| Background:stroke is the leading cause of death and disability among adults in China,with the characteristics of high incidence,high disability rate,high mortality rate and high recurrence rate.Post stroke aphasia(PSA)is a common sequela of stroke.About 30-40%of stroke patients are accompanied by aphasia.PSA patients lose their social functions and inefficient rehabilitation,which brings a heavy burden to the society and families.Acupuncture and language rehabilitation training can effectively improve the language function of patients with PSA.Our team has confirmed that the acupuncture scheme of "Yi sui Xing sheng" is effective,but its mechanism is still unclear.Language is a unique cognitive function of human beings,so it is difficult to carry out simulation experimental research on animals.For a long time,due to the lack of objective and visible experimental means,its injury and recovery mechanism has always been a difficult problem in the field of neuro-language rehabilitation.Multimodal brain imaging technology effectively makes up for the disadvantage that the cognitive behavior scale is unable to make brain function objective and visible,which ushered in an opportunity for the study of aphasia.The process of language occurrence has high temporal and spatial dynamic properties,so this study combines EEG and MRI detection techniques with high temporal and spatial resolution to objectively record the structural and functional characteristics of the brain in the process of language injury and recovery.To explore the mechanism of PSA brain injury horizontally,and longitudinally verify the therapeutic mechanism of " Yi sui Xing sheng" acupuncture on PSA.Methods:this study is mainly divided into two parts.The first part is the study on the mechanism of cross-sectional PSA injury.the first unit included 33 patients with PSA and matched 30 healthy subjects.Combined with the language behavior scale evaluation and multimodal neural structure/functional image data of the Chinese Standard Aphasia Checklist(CRRCAE),the high-order network analysis based on topological profile(tHON),as well as Graph theory analysis of complex high-order network and EEG power spectrum network analysis technology,to study the functional impairment of language processing and the characteristics of brain network changes in patients with PSA.in order to explore the mechanism of PSA brain network damage.In the second unit,42 PSA patients with only left stroke lesions were selected and matched with 30 healthy controls.Voxel-based symptom mapping analysis(VLSM)was used to correlate the distribution of lesions and the characteristics of language function impairment.The structural covariant was used to analyze the correlation between right cerebral gray matter changes and lesions by measuring the volume and structural covariation of right cerebral hemisphere.in addition,a spatial statistical method based on fiber bundle tracer(TBSS)and deterministic fiber tracing method were used to observe the characteristics of white matter fiber structure in order to explore the mechanism of stress injury in the right brain of PSA.The second part was a prospective self-control study.23 patients with PSA were treated with "Yi sui Xing sheng" acupuncture therapy for 60 days.CRRCAE,boston aphasia rating scale(BDAE),activity of daily living scale(ADL)and national Institutes of health stroke scale(NIHSS)were used on the same day and 60 days after intervention.NIHSS),atroke aphasia depression scale(SADQ),quality of life Index(QLI)and other scales to comprehensively evaluate the overall neurological function recovery of patients with aphasia after stroke treated with Acupuncture.At the same time,T1,DTI and fMRI scans were performed,and dynamic functional(DFC)method was used to construct brain functional network.Combined with whole brain gray matter volume calculation and white matter deterministic fiber tracking,the changes of brain function and structure of PSA before and after treatment were evaluated.Among them,10 patients underwent EEG examination at the same time,and the "word-graph" matching language task was introduced to complete the event-related potential(ERP)task experiment.EEG time domain and time frequency analysis were used to detect the changes of neuronal electrical activity under semantic judgment task before and after treatment,in order to explore the therapeutic mechanism of "Yi sui Xing sheng" acupuncture scheme.Results:in the first part,the main results of the study on the mechanism of network injury in unit 1 showed that:(1)the intensity of functional connection between left and right hemispheres in PSA group was significantly weaker than that in HC group,while that in right frontal and temporal regions was significantly stronger than that in HC group,and there was a significant positive linear correlation between the difference of functional connection and the score of CRRCAE.(2)tHON functional network showed that the functional connection between the left and right hemispheres of PSA was significantly decreased,while the internal functional network connection of the right hemisphere was enhanced.(3)compared with healthy subjects,the indexes of tHON functional complex network in PSA patients showed a significant decrease in global efficiency,local efficiency and small world attributes(Sigma and Gamma),while the shortest path length increased significantly.(4)compared with PSA,the internal connection of bilateral language related network decreased,and the connection between bilateral language related network and high-order structure of subcortical structure was enhanced.(5)the(Sigma)of PSA was significantly increased,while the global efficiency of network was significantly decreased.(6)the connection between coh and plv network in theta band was significantly decreased in PSA patients,while the connection between plv and wpli network in delta band was significantly enhanced in PSA patients.(7)the results of tHON network index show that the network compatibility,shortest path length and small-world attribute(lambda)of PSA in Theta band COH and PLV are significantly decreased,while the global network efficiency and Sigma value are significantly increased.In the Delta band,the network compatibility,the shortest path length and the small-world attribute(lambda)decreased significantly,while the network global efficiency and Sigma value increased significantly.The network compatibility and small-world attribute(lambda)of PLV network decreased significantly,while Sigma value increased significantly.In the first part,the main results of the study on the mechanism of structural damage in unit 2 showed that:(1)VLSM suggested that the decrease of PSA expression score was related to the lesion areas of precentral gyrus,dorsolateral superior frontal gyrus,middle frontal gyrus and postcentral gyrus.The scores of language comprehension scale were related to the lesion areas of precentral gyrus,dorsolateral superior frontal gyrus,middle frontal gyrus,insular,postcentral gyrus and inferior parietal angular gyrus.(2)with the decrease of PSA language performance,the volume of right gray matter decreased significantly compared with HC in the right central sulcus tectum and temporal lobe(middle temporal gyrus,temporal pole:middle temporal gyrus,inferior temporal gyrus),and had a structural covariant relationship with the main responsible lesions on the left(precentral gyrus,dorsolateral superior frontal gyrus,middle frontal gyrus,insular,postcentral gyrus and inferior parietal angular gyrus).(3)the results of TBSS showed that the FA of right white matter of PSA patients with left injury was significantly lower than that of healthy controls,while MD,AD and RD were significantly higher than those of healthy controls.(4)the deterministic tracing of white matter fibers through the reduced gray matter volume area on the right side showed that with the decrease of PSA language function,the white matter fibers in the region of interest(ROI)were significantly higher in MD and RD than those in HC group.The second part is the study on the therapeutic mechanism of "Yi sui Xing sheng"acupuncture scheme.the main results are as follows:(1)after 60 days of acupuncture treatment,the scores of language scale at the level of understanding and expression are significantly higher than those before treatment.At the same time,the scores of BDAE,ADL and QLI were significantly higher than those before treatment,while the scores of NIHSS and SADQ-H depression scale were significantly lower than those before treatment.(2)the shortest path length of the whole brain network of PSA patients decreased significantly after treatment,and there was a positive correlation between the difference of shortest path length and the score of word command and sentence copying function.(3)the intensity of dynamic functional connection decreased significantly and the variability of dynamic functional connection increased significantly in patients with PSA aphasia after treatment,(4)the homogeneity of dynamic network global network index and the variability of small-world attribute sigma index were significantly improved after treatment with Acupuncture,accompanied by a significant decrease in the stability of small-world attribute sigma index.(5)after the treatment of Acupuncture scheme,the volumes of left hippocampal gyrus,caudate nucleus,lentiform putamen,globus pallidus and thalamus gray matter of PSA patients decreased significantly compared with those before treatment,(6)the white matter fiber indexes across the reduced area of gray matter increased significantly after 60 days of treatment with " Yi sui Xing sheng"acupuncture regimen.(7)under the condition of "word-graph" matching language task,under the condition of "word-graph" mismatch task representing language ambiguity,PSA patients showed a decrease of N400 amplitude in the left parietal-occipital region compared with healthy controls.After treatment with "Yi sui Xing sheng" acupuncture Kang,the amplitude of N400 in patients with PSA was higher than that before treatment,and the latency was significantly shortened.(8)after treatment,the changes of N400 time window topology images tended to be normalized.(9)after treatment,the frequency amplitude decreased in the middle and low frequency(?,?)band,which was higher than that before treatment,and tended to be normalized in the(?,?)middle and high frequency band.Conclusion:(1)the damage mechanism of PSA at the brain network level is mainly as follows:the decrease of bilateral hemispheric network connection,the enhancement of the synchronization of the right language-related network,and the decrease of the small-world attribute of the whole brain functional network.(2)language expression and comprehension dysfunction in Chinese native speakers was associated with left sensorimotor cortex damage,and(3)with left hemispheric stroke injury,the right brain structure of PSA showed structural changes such as decreased volume of gray matter and decreased integrity of white matter.(4)the main therapeutic mechanisms of Acupuncture in the treatment of PSA are as follows:to promote the reorganization of the frontal-temporal-parietal functional network,to stimulate the functional recovery of the nodes related to the subcortical language pathway,and to inhibit the abnormal functional activity of the right brain so as to relieve the inhibition of compensatory language function in the left residual tissue. |
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