卒中后失语患者脑电相位同步性改变对上肢功能的影响

Changes in electroencephalography(EEG)phase synchronization and the effects on upper limb function in post-stroke aphasia patients

目的探索卒中后失语患者脑电相位同步性的改变对上肢功能的影响。方法回顾性连续纳入2020年10月至2023年6月入住同济大学附属养志康复医院神经康复中心的卒中患者33例。收集患者的一般资料,包括性别、年龄、病程(发病至入组时间)、卒中类型(脑出血、脑梗死)及偏瘫上肢功能评分情况;所有患者入院后1周内行波士顿诊断失语检查(BDAE),对于BADE<5级者行失语商(AQ)测试,将AQ<93.8分定义为失语,AQ≥93.8分为非失语;采用偏瘫侧上肢运动功能评估-香港版(FTHUE-HK)分级(将FTHUE-HK1~7级分别赋值为1~7分)评估患者偏瘫侧上肢功能;收集所有患者的脑电图数据并计算语言-运动区(C3F7、C3T5)、运动感觉区(C3P3)及运动区(C3C4)各5个频带(δ、θ、α、β、γ)的脑电相位同步指数(PSI)值,并分别进行组间比较。采用Spearman相关性分析卒中后失语组PSI与FTHUE-HK评分的相关性。结果33例患者中卒中后失语组17例,男11例,女6例,年龄50~75岁,平均(63±12)岁,平均AQ(22.5±18.2)分。卒中后非失语组16例,男12例,女4例,年龄47~74岁,平均(58±11)岁,平均AQ(99.1±0.3)分。(1)两组患者性别、年龄、病程、卒中类型差异均无统计学意义(均P>0.05)。卒中后失语组FTHUE-HK评分低于卒中后非失语组[(1.6±1.1)分比(3.0±1.2)分],组间差异有统计学意义(P=0.003)。(2)卒中后失语组C3F7-PSI在δ及θ频带均高于卒中后非失语组(δ:t=3.869,P=0.001;θ:t=3.409,P=0.002);卒中后失语组C3T5-PSI在θ及δ频带高于卒中后非失语组(θ:t=2.376,P=0.024;δ:t=2.787,P=0.009)。卒中后失语组C3P3-PSI在δ及θ频带均高于卒中后非失语组(δ:t=2.761,P=0.010;θ:t=2.834,P=0.008);卒中后失语组患者的C3C4-PSI在α、θ、δ频带均高于卒中后非失语组,组间差异均有统计学意义(α:t=2.426,P=0.021;θ:t=3.263,P=0.003;δ:t=2.851,P=0.008)。两组患者余语言-运动区、运动感觉区及运动区频带PSI差异均无统计学意义(均P>0.05)。(3)卒中后失语组患者C3F7-PSI在δ及θ频带与FTHUE-HK评分均呈中等负相关(δ:r=-0.540,P=0.041;θ:r=-0.425,P=0.035);卒中后失语组患者左侧运动感觉区C3P3-PSI在γ频带与FTHUE-HK评分呈正相关(r=0.519,P=0.033)。卒中后失语组患者C3C4-PSI在δ频带与FTHUE-HK评分呈负相关(r=-0.510,P=0.036);余语言-运动区、运动感觉区及运动区频带PSI与FTHUE-HK评分无关(均P>0.05)。结论卒中后失语患者较卒中后非失语患者上肢功能障碍更重。卒中后失语患者左侧额顶叶δ和θ频带脑电相位同步性较卒中后非失语患者高,且与上肢功能的FTHUE-HK评分相关。本研究结果有待进一步验证。

Objective To investigate the effect of electroencephalography(EEG)phase synchronization on upper limb function in post-stroke aphasia patients.Methods A total of 33 stroke patients admitted to Neurological Rehabilitation Center,Yangzhi Rehabilitation Hospital affiliated to Tongji University from October 2020 to June 2023 were retrospectively included.The general data of the patients were collected,including gender,age,course of disease(onset to enrollment time),type of stroke(cerebral hemorrhage,cerebral infarction)and function scores of hemiplegic upper limbs.All patients underwent the Boston diagnostic aphasia test(BDAE)within 1 week after admission,and the aphasia quotient(AQ)test was performed for those with BADE<5,and the AQ<93.8 score was defined as aphasia.AQ≥93.8 score was non-aphasia,and the hemiplegic upper limb function was evaluated by using the function test for the hemiplegic upper extremity-Hong Kong Version(FTHUE-HK)classification(FTHUE-HK1-7 grades were assigned as 1-7 points,respectively),and the EEG data of all patients were collected.The EEG phase synchronization index(PSI)of 5 frequency bands(δ,θ,α,β,andγ)in the language-motor regions(C3F7,C3T5),motor-sensory regions(C3P3)and motor regions(C3C4)were calculated and compared between groups.Spearman′s correlation was used to analyze the correlation between PSI and FTHUE-HK scores in post-stroke aphasia group.Results A total of 33 patients were included in this study.There were 17 patients in the post-stroke aphasia group,including 11 males and 6 females,age range 50-75 years,mean ages(63±12)years and an average AQ of(22.5±18.2)score.There were 16 patients in the non-aphasia group after stroke,including 12 males and 4 females,age range 47-74 years,mean age(58±11)years and an average AQ of(99.1±0.3)score.(1)There were no significant differences in gender,age,course of disease,and stroke type between the two groups(all P>0.05).The FTHUE-HK score in the post-stroke aphasia group was lower than that in the non-aphasia group([1.6±1.1]score vs.[3.0±1.2]score),and the difference between two groups was statistically significant(P=0.003).(2)The C3F7-PSI in the post-stroke aphasia group was higher in theδandθfrequency bands than those in the non-aphasia group(δ:t=3.869,P=0.001;θ:t=3.409,P=0.002);the C3T5-PSI in the post-stroke aphasia group was higher than those in theθandδbands(θ:t=2.376,P=0.024;δ:t=2.787,P=0.009).The C3P3-PSI in the post-stroke aphasia group was higher in theδandθbands than those in the non-aphasia group(δ:t=2.761,P=0.010;θ:t=2.834,P=0.008);the C3C4-PSI in the post-stroke aphasia group was significantly higher in theα,θ,andδbands than those in the non-aphasia group,and the differences between two groups were statistically significant(α:t=2.426,P=0.021;θ:t=3.263,P=0.003;δ:t=2.851,P=0.008).(3)The C3F7-PSI was moderately negative correlated with FTHUE-HK scores in theδandθbands of patients in the post-stroke aphasia group(δ:r=-0.540,P=0.041;θ:r=-0.425,P=0.035).The C3P3-PSI in the post-stroke aphasia group was positively correlated with the FTHUE-HK scores in theγband(r=0.519,P=0.033).In the post-stroke aphasia group,C3C4-PSI was negatively correlated with FTHUE-HK scores in theδband(r=-0.510,P=0.036).The FTHUE-HK score was not correlated with the PSI of frequency bands in the remaining language-motor regions,motor-sensory regions and motor regions(all P>0.05).Conclusions Patients with post-stroke aphasia have worse upper limb dysfunction than those without post-stroke aphasia.The EEG phase synchronicity of left frontoparietal lobeδandθof patients with post-stroke aphasia was higher than those of patients without post-stroke aphasia and correlated with the FTHUE-HK score of upper limb function.The results need to be further verified.