中老年患者脑卒中后失语症与优势侧上纵束损伤的相关性研究

Relationship between post-stroke aphasia and injury of the dominant superior longitudinal fasciculus in middleaged and elderly patients

目的利用DTI纤维追踪技术,对中老年脑卒中后失语症患者的优势侧上纵束进行初步研究,旨在探索上纵束损伤与失语症发生的关系。方法选取2018年1月—2019年12月在复旦大学附属华山医院康复科住院的中老年脑卒中后失语症患者18例为失语症组,另选年龄、性别、学历与失语症组匹配的体检健康受试者18例为对照组。对2组进行DTI检查。采用DiffusionToolkit进行全脑纤维追踪,用MricronTrackvis软件手绘感兴趣区,用TrackVis进行基于感兴趣区的SLF-Ⅰ、SLF-Ⅱ和SLF-Ⅲ纤维确定性追踪,得到FA值、纤维数量和纤维长度指标。结果与对照组比较,失语症组的优势侧SLF-Ⅱ和SLF-Ⅲ的FA值、纤维数量、纤维长度明显减少(P<0.05),而2组优势侧SLF-Ⅰ的FA值、纤维数量和纤维长度差异均无统计学意义(P> 0.05)。失语症低分亚组与失语症高分亚组的优势侧SLF-Ⅰ、SLF-Ⅱ和SLF-Ⅲ的FA值、纤维数量、纤维长度差异均无统计学意义(P> 0.05)。结论优势侧SLF-Ⅱ和SLF-Ⅲ损伤可能是中老年患者脑卒中后发生失语症的主要机制之一。

Objective To use diffusion tensor imaging(DTI)to study the relationship between the injury of the dominant superior longitudinal fasciculus and post-stroke aphasia in middle-aged and elderly patients. Methods Eighteen middle-aged and elderly patients with post-stroke aphasia who were hospitalized in Department of Rehabilitation Medicine of Huashan Hospital Affiliated to Fudan University from January2018 to December2019 were selected as the aphasia group.Another18 healthy subjects matched with aphasia group in age,gender and educational background were selected as the control group. DTI examination was performed in both groups. The Diffusion Toolkit was used for whole brain fiber tracking,and the region of interest was hand drawn with mricrontrackvis software. The fibers of SLF-Ⅰ,SLF-Ⅱand SLF-Ⅲbased on the region of interest was tracked with TrackVis,and the FA value,fiber number and fiber length were obtained. Results Compared with the control group,the FA value,fiber number and fiber length of SLF-Ⅱand SLF-Ⅲin the dominant side of the aphasia group were significantly reduced(P< 0.05),but there were no significant differences in the FA value,fiber number and fiber length of SLF-Ⅰin the dominant side between the two groups(P> 0.05). There were no significant differences in the FA value,fiber number and fiber length of SLF-Ⅰ,SLF-Ⅱand SLF-Ⅲin the dominant side between the aphasia low score subgroup and aphasia high score subgroup(P> 0.05). Conclusion The injury of SLF-Ⅱand SLF-Ⅲin the dominant side may be one of the main mechanisms of aphasia after stroke in middle-aged and elderly patients.