交叉性失语语言功能重组的功能磁共振研究  

Language functional reorganization of crossed aphasia: A fMRI study

作　　者：王伶杰 张洧 李映凯[2] 刘榴 黎春镛[2] 罗高权[2] 武肖娜[2] 王俊[3] 韩立新[3] 刘雁[1] 

机构地区：[1]南方医科大学研究生院,广东广州510515 [2]广州军区广州总医院神经内科 [3]广州军区广州总医院磁共振室

出　　处：《中国老年学杂志》2017年第20期5007-5010,共4页Chinese Journal of Gerontology

基　　金：国家自然科学基金资助项目(81471172)

摘　　要：目的探讨交叉性失语患者语言功能区的动态重组。方法 8例脑卒中后交叉性失语患者在脑卒中发病后第(7±2)天(T1期)、第(30±7)天(T2期)和第(90±7)天(T3期)分别进行3次语言功能测试和功能磁共振检查,健康对照组仅行1次上述各项检查。使用xjview软件呈现脑区激活图。结果病例组在T1期有不同程度的语言功能障碍,其中以自发语流畅度和命名功能受损最为明显。病例组在单因子重复测量的方差分析比较中,T1期、T2期和T3期失语指数的差异均有统计学意义(F=122.96,P<0.001)。通过独立样本t检验发现病例组在T1期、T2期和T3期的失语指数和对照组相比差异有统计学意义(P<0.05),但T3期自发语流畅度测试和图片命名测试得分和对照组相比差异无统计学意义(t=0.71,1.26;P=0.243,0.487)。在进行图片命名时,健康对照组主要表现为左侧语言区激活,同时在双侧额叶中下回、左侧额上回、左侧颞中回、左侧梭状回、双侧枕中回观察到显著激活。而病例组在T1期表现为激活降低的双侧激活模式,其中左侧额下回后部、左侧中央前回、右侧额叶上中回激活较为显著。在T2期和T3期均表现为激活增强偏左的双侧激活模式,但T3期的激活强度高于T2期。T1期至T2期左侧Broca区的激活增加与失语指数的改善呈正相关(r=0.916,P=0.001),而T2期至T3期左侧颞叶上中回的激活增加与失语指数的改善呈正相关(r=0.873,P=0.005)。结论交叉性失语患者主要表现为非流畅性失语,大部分患者的语言功能在发病后3个月逐渐恢复。交叉性失语患者的语言区重组主要通过左侧大脑半球语言区的功能上调来实现且上调程度与语言能力改善呈正相关,这表明在交叉性失语患者的语言恢复过程中左侧大脑半球发挥了重要作用。Objective To investigate the dynamic reorganization of the language functional area in patients with crossed aphasia.Methods 8 patients with crossed aphasia were studied by functional MRI（ f MRI） examinations with parallel language function testing. In patient group,three language functional tests and f MRI examinations were performed at（7 ± 2） d（T1）,（30 ± 7） d（T2） and（90 ± 7） d（T3） after stroke,while the healthy control cases were examined once.The presentation of the activation map was carried out by xjview software.Results In patient group,there were different degrees of language dysfunction in T1,in which spontaneous fluency and naming function were the most obvious. There were statistically significant differences in aphasia quotient in each phase（T1,T2 and T3） by the variance analysis of single factor repeated measurements（ F = 122.96,P〈0.001）. The aphasia quotient of the patient group in each phase was significantly different from the control group（ P〈0.05）. However,there were no significant differences between the spontaneous fluency test and the picture naming test in T3 compared with those of control group（t = 0.71,P = 0.487; t = 1.26,P = 0.243）. The control group showed a left lateralized pattern of brain activity with significant activations in the bilateral middle and inferior frontal gyrus,the left frontal superior gyrus,the left temporal middle gyrus,the left fusiform gyrus and the bilateral occipital middle gyrus. The patient group showed a bilateral decreasing activation mode in T1,which were activated in the left Broca area,the precentral gyrus and the right superior and middle frontal gyrus and showed a left lateralized pattern of bilateral activation in T2 and T3. There was a positive correlation between increased activation of the Broca＇s area and improved language performance during T2 phase（r = 0.916,P = 0.001） as well as between increased activation of the left superior and middle temporal gyrus and improved language performance duri

关 键 词：交叉性失语 功能磁共振 功能重组 失语恢复 

分 类 号：R743[医药卫生—神经病学与精神病学]