卒中后失语症类型及其影响因素分析

目的 通过探讨性别、年龄、病变部位及卒中病因等与失语症类型之间的关系，探索影响卒中后失
语类型的因素。
方法 回顾性分析2004年1月-2018年12月于首都医科大学附属北京天坛医院就诊、因语言障碍进行
西部失语成套测验（western aphasia battery，WAB）的卒中后失语症患者临床资料。分析失语症类型与
性别、年龄、卒中类型、卒中病因及发病机制之间的关系。
结果 共纳入失语症患者681例，按照失语症类型分为完全性失语（global aphasia，GA）（n =185）、
运动性失语（broca’s aphasia，BA）（n =148）、经皮质混合性失语（mixed transcortical aphasia，MTCA）
（n =30）、经皮质运动性失语（transcortical motor aphasia，TCMA）（n =67）、感觉性失语（werni cke’s
aphasia，WA）（n =69）、经皮质感觉性失语（transcortical sensor aphasia，TCSA）（n =21）、传导性失
语（conduction aphasia，CA）（n =32）和命名性失语（anomic aphasia，NA）（n =129）。将患者分为青年组
（18～44岁）、中年组（45～59岁）、老年组（≥60岁），校正其他因素影响后，三组人群间失语症类型
无统计学差异。男性和女性患者的失语症类型也无统计学差异。各类型失语症患者的病变部位具有
异质性，除合并经典语言区损伤外，还可合并左侧基底节及丘脑损伤。在脑出血所致的各类型失语
症患者中，最常见的病因均为高血压（77.8%～100.0%）。脑梗死后GA患者中，最常见的卒中发病机制
是混合型（42.4%）和动脉-动脉栓塞（27.3%），而BA、WA及CA患者以动脉-动脉栓塞（分别占51.5%，
71.4%和40.0%）最常见，TCMA、TCSA及NA以低灌注/栓子清除能力下降（分别占65.9%，58.3%和
38.4%）最常见。
结论 年龄及性别对失语症类型均无明显影响。男性和女性患者均以GA、BA和NA最为常见。病变
部位对失语症类型具有重要影响，卒中病因及发病机制对失语症类型的影响可能与特定血管及血管
供血区损伤有关。

Factors Associated with the Type of Post-aphasia: Implications from a Single-center Retrospective Study

Objective To investigate the factors associated with the type of aphasia after stroke and the types
of post-stroke aphasia.
Methods A retrospective analysis of clinical data of patients with post-stroke aphasia who received
Western Aphasia Battery (WAB) test from Beijing Tiantan Hospital between January 2004 and
February 2018 was performed. The relationship between aphasia type and gender, age, stroke type,stroke etiology and pathogenesis was analyzed.
Results A total of 681 patients with post-stroke aphasia were included, including 185 patients with
global aphasia (GA), 148 patients with Broca's aphasia (BA), 30 patients with mixed transcortical
aphasia (MTCA), 67 patients with transcortical motor aphasia (TCMA), 69 patients with Wernicke's
aphasia (WA), 21 patients with transcortical sensory aphasia (TCSA), 32 patients with conductive
aphasia (CA), and 129 patients with anomic aphasia (NA). The subjects were divided into youth group
(18-44 years), middle-aged group (45-59 years), and elderly group (≥60 years). The types of aphasia
among three groups had no statistical difference after adjusting for confounding factors, so did that
between men and women. Different type of aphasia had heterogeneity in lesion location, except for
the classical language areas, the left basal ganglia and thalamus were often damaged. Among patients
with aphasia caused by cerebral hemorrhage, the most common cause of cerebral hemorrhage was
hypertension (77.8%-100.0%). For GA patients, the most common pathogenesis of stroke was mixed
(42.4%) and artery-to-artery embolization (27.3%), while artery-to-artery embolization was the most
common in BA, WA and CA patients (51.5%, 71.4% and 40.0%, respectively), and hypoperfusion/
impaired emboli clearance were the most common in TCMA, TCSA, and NA patients (65.9%, 58.3%,
and 38.4%, respectively).
Conclusions Age and gender were not associated with the type of aphasia. The most common
types in post-stroke aphasia patients were GA, BA and NA. The lesion location was associated with
the type of aphasia. The influence of the etiology and pathogenesis of stroke on the type of aphasia
may be related to specific culprit vessels and the corresponding affected territory.