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

邬刚; 郭艳吉; 崔树兰; 涂坤; 马鹏程; 李妍平; 吴海燕

doi:DOI：10.13406/j.cnki.cyxb.003057

您当前的位置：

首页 >

文章列表页 >

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

脑血管疾病研究 | 更新时间：2025-10-21

- 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
- 重庆医科大学学报 2022年47卷第7期页码：802-810
- 作者机构：
  
  1.昆明医科大学附属延安医院，神经内科，昆明 650051
  2.昆明医科大学附属延安医院，影像科，昆明 650051
  1.云南省第一人民医院心内科，昆明 650051
- 作者简介：
  
  邬　刚，Email：277690728@qq.com，研究方向：脑血管疾病、帕金森病、脱髓鞘疾病等。
  马鹏程，Email：51769229@qq.com。
- 基金信息：
  
  云南省高层次卫生健康技术人才医学学科后备人才计划资助项目(H-2018060);云南省科技厅-昆明医科大学联合专项资助项目（编号：2019FE001（-292）、202101AY070001-210）;昆明市卫生科技人才培养项目暨“十百千”工程培养计划资助项目[编号：2020-SW（后备）-10];昆明市卫生健康委员会卫生科研课题资助项目(2021-03-07-003)
- DOI：DOI：10.13406/j.cnki.cyxb.003057
  中图分类号： R741
- 收稿：2022-03-13，
  
  纸质出版：2022-07-28
- 稿件说明：
移动端阅览
邬刚,郭艳吉,崔树兰,等.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[J].重庆医科大学学报,2022,47(7):802-810.

Wu Gang,Guo Yanji,Cui Shulan,et al.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[J].Journal of Chongqing Medical University,2022,47(7):802-810.
邬刚,郭艳吉,崔树兰,等.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[J].重庆医科大学学报,2022,47(7):802-810. DOI： DOI：10.13406/j.cnki.cyxb.003057.

Wu Gang,Guo Yanji,Cui Shulan,et al.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[J].Journal of Chongqing Medical University,2022,47(7):802-810. DOI： DOI：10.13406/j.cnki.cyxb.003057.

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（

0.05）；左右两侧脑区的激活强度差异无统计学意义（

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（

0.05）； there was no significant difference in activation intensity between the left and right brain areas（

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.

关键词

Keywords

references

Abiko K ， Shiga T ， Katoh C ， et al . Relationship between intelligence quotient（IQ）and cerebral metabolic rate of oxygen in patients with neurobehavioural disability after traumatic brain injury [J ] . Brain Inj ， 2018 ， 32 （ 11 ）： 1367 - 1372 .

Barer DH . The natural history and functional consequences of dysphagia after hemispheric stroke [J ] . J Neurol Neurosurg Psychiatry ， 1989 ， 52 （ 2 ）： 236 - 241 .

Wang ML ， Ma H ， Wang XD ， et al . Integration of BOLD-fMRI and DTI into radiation treatment planning for high-grade gliomas located near the primary motor cortexes and corticospinal tracts [J ] . Radiat Oncol ， 2015 ， 10 ： 64 .

Lu Z ， Huang YF ， Lu QL ， et al . Abnormal intra-network architecture in extra-striate cortices in amblyopia：a resting state fMRI study [J ] . Eye Vis（Lond）， 2019 ， 6 ： 20 .

Glover GH . Overview of functional magnetic resonance imaging [J ] . Neurosurg Clin N Am ， 2011 ， 22 （ 2 ）： 133 - 139 ， vii .

中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，彭斌，等 . 中国急性缺血性脑卒中诊治指南2018 [J ] . 中华神经科杂志， 2018 ， 51 （ 9 ）： 666 - 682 .

Society of Neurology ， Chinese Medical Association ， Cerebrovascular disease group , neurology branch ， Chinese Medical Association ， Peng B ， et al . Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018 [J ] . Chin J Neurol ， 2018 ， 51 （ 9 ）： 666 - 682 .

Peck KK ， Branski RC ， Lazarus C ， et al . Cortical activation during swallowing rehabilitation maneuvers：a functional MRI study of healthy controls [J ] . Laryngoscope ， 2010 ， 120 （ 11 ）： 2153 - 2159 .

Malandraki GA ， Johnson S ， Robbins J . Functional MRI of swallowing：from neurophysiology to neuroplasticity [J ] . Head Neck ， 2011 ， 33 Suppl 1 ： S14 - S20 .

Niu C ， Liu X ， Yang Y ， et al . Assessing region of interest schemes for the corticospinal tract in patients with brain tumors [J ] . Medicine ， 2016 ， 95 （ 12 ）： e3189 .

Malandraki GA ， Perlman AL ， Karampinos DC ， et al . Reduced somatosensory activations in swallowing with age [J ] . Hum Brain Mapp ， 2011 ， 32 （ 5 ）： 730 - 743 .

Barhoum S ， Rodgers ZB ， Langham M ， et al . Comparison of MRI methods for measuring whole-brain venous oxygen saturation [J ] . Magn Reson Med ， 2015 ， 73 （ 6 ）： 2122 - 2128 .

Ogura E ， Matsuyama M ， Goto TK ， et al . Brain activation during oral exercises used for dysphagia rehabilitation in healthy human subjects：a functional magnetic resonance imaging study [J ] . Dysphagia ， 2012 ， 27 （ 3 ）： 353 - 360 .

Babaei A ， Ward BD ， Siwiec RM ， et al . Functional connectivity of the cortical swallowing network in humans [J ] . Neuroimage ， 2013 ， 76 ： 33 - 44 .

Jayasekeran V ， Rothwell J ， Hamdy S . Non-invasive magnetic stimulation of the human cerebellum facilitates cortico-bulbar projections in the swallowing motor system [J ] . Neurogastroenterol Motil ， 2011 ， 23 （ 9 ）： 831 - 841 .

Smith EE ， Biessels GJ ， de Guio F ， et al . Harmonizing brain magnetic resonance imaging methods for vascular contributions to neurodegeneration [J ] . Alzheimers Dement（Amst）， 2019 ， 11 ： 191 - 204 .

Cha J ， Hwang JM ， Jo HJ ， et al . Assessment of functional characteristics of amnestic mild cognitive impairment and Alzheimer's disease using various methods of resting-state fMRI analysis [J ] . Biomed Res Int ， 2015 ， 2015 ： 907464 .

Wang L ， Li K ， Zhang QG ， et al . Interhemispheric functional connectivity and its relationships with clinical characteristics in major depressive disorder：a resting state fMRI study [J ] . PLoS One ， 2013 ， 8 （ 3 ）： e60191 .

Lajoie I ， Nugent S ， Debacker C ， et al . Application of calibrated fMRI in Alzheimer's disease [J ] . Neuroimage Clin ， 2017 ， 15 ： 348 - 358 .

Mihai PG ， Otto M ， Domin M ， et al . Brain imaging correlates of recovered swallowing after dysphagic stroke：a fMRI and DWI study [J ] . Neuroimage Clin ， 2016 ， 12 ： 1013 - 1021 .

Rehme AK ， Eickhoff SB ， Rottschy C ， et al . Activation likelihood estimation Meta-analysis of motor-related neural activity after stroke [J ] . NeuroImage ， 2012 ， 59 （ 3 ）： 2771 - 2782 .

龙耀斌，黎伟雄，黄雅琳，等 . 脑梗死后吞咽障碍患者脑功能成像与吞咽功能相关性研究 [J ] . 中国全科医学， 2019 ， 22 （ 6 ）： 726 - 730 .

Long YB ， Li WX ， Huang YL ， et al . Relationship between functional magnetic resonance imaging and swallowing function in patients with dysphagia after cerebral infarction [J ] . Chin Gen Pract ， 2019 ， 22 （ 6 ）： 726 - 730 .

Liu L ， Xiao Y ， Zhang WJ ， et a1 . Funcional changes of neural eircuis in strokepaients with dysphagia: a Meta-analysis [J ] . J Evid Based Med ， 2017 ， 10 （ 3 ）: 189 - 195 .

Puig J ， Blasco G ， Alberich-Bayarri A ， et al . Resting-state functional connectivity magnetic resonance imaging and outcome after acute stroke [J ] . Stroke ， 2018 ， 49 （ 10 ）： 2353 - 2360 .

Toogood JA ， Smith RC ， Stevens TK ， et al . Swallowing preparation and execution：insights from a delayed-response functional magnetic resonance imaging（fMRI）study [J ] . Dysphagia ， 2017 ， 32 （ 4 ）： 526 - 541 .

Grefkes C ， Fink GR . Connectivity-based approaches in stroke and recovery of function [J ] . Lancet Neurol ， 2014 ， 13 （ 2 ）： 206 - 216 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

血清固醇调节元件结合蛋白2与急性脑梗死相关性研究

从血清降钙素原及同型半胱氨酸水平研究补阳还五汤治疗急性脑梗死的作用机制

致残性小卒中静脉溶栓后使用替罗非班抗血小板治疗的安全性和有效性

C-反应蛋白对初发急性脑梗死患者神经功能康复预测的相关性研究

盐酸法舒地尔治疗急性脑梗死50例临床观察