失语症类型与语言中枢之间的关系

背景:多数研究认为病变部位对失语症的发病及失语症的类型起着决定性的作用,但对此也有争议。目的:对失语症进行分类评估及CT,MRI检查,揭示失语症类型与病变部位之间的关系。设计:横断面调查。单位:首都医科大学附属北京天坛医院神经内科。对象:选择2002-02/2005-02首都医科大学附属北京天坛医院神经内科卒中单元住院的1198例脑梗死患者病变部位,纳入失语症患者325例。纳入标准:①诊断符合全国脑血管病会议拟订脑梗死诊断标准并经头CT或MRI证实为左侧大脑半球病变引起的脑梗死患者。②母语为汉语语种者。③意识清醒能合作者。④文化程度小学以上,发病前智力正常,无精神疾病史。⑤初次发病或多次发病但没有言语功能障碍。⑥不合并严重肝、肾及其他内、外科疾病。⑦不合并其他影响语言功能的疾病。⑧不合并其他影响认知功能的疾病。⑨西部失语成套测验得分≤93.8分。排除标准:①右侧大脑半球病变引起的脑梗死。②母语不为汉语者,或普通话不标准。③文盲。④多次发病且遗留语言障碍。⑤合并记忆力、智力障碍。⑥合并严重的视力、听力障碍。⑦不合作者。⑧西部失语成套测验得分>93.8分。其中男221例,女104例,平均年龄(68.72±4.56)岁。方法:①入院前进行CT检查,入院后1周内完成MRI检查,利用SIEMENSTrio2003T磁共振仪及siemensAG2003workstation完成全脑的数据收集和后处理。②入院2周内由卒中单元专业语言治疗师用西部失语成套测验进行失语症分类评估。③进行西部失语成套测验检查的同一天由同一语言治疗师应用波士顿诊断性失语严重程度分级标准进行失语症严重程度分级,共分6级,0级为无有意义的言语或听觉理解能力,5级为有极少的可分辨得出的言语障碍,患者主观上可能感到有点儿困难,但听者不一定能明显觉察到。主要观察指标:失语症类型与病变部位间的关系;失语症严重程度分级。结果:纳入患者325例,均进入结果分析。①语言中枢受累未引起失语情况:1198例脑梗死患者中,有5例Broca区及4例Wernicke区受累,没有引起失语症候群的患者。②失语症的分类:失语症患者325例中,西部失语成套测验评定结果为Broca失语83例,Wernicke失语48例,完全性失语58例,传导性失语12例;经皮质运动性失语36例,经皮质感觉性失语17例,经皮质混合性失语19例,命名性失语52例。病变部位位于经典语言中枢240例,非语言中枢受累85例。③波士顿诊断性失语严重程度分级标准评定结果:0级84例,1级79例,2级77例,3级63例,4级22例,其中失语严重程度为0级、1级的患者多为经典的语言中枢受累。结论:多数失语症的类型与病变部位之间的关系符合经典的失语症模式,但也有少数失语症类型与病变部位不完全相符,非语言中枢病变也可引起失语,病变部位位于语言中枢的失语症患者,失语严重程度大。

Association between aphasia types and language center

BACKGROUND: Most studies believed that lesion sites are decisive to the attack and types of aphasia, which is also in disputation.OBJECTIVE: To classify and evaluate aphasia with CT and MRI examinations, so as to reveal the association between aphasia types and lesion sites.DESIGN: A cross-sectional study.SETTING: Department of Neurology, Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences.PARTICIPANTS: The lesion sites were selected from 1 198 patients with cerebral infarction, who were hospitalized in the stroke unit of the Department of Neurology, Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences between February 2002 and February 2005, the diagnosis accorded with the diagnostic standard of cerebral infarctionset by National Meeting for Cerebrovascular Disease, and the patients with cerebral infarction were caused by lesions of left cerebral hemisphere ry school and above, the intellect was normal before attack, and there was score of Western battery aphasia was ＞ 93.8. Totally 221 males and 104 females were enrolled, and the average age was (68.72±4.56) years.and received MRI examination within 1 week after admission. The data collection and treatment were finished with the Siemens Trio 2003T magaphasia of the patients was classified and evaluated with the Western battery aphasia by professional language therapist within 2 weeks after adtic aphasia examination severity grading standard by the same language therapist on the same day of Western battery aphasia. There were 6 grades, grade 0 was taken as meaningless language or auditory understanding ability, and grade 5 as extremely few differentiable language disorders, the patients could feel some difficulties subjectively, but the hearer was uncertain to obviously detect.MAIN OUTCOME MEASURES: Association between aphasia types and lesion sites; Grading of aphasia severity. Aphasia not caused by the involvement of language centers: Of the 1 198 patients with cerebral infarction, the Broca area in 5 cases and Wernicke area in 4 cases were involved, and did not cause aphasia syndrome in the Western battery aphasia showed that 83 cases had Broca aphasia, 48 cases Wernicke aphasia, 58 cases complete aphasia, 12 cases conduction aphasia, 36 cases transcortical motor aphasia, 17 cases transcortical sensory aphasia, 19 cases transcortical mixed aphasia and 52 cases nominal aphasia. The lesions located at typical language center in 240 cases and at nonaphasia examination severity grading standard: It was grade 0 in 84 cases, grade 1 in 79 cases, grade 2 in 77 cases, grade 3 in 63 cases and grade 4 in 22 cases, and the typical language centers were involved in most of the patients of grade 0 and grade 1.CONCLUSION: The association between types and lesion sites of most aphasia are in accordance with the typical aphasia mode, but it was not completely accordant in a few aphasias, the lesion of non-language centers can also cause aphasia, and the aphasia is greatly severe in the patients with the lesion site of language centers.