正常成人与伴吞咽障碍的急性脑梗死患者吞咽相关脑功能区激活机制的血氧水平依赖功能磁共振研究

On the activation mechanism of swallowing-related brain functional areas via blood oxygenation level dependent-functional magnetic resonance imaging between normal adults and acute cerebral infarction patients with dysphagia

摘要:

目的 运用血氧水平依赖功能磁共振（blood oxygenation level dependent-functional magnetic resonance imaging，BOLD-fMRI）技术对伴吞咽功能障碍的急性脑梗死患者和正常成人在吞咽活动时相应的脑功能区域激活特点进行研究，探索急性脑梗死患者吞咽功能障碍恢复过程中相关的脑功能区域调控方式。方法 选取2018年7月至2021年7月在昆明医科大学附属延安医院住院的伴吞咽障碍的急性脑梗死患者150例和正常成人100例，对其进行BOLD-fMRI扫描，记录两者在吞咽活动时相关脑功能区域的激活体积和强度，并对比两者间的差异。结果 共收集病例组150例，其中右侧脑梗死组患者50例，男29例，女21例，平均年龄（56.22±7.33）岁；左侧脑梗死组患者100例，男61例，女39例，平均年龄（58.07±6.84）岁；对照组100例，男57例，女43例，平均年龄（53.56±11.41）岁。对照组吞咽活动时激活的相关脑功能区域特点显示：两侧初级运动皮层中枢（BA4区）、运动前区/辅助运动区（BA6/8区）、缘上回（BA40区）、岛叶（BA13区）、颞上回（BA22区）、扣带回皮层（BA24区）、额叶内侧面（BA32区）、延髓、脑桥、基底核团、丘脑、小脑及左侧颞极（BA38区）和右侧颞横回（BA41区）等脑功能区激活体积和强度增加，左侧BA4区、BA40区、小脑激活体积较右侧大，差异有统计学意义（P<0.05）；左右两侧脑区的激活强度差异无统计学意义（P>0.05）。右侧脑梗死病例组患者BOLD-fMRI扫描各脑区激活体积显示：右侧BA4区、BA6/8区激活体积较对照组减小，左侧BA6/8区、BA4区激活体积较对照组增大，双侧后扣带回皮层的BA23和顶叶内侧面BA31区体积较对照组增大，左侧视觉中枢的BA18/19和BA41区皮层激活体积较对照组增大，差异有统计学意义。右侧BA4区、BA6/8区、BA40区、BA13区激活强度较对照组降低，差异有统计学意义。左侧脑梗死病例组患者BOLD-fMRI扫描各脑区激活体积显示：左侧BA4区、BA6/8区的激活体积较对照组减小，右侧BA4区、BA6/8区激活体积较对照组增大，双侧BA23/31区、左侧BA41区、双侧BA7区、双侧BA18/19区和双侧小脑激活体积较对照组增大，差异有统计学意义。左侧BA4区、BA6/8区、BA40区、BA13区激活强度较对照组降低，差异有统计学意义。结论 双侧运动、运动前、感觉、嗅觉、听觉、脑干、小脑、基底核团等脑功能区均参与调控正常人的吞咽活动，且调控具有一定的偏侧性。同侧的运动功能区、运动功能前区激活体积降低，对侧运动功能区、运动功能前区激活体积增加是伴吞咽障碍的急性脑梗死患者吞咽相关脑功能区的主要代偿特点。

Abstract:

Objective To study the activation characteristics of swallowing-related brain functional areas of acute cerebral infarction（ACI）patients with dysphagia and normal adults using blood oxygenation level dependent-functional magnetic resonance imaging（BOLD-fMRI），and to explore the regulation way of relevant brain functional areas during dysphagia recovery of ACI patients.Methods One hundred and fifty ACI patients with dysphagia，who were hospitalized in Yan’an Hospital Affiliated to Kunming Medical University from July 2018 to July 2021，and 100 normal adults were selected in the study and received BOLD-fMRI. The activation volume and intensity of relevant brain functional areas during swallowing activities were recorded and the differences between them were compared.Results Among the 150 ACI patients with dysphagia collected during the study，50 cases［29 males and 21 females，averaged at （56.22±7.33） years］ old）were classified into the right ACI group，and 100 cases［61 males and 39 females，averaged at （58.07±6.84） years old］ were classified into the left ACI group. There were 100 normal adults［57 males and 43 females，averaged at （53.56±11.41） years old］ in the control group. Characteristics of relevant brain functional areas activated during swallowing activities in the control group showed that increased activation volume and intensity were observed for brain functional areas including bilateral primary motor cortex center（BA4），premotor area/supplementary motor area（BA6/8），supramarginal gyrus（BA40），insular lobe insular（BA13），superior temporal gyrus（BA22），cingulate cortex（BA24），frontal medial surface（BA32），medulla oblongata，pons，basal ganglia，thalamus and cerebellum as well as left temporal pole（BA38） and right Heschl’s gyrus（BA41），etc.，and the activation volumes of BA4，BA40 and cerebellum were significantly larger in the left than in the right（P<0.05）； there was no significant difference in activation intensity between the left and right brain areas（P>0.05）. The activation volume of each brain area of the right ACI group suggested by BOLD-fMRI showed that the activation volumes of the right BA4 and BA6/8 were smaller than those of the control group，the activation volumes of the left BA6/8 and BA4 were larger than those of the control group，and the activation volumes of the bilateral posterior cingulate cortex（BA23），the parietal medial surface（BA31） were larger than those of the control group，and in the BA18/19 of the left visual center and BA41 of the primary auditory center，the cortical activation volumes were larger than those of the control group，with statistically significant differences. The activation intensities of the right BA4，BA6/8，BA40 and BA13 were significantly lower than those of the control group. The activation volume of each brain area of the left ACI group suggested by BOLD-fMRI showed that the activation volumes of the left BA4 and BA6/8 were smaller than those of the control group，the activation volumes of the right BA4 and BA6/8 were larger than those of the control group，and the activation volumes of bilateral BA23/31，left BA41，bilateral BA7，bilateral BA18/19 and bilateral cerebellums increased compared with the control group，with statistically significant differences. The activation intensities of the left BA4，BA6/8，BA40 and BA13 were significantly lower than those of the control group.Conclusion Brain functional areas involved in regulating swallowing activities of normal people include bilateral motor，pre-motor，sensory，olfactory，auditory，brain stem，cerebellum，and basal ganglia，etc.，and the regulation is hemilateral to some extent. Decreased activation volume of the ipsilateral motor area and premotor area and increased activation volume of the contralateral motor area and premotor area are the main compensatory features of swallowing-related brain functional areas in ACI patients with dysphagia.