脑梗死后失语症的磁共振波谱分析

目的应用磁共振波谱分析(magnetic resonance spectroscopy,MRS)揭示脑梗死后运动性、感觉性失语的语言功能区代谢的变化,探讨失语症可能的发病机制,为语言康复训练提供理论指导。方法对2003年5月至2005年2月在北京天坛医院神经内科住院的58例经CT或MRI证实为脑梗死的患者,采用西部失语成套测验评定标准判断失语症类型。对评定结果为运动性或感觉性失语的患者的病变波及的Broca区、Wernicke区进行磁共振波谱分析,测定N-乙酰天门冬氨酸(N-acetylaspartate,NAA),胆碱(Choline,Cho),肌酸(Creatine,Cr)和乳酸(Lactate,Lac),并与对侧镜像区进行对比。结果在符合入选标准的58例脑梗死患者中,男39例,女19例,平均年龄(64.02±3.87)岁。经西部失语成套测验评定12例为运动性失语、21例为感觉性失语,其他失语症类型25例。对12例运动性失语和21例感觉性失语患者的MRS结果进行统计学分析,发现受累语言功能区即Broca或Wernicke区的NAA、Cho的代谢较对侧镜像区降低,两者相比有显著性差异,而受累语言功能区的Cr与对侧镜像区相比无统计学意义,在受累的Broca区或Wernicke区出现Lac峰,而对侧镜像区没有Lac峰出现,两者相比有统计学意义。结论失语症患者急性期语言功能区呈低代谢表现,这可能是失语症的发病机制之一。

Studies of Aphasia after Acute Ischemic Stroke With Proton Magnetic Resonance Spectroscopy

Objective Proton magnetic resonance spectroscopy(MRS) can be used to study metabolite abnormalities in the brains of patients with stroke. We have used it to approach aphasia pathogenesis by observing metabolic changes of language areas on functional magnetic resonance in order to provide theoratic instruction to language rehabilitation of aphasia patients. Methods Between May 2003 and February 2005, 58 in-patients in the Neurology Ward of Beijing Tiantan Hospital, who had been diagnosed with cerebral ischemic by CT or MRI and had language disorders were enrolled for this study. We classified the aphasia types according to by the Western Aphasia Battery, Broca's aphasia and Wernicke's aphasia patients were examin with magnetic resonance spectroscopy(MRS). We measured the Broca's or Wernicke's areas macromolecules and micro molecules, in such as N-acetylaspartate(NAA), choline(Cho), creatine(Cr) and lactate(Lac), and compared the results with that of the mirror hemisphere. Results Of 58 cases, there were 39 male and 19 female. The average age was (64.02±3.87) years. There were 12 Broca's aphasia cases and 21 Wernicke's aphasia cases, rest the other were aphasia types. The results of NAA, Cr, Cho, Lac showed that there were statistically significant differences in the amount of NAA and Cho between Broca's or Wernicke's areas and the mirror hemisphere, but there were no significant differences in Cr. Lactate peak appeared in Broca's or Wernicke's areas, but not appeared in the mirror hemisphere, with significant differences between them. Conclusion Language areas of patients with aphasia are in a state of hypometabolism which may be one of the mechanisms of aphasia.