汉语阅读障碍儿童脑血流改变与阅读技能测试的关系

背景阅读障碍是儿童障碍的主要类型,目前人们尚不明了病因、病理机制.目的探讨儿童汉语阅读障碍的脑血流改变与阅读技能诊断测试评分的相关性,以期为阅读障碍患儿的早期干预和功能监测提供理论参考.设计以阅读障碍患儿为研究对象,正常儿童为对照组的观察对比研究.单位一所大学医院的核医学科及精神卫生研究所.对象本研究由中南大学湘雅二医院核医学科及精神卫生研究所共同完成.于1998-08/1999-08在长沙市2所小学3～6年级学生中筛查出阅读障碍儿童25例作为阅读障碍组,男15例,女10例,年龄(10±1)岁.纳入标准①根据教师评价有语文学习困难持续1年以上,学习困难发生于学龄早期(三年级以前),学习成绩在班上一直居后或考试经常不及格或因学习困难留级者;②课堂、家庭作业独立完成困难者;③家长、教师评定、作业调查与临床检查符合阅读障碍的国际疾病分类第10版诊断标准者;④阅读技能诊断测试评定阅读技能障碍者;⑤智商测验IQ≥70者.排除标准①视听觉障碍者;②明显的情绪障碍、多动症及器质性脑病患者.在阅读障碍患儿所在班级随机抽取身心健康、智力测验正常的儿童20例作为对照组,男12例,女8例,年龄为(10±1)岁.方法用非采血法单光子发射计算机断层摄影术显像测定阅读障碍患儿和正常对照者全脑血流量、左右脑血流量及局部脑血流量.阅读技能诊断测试测得阅读技能总粗分,并分析阅读技能总粗分与全脑血流量间的关系.主要观察指标①两组全脑血流量、局部脑血流量测定结果比较;②阅读障碍组阅读技能总粗分与全脑血流量的相关性.结果阅读障碍组CBF为(388.7±37.7)μL/(g·min),明显低于对照组(436.5±26.4)μL/(g·min)(t=2.820,P＜0.01);患儿局部脑血流量显著降低的区域分布频率为额叶、枕叶＞顶枕交界区＞颞叶＞顶叶＞丘脑＞其他(小脑、脑干、基底节);阅读障碍组阅读技能总粗分与全脑血流量呈明显正相关(r=0.651,P＜0.05).结论阅读障碍儿童存在脑血流代谢降低,单光子发射计算机断层摄影术脑血流显像及阅读技能诊断测试均能够客观评价其病变的严重程度,评价患儿的脑功能变化,以期对阅读障碍患儿进行早期干预,改善其远期生活质量.

Relationship between the change of brain blood flow and reading skill test in children with Chinese reading disorder

BACKGROUND: Reading disorder is the main obstacle in children, but its etiology and pathogenesis are still uncovered.OBJECTIVE: To explore the relationship between brain blood flow (BBF)and scores for children reading skill detecting test (CRSDT), in order to provide theoretical references for earlier intervention and functional monitoring for children with reading disorder(RD).DESIGN: Comparative observation study with RD children as subjects and normal children as controlSETTING: Nuclear medicine and psychological-health institute of a university.PARTICIPANTS: This study was carried out in Nuclear Medicine and Psychological-health Institute of Second Xiangya Hospital, Central South University. Between August 1998 and August 1999, 25 children with RD were screened out from the students from grade 3 to grade 6 in two Changsha civic elementary schools, including 15 males and 10 females aged(10±1)teacher lasted for more than one year and began from the earlier stage of school age(before grade three), with their achievement ranked last or often failed in examinations, even stay in the same grade due to learning disorder;and teacher or investigation of their homework accorded to the ICD-10 didiseases. Meanwhile 20 healthy children with normal intelligence were randomly selected as control group from the same class of RD children,including 12 males and 8 females with age of (10 ± 1 )years.METHODS: Non blood sampling-SPECT images was used for detecting cerebral blood flow(CBF), as well as right and left CBF and regional CBF (rCBF) of both RD children and normal controls. Rough scores for CRSDT were obtained for analyzing the relationship between it and CBF.group .RESULTS: CBF was(388.7 ± 37.7) μL/g per minute in RD group obviously lower than(436.5 ± 26.4) μL/g per minute in control gruop( t = 2. 820, P ＜ 0.01 ) ;The distribution frequency of regions with obviously decreased rCBF ranked as follows: frontal lobe, occipital lobe ＞ parietal-occipital boundary ＞ temporal lobe ＞ parietal lobe ＞ thalamus ＞ other regions(cerebellum,brain stem and basal ganglion) in RD children; moreover rough scores for reading skill was found positively correlated with CBF in RD group( r = 0.651,P ＜0.05).CONCLUSION: CBF was proved decreased in children with RD, and CBF obtained by SPECT image and CRSDT can be used for reflecting the severity of disease and brain function, expecting to improve their long-term life quality of RD children by earlier intervention.