DTI量化评估旋律语调疗法治疗Broca失语症后脑细微结构变化的研究

目的通过扩散张量成像(diffusion tensor imaging,DTI)提供语言功能相关的纤维结构信息,探讨旋律语调疗法(melody intonation therapy,MIT)治疗Broca失语症脑纤维结构改变的特征。材料与方法收集新疆医科大学第一附属医院2019年1月至2020年6月卒中后Broca失语症37例患者,随机分为两组,对照组19例,采取常规语言疗法,实验组18例,在常规语言疗法基础上再行旋律语调疗法治疗,两组患者均在治疗前及治疗2月后行DTI扫描,分别测量并比较实验组治疗前后双侧Broca区及弓状纤维束的各向异性分数(fractional anisotropy,FA),以及比较实验组与对照组治疗前后双侧Broca区及弓状纤维束的FA值。结果实验组治疗前后对比显示,双侧Broca区、弓状纤维束FA值差异均有统计学意义(双侧弓状纤维束区及左侧Broca区P<0.001,右侧Broca区P=0.008);治疗前实验组与对照组双侧Broca区及弓状纤维束区FA值无统计学差异(右侧Broca区P=0.154,左侧Broca区P=0.228,右侧弓状纤维束区P=0.361,左侧弓状纤维束区P=0.135),治疗后实验组与对照组右侧弓状纤维束FA值差异有统计学意义(P=0.008),左侧弓状纤维束及双侧Broca区FA值差异无统计学意义(右侧Broca区P=0.138,左侧Broca区P=0.093,左侧弓状纤维束P=0.259)。结论旋律语调疗法对Broca失语患者的强化康复治疗后,右侧弓状纤维束区FA值增加,提示MIT的治疗机制与右侧弓状纤维的结构变化相关。

DTI quantitative evaluation of brain microstructural changes after melodic intonation therapy in the treatment of Broca aphasia

Objective:To explore the characteristics of brain fiber structure changes in Broca aphasia treated with melody intonation therapy(MIT)through information of language related fiber structure provided by diffusion tensor imaging(DTI).Materials and Methods:A total of 37 patients with Broca aphasia after stroke admitted to the First affiliated Hospital of Xinjiang Medical University between January 2019 and June 2020 were enrolled.Divided the patients into two groups:control group(n=19)were treated with routine speech therapy,experimental group(n=18)were treated with MIT and routine speech therapy.Patients in both groups underwent DTI before and 2 months after the therapy.The fractional anisotropy(FA)of bilateral Broca area and arcuate fasciculus were measured before and after the therapy in experimental group.FA of both Broca area and arcuate fasciculus before and after treatment were compared between the experimental group and the control group.Results:Comparison of experimental group before and after therapy showed:FA of both Broca and arcuate fasciculus were statistically significant(Bilateral arcuate fasciculus and left Broca area P<0.001,Right Broca area P=0.008).There was no significant difference in FA of bilateral Broca area and arcuate fasciculus between the experimental group and the control group before therapy(right Broca P=0.154,left Broca P=0.228,right arcuate fasciculus P=0.361,left arcuate fasciculus P=0.135).Two months after thrapy,between the experimental group and the control group,FA of right arcuate fasciculus were statistically significant(P=0.008).There was no significant difference in FA between left arcuate fasciculus and bilateral Broca(right Broca P=0.138,left Broca P=0.093,left arcuate fasciculus P=0.259).Conclusions:After MIT intensive rehabilitation therapy for patients with Broca aphasia,the FA of the right arcuate fasciculus increased,suggesting that the therapeutic mechanism of MIT is related to the structural changes of the right arcuate fasciculus.