球的语言代偿能力具有一定价值。

Objective To explore the value of the asymmetry rate of the cerebral peduncle(ARCP)for assessing the compensatory ability of the non-dominant hemisphere in patients with post-stroke aphasia(PSA).Methods Thirty-three recurrent stroke(RS)participants with PSA completed the retrospective study.They were divided into two groups according to the sides of recurrent stroke compared to the first time stroke(FS):the contralateral group(CG,n=17),and ipsilateral group(IG,n=16).The aphasia quotient(AQ)of post-FS(AQ_(postFS))within one week,one year after FS to pre-RS(AQpreRS),and post-RS(AQ_(postRS))within one week were collected.The change of AQ pre-RS showed as∆AQ1(AQ_(preRS)-AQ_(postFS)),and the change of AQ post-RS showed as∆AQ2(AQ_(preRS)-AQ_(postRS)).The ARCP was calculated based on the lat⁃est magnetic resonance imaging(MRI),which was within one week after RS.∆AQ1,∆AQ2,and the correlation between∆AQ and ARCP of the two groups were analyzed.Results The AQ_(postRS) of the CG was significantly lower than that of the IG(P<0.05),∆AQ2 in CG was higher than that in IG(P<0.05).There was no significant difference in ARCP,AQ_(postFS),AQ_(preRS),or∆AQ1 between the two groups.In CG,ARCP was positively correlated with∆AQ1 and∆AQ2,and negatively correlated with AQ_(postFS)(all P<0.01).AQ_(preRS) was not correlated with ARCP in both groups.In IG,ARCP was positively correlated with∆AQ1 and AQ_(postRS),and negatively correlated with AQ_(postRS)(all P<0.01).Patients in CG with an ARCP≥1.5 had a higher∆AQ2 than patients with ARCP<1.5,and a contrary consequence was observed in IG(P<0.05).Conclusions For patients with PSA,a higher ARCP correlates with a better language compensatory ability of the non-dominant hemisphere.ARCP is valuable in assessing the language compensatory ability of the non-dominant hemisphere after the dominant hemisphere stroke.