针刺、语言任务干预卒中后运动性失语的fMRI/ERP双模态脑网络效应机制研究

The patients of motor aphasia after stroke with the injury of frontal lobe involved were taken as the subjects. They were randomized into an acupuncture group, a language task group, an acupuncture + language task group and a blank group. The effective comprehensive therapeutic program of acupuncture and language rehabilitation at the early stage was applied clinically as the intervention approach. Under the guide of kidney-brain coordination and the body-mind unity in the theory of traditional Chinese medicine, the intervention was given for 60 days with the basic comprhensive therapeutic program of acupuncture + comprehensive languages training + basic medical treatment. On the date of group enrolment and in 60 days of intervention, linguistic scale assessment, fMRI/ERP assessment and experiment were adopted separately. Bringing the roles of multi-interdisciplinary into play, such as traditional Chinese medicine, linguistics and neuroelectrophysiology, using linguistic scale, fMRI and ERP as the approach to assessment and in reference to fMRI, brain structure and function network analystic technology of neuroelectrophysiology and the fusion technology of event related potential (ERP) and fMRI, the brain structure and function network were observed transversely after the treatment with acupuncture, language task and acupuncture + langugage task separately. The dynamic changes in language function and brain network were observed longitudinally before and after the comprehensive treatment with acupuncture and language training. Finally, the law and pattern of brain network changes in the language function recovery was explored for the patients of motor aphasia after stroke with the injury of frontal lobe involved so as to provide the evidence on the efficacy of the comprehensive therapy of acupuncture and language training.

以额叶损伤为主的脑卒中后运动性失语患者为研究对象，将病例随机纳入针刺组、语言任务组、针刺+语言任务组及空白组，以前期临床有效的针刺加语言康复综合治疗方案为干预手段，在肾-脑相关、形神合一的中医理论指导下，对入组患者给予针刺+语言康复训练+内科基础综合治疗方案干预60天，并在入组当天、干预后60天进行语言学量表测评、fMRI /ERP测评及实验，发挥神经语言学、神经影像学、神经电生理学的多学科交叉，以语言学量表、fMRI、ERP为评价手段，借鉴功能磁共振影像、神经电生理的脑结构与功能网络分析技术、事件相关电位(ERP)与功能磁共振影像（fMRI）融合技术，横向观察针刺、语言任务、针刺+语言任务分别激活的脑结构与功能网络；纵向观察针刺加语言康复训练综合治疗前后的语言功能和脑网络动态变化，探索额叶损伤后运动性失语患者语言功能恢复的脑网络变化规律与模式，为针刺加语言康复训练综合治疗提供疗效证据。

目前卒中后失语的中西医治疗方法较多，但存在疗程长、显效慢、针对性不强、评价不系统等问题。诊疗技术规范化程度不高、发病及恢复机制不明确等现状，都制约着该病的疗效提升。为解决以上现实问题，项目主持者率领的研究团队，基于中医“形神合一”理论新内涵，开展了ERP/fMRI多模态评价针刺治疗失语的疗效机制探索研究。.本项目针对48例卒中后失语患者开展了动态、多时点平行对照研究，借鉴先进的脑形态与功能网络构建技术，探索卒中后失语的发病机制，揭示针刺、语言康复训练治疗卒中后运动性失语的恢复机制，形成基于脑功能网络的神经语言、神经影像、神经电生理学多视角疗效评价模式，构建 “形神合一”针刺治疗卒中后失语的评价体系。.本课题以北京中医药大学东直门医院为研究中心，根据纳入排除标准，共完成48例卒中后失语患者病例采集，因实验完成度差、伪迹噪声大等因素剔除3名被试，有效病例45例，其中：采集了核磁数据45例、脑电数据20例，并进行了神经学、心理学、语言学等多维行为学评价，对“形神合一”治疗方案进行疗效机制研究。研究结果显示，与健康被试相比，卒中后失语症患者主要表现为dual stream网络内的连接增强；进行针刺治疗前后对比显示，患者语言功能改善，dual stream网络内连接减弱，推测dual stream网络连接增强为卒中后失语症的病理表现之一，而这种病理表现的正常化（连接减弱）可能与卒中后失语症患者语言功能恢复有关，针刺治疗疗效机制可能是通过调节dual stream网络来实现的。同时研究结果还发现脑电α、δ等关键频段的优势半球脑网络节点连接及非优势半球脑网络代偿性调节功能对卒中后失语患者语言功能的恢复起关键作用；进一步提示语言康复训练治疗应重视强化对非优势半球功能的训练。此外，dual stream内连接模式及左右半球功能联系的改变参与了失语症语言功能修复，该结果也为未来探索卒中后失语恢复脑机制的工作拓展了新思路。