MIT治疗维吾尔语Broca失语症的脑功能重塑机制研究

The Uyghurs are the main ethnic minorities in XinJiang, and the incidence of aphasia after stroke among them is high. But at present, the discoveries of effective methods aimed at Uyghur aphasia is absence, so it is very necessary to research target method and to explore its mechanism. Our Previous research findings that right inferior frontal gyrus and right middle frontal gyrus of normal Uyghur people is thicker than normal people of the Han nationality, but the main activated areas are left hemisphere when normal Uyghur people executing language task, however right superior frontal gyrus activated significantly when Uyghur aphasia patients executing this task, and the resting state Reho of right superior frontal gyrus is significantly higher than the Chinese group. So we consider that because the left language area is intact, the right brain activation does not significant, but when the left brain language area damaged, the right brain will be activated. Studies have shown that the melodic intonation therapy (MIT) in the treatment of aphasia main activate the right brain. Uyghur people is known for singing and dancing since childhood, Sensitive to music innate, In clinical,we also found that the expression of melody and rhythm have good effects on improving presentation skills of Uighur Broca aphasia, So we speculates that when adopt the MIT , the right brain compensatory function will be more remarkable activated. Therefore, this research is proposed to use MIT on Uygur patients with Broca aphasia, through language assessment and fMRI detection of different time point, explore the possible brain function reorganization mechanism of the MIT for the treatment of Uighur Broca aphasia.To provide a theoretical basis for the Uighur aphasia treatment scheme optimization and guidance.

维吾尔族作为新疆的主要少数民族，其脑卒中后失语症的发生率高，但目前缺乏针对维语失语症的有效方法，研究针对性治疗方法并探讨其机制确有必要。我们前期研究发现维族正常人右侧额中回和额下回比汉族正常人厚，但执行语言任务时主要激活左脑，而运动性失语患者执行此任务时右侧额上回明显激活，且该部位静息态Reho值也明显高于汉语组。故认为其正常人因左脑语言区完好，右脑激活不明显，可当左脑语言区受损后右脑会被激活。研究表明旋律语调疗法（MIT）治疗失语时主要激活右脑。临床中我们采用MIT治疗维语运动性失语症效果良好。推测维族人自幼能歌善舞，对乐感天生敏感，且右脑皮层厚度显著高于汉族人，采用MIT治疗维语运动性失语时右脑代偿功能会显著激活。针对此问题，本课题组拟采用MIT治疗维语运动性失语症，研究其不同时间节点的语言功能和多模fMRI变化，进而探讨脑功能重组机制。为制定针对性维语失语症治疗方案提供理论依据。

失语症是因脑部器质性病变而导致的获得性语言障碍，柳叶刀杂志曾发表文章称应将寻找失语症最佳康复方案确定为与卒中后生活相关的十大研究重点之一。旋律语调疗法（MIT）就是运用语言中的音乐成分，通过患者未受损的歌唱能力促进言语输岀的一种结构化治疗模式，治疗失语症的机制研究尚在探索。本研究通过对汉语和维吾尔语脑卒中后Broca失语症患者在接受MIT治疗前后的语言功能比较，采集MIT强化康复治疗前后的脑影像数据，通过不同的研究方法深入刻画MIT治疗Broca失语症的临床疗效、脑影像改变，探究MIT治疗的脑功能重塑机制。本项目的相关研究工作发现MIT对Broca失语患者的语言功能有多方面的改善，给予为期2周的MIT治疗即可显效，本研究率先纳入维吾尔语系人群参与MIT的治疗，为制定针对性维语失语症治疗方案提供理论依据。我们的研究还发现Broca失语患者存在不同程度左侧弓状纤维束的损伤，MIT可以增加双侧Broca区及双侧弓状纤维束的完整性，且以右侧弓状纤维区FA值的增加较为显著，患者的言语功能也相应显著提高；初步揭示了MIT的治疗机制之一可能是增加了右侧弓状纤维的密度。此外，本研究还收集了维汉正常人群大脑磁共振数据，进行相关脑区差异分析，发现维汉人群脑灰质体积存在差异。结构决定功能，我们正在探究不同脑区的差异与旋律语调、Broca失语恢复的相关性，以及脑重塑的机制。