| Objective:Stroke,as a major global health problem,was the second leading causes of death and disease burden in China,which seriously threatens human health.In recent years,stroke has become the leading cause of death in China,and countries around the world are all facing a series of serious problems caused by stroke and its complications.Stroke can cause many complications,and dysphagia after stroke is one of the most common complications of stroke.Dysphagia can induce aspiration,aspiration pneumonia,dehydration,and malnutrition,which prolonged hospital stay and increased the risk of death and poor prognosis.Therefore,dysphagia is an important factor affecting the death and poor prognosis of stroke patients.Therefore,patients with dysphagia should be involved in rehabilitation treatment as soon as possible,and the effective treatment of dysphagia after stroke is the focus of current clinical research.In recent years,how to promote the functional recovery of damaged central neural network has become an intensely focused area of dysphagia after stroke.Repetitive transcranial magnetic stimulation(rTMS)is used as a therapeutic tool in neurology.The use ofTMS reveals the cortical regulation to muscle activity,and provides strong evidence for the study of the central nervous system regulation mechanism and the evaluation of the function of central nervous pathway.This study investigated the clinical characteristics of patients with post-stroke dysphagia in Liaoning provincial,collected the current treatment methods for dysphagia treatment and the treatment effect of dysphagia rehabilitation,so that to provide the basis for the current treatment strategy of the rehabilitation department of the hospital for poststroke dysphagia and improve the recovery efficiency of patients.Investigated the advantages of rTMS in the treatment of dysphagia after stroke,and analyzed the factors that influence the prognosis of patients during treatment and at 6 months.On the other hand,explored the relationship between SNP and the difference in efficacy of rTMS in the treatment of dysphagia after stroke.Methods: In the first part of the study,an observational study was used to retrospectively collect the medical records of patients with dysphagia after stroke in order to understand the current status of diagnosis and treatment for patients with dysphagia after stroke in Liaoning provincial.We collected the data of patients from rehabilitation department of Shengjing Affiliated Hospital of China Medical University and rehabilitation department of Dalian Hospital during January 2017 to December 2018.And all clinical information was collected by the patient’s usual clinician.The swallowing function assessment of 517 patients included in the study was collected at admission,1 week and discharge,respectively.Friedman’s test,Cochran’s Q test and Bonferroni test were used to compare group data.The second part was a prospective cohort study that compared patients who received rTMS in combination with traditional swallowing therapy with patients who received traditional swallowing therapy alone.The swallowing function was monitored every once week for three weeks during inpatient treatment and then once every three months for six months after discharge to compare treatment in-hospital and long-term prognosis.Multivariate analysis was performed to explore the factors associated with treatment efficacy and prognosis after discharge.In the third part,131 patients who received rTMS combined with traditional swallowing therapy included in the second part were enrolled.Genomic DNA was extracted from peripheral venous blood and SNP genotyping was performed.Ridit test and ANOVA were used to explore the association between genotypes and effects of rTMS in the treatment of dysphagia after stroke.And to provide a basis for targeted treatment of different patients.Results:1.This study investigated the diagnosis and treatment of 517 patients with dysphagia after stroke in Liaoning province.Progress has been made in the treatment of swallowing disorders and in reducing the number of people with swallowing disorders.With the progress of rehabilitation treatment,the patient’s swallowing assessment improved significantly.The swallowing assessment of patients before treatment,one week after admission,and before discharge were statistically different.Most patients had significant improvement in swallowing function before discharge(P <0.001).2.The treatment efficacy of rTMS combined with traditional swallowing therapy was superior to traditional swallowing therapy alone at different time points in patients with post-stroke dysphagia.It is safe and effective to administer bilateral rTMS in the treatment of dysphagia.Multivariate analysis showed that among stroke patients,female patients and the lesion sites of left cerebral hemisphere,frontal lobe,cerebellum,thalamus or basal ganglia had relatively better recovery of swallowing function,while those with stroke older age and the lesion sites of right cerebral hemisphere or lateral ventricle had worse recovery of swallowing function(p<0.05).3.A variety of swallowing assessment methods indicated that the treatment efficacy of rTMS of swallowing disorders after stroke was different among different genotypes at rs6265 locus(p<0.05).Among them,homozygous TT type had better swallowing function recovery than homozygous CC type and heterozygous CT type.The WST evaluation of rTMS for post-stroke dysphagia found that homozygous AA and homozygous CC had better recovery of swallowing function than heterozygous AC in rs4880214.Conclusion: 1.Rehabilitation therapy has a positive and effective effect on the recovery of deglutition function in stroke patients.2.The efficacy of rTMS combined with traditional swallowing therapy was superior to traditional swallowing therapy alone at different time points in patients with post-stroke dysphagia.3.Polymorphisms of BDNFrs6265 and GRIN1-rs4880214 are associated with the efficacy of rTMS in the treatment of dysphagia after stroke. |
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