脑卒中后汉语语法缺失与脑损害区域的关系

背景约1/3的脑损害患者存在不同程度的语言功能受损或丧失,其中大部分存在不同程度的语法缺失.目前,关于汉语语法加工究竟由左半球或右半球还是两半球共同参与完成的尚不清楚.目的探讨脑卒中后汉语语法缺失与脑损害区域的关系,为脑卒中后汉语语法缺失患者的语言康复提供理论依据.设计病例-对照分析.对象收集2001-10/2002-08武汉大学附属人民医院住院的脑卒中患者60例,所有患者均首次发病,经颅脑CT检查证实为左或右半球单发病灶.根据病灶所在侧分为左半球脑卒中组和右半球脑卒中组各30例.正常对照组为30名既往无脑器质性疾病史和神经系统症状、体征的健康志愿者.方法先用标准汉语失语检查法检查语言,初步确定有无语法障碍;然后应用汉语语法量表(包括词类、语序、语用、句子-图画匹配、语言符号操作等)对3组被试者进行测试,利用统计学结果分析汉语语法缺失与CT所示脑损害区域的关系及意义.应用计算机图像处理技术对20例汉语语法缺失患者的颅脑CT图像进行标准化处理,观察病变的集中趋势.主要观察指标①汉语语法量表评估结果.②CT图像标准化处理结果.结果按意向处理分析,90名被试者全部进入结果分析.①汉语语法量表评估结果左半球脑卒中组患者的词类、语序、语用、句图匹配和语言符号操作评分显著低于右半球卒中组和正常对照组(P＜0.01),右半球脑卒中组仅句-图匹配项低于正常对照组(79.73±13.67,1.76±7.78,P＜0.01),其他项目差异无显著性意义(P＞0.05).②CT图像标准化处理后,病变部位主要集中在左额叶和左颞叶.结论左额-颞叶神经网络系统损伤与汉语语法缺失密切相关,右额-颞叶神经网络系统参与句法辅助加工,完整的汉语语法认知需要大脑两半球的协同活动.

Relationship between Chinese agrammatism and cerebral lesion sites in stroke patients

BACKGROUND: Approximately one third of the patients with cerebral lesions have various language dysfunction or even total loss of language capacity, with most of them suffering agrammatism of various degrees. At present, whether Chinese grammar processing involves the left or right hemisphere or both is still unclear.OBJECTIVE: To investigate the relationship between Chinese agrammatism and the location of the cerebral lesions for the benefit of language rehabilitation for patients with post-stroke Chinese agrammatism.DESIGN: Case-control analysis.PARTICIPANTS: Sixty stroke patients admitted in the Renmin Hospital affiliated to Wuhan University between October 2001 and August 2002were enrolled in this study. All patients suffered stoke for the first time,which was confirmed by the presence of single lesions in the left or right hemisphere by head CT examination. According to the location of the lesions, the patients were divided into left hemispheric stroke group and right hemispheric stroke group with 30 patients in each group. Meanwhile 30 healthy volunteers without previous brain organic diseases or abnormal nervous system manifestations were recruited as normal controls.METHODS: Standard Chinese aphasia examination was performed to assess the language function for primarily diagnosis of agrammatism, and Chinese agrammatism battery (including tasks of recognizing word category,word order, pragmatics, sentence-chart matching, linguistic symbol operation etc) was applied for investigating the relationship between Chinese agrammatism and CT findings with statistical analysis. Computer-aided image processing was used to standardize the head CT images of 20 patients with Chinese agrammatism to identify the areas with high-density lesions.MAIN OUTCOME MEASURES: Results of Chinese grammar assessment and standardization of the CT images.RESULTS: According to the intention-to-treat analysis, all the 90 cases entered the result analysis. The patients with left hemisphere stroke scored remarkably lower for word category, word order, pragmatics, sentence-chart matching and linguistic symbol operation than those with right hemisphere stroke and normal control subjects (P ＜ 0.01), but patients with right hemisphere stroke scored lower than the control group only for sentencechart matching (79.73±13.67 vs 1.76±7.78, P ＜ 0.01), but not for other tests (P ＞ 0.05). Standardization of the CT images revealed that the lesions mainly located in the left frontal and temporal lobes.CONCLUSION: The left temporal-frontal neural network dominated the processing of Chinese grammar and the right temporal-frontal neural network assists in grammar processing, thereby the integration of Chinese grammar cognition necessitates the cooperation of the bilateral hemispheres.