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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 explore the dynamic reorganization of language functional areas in patients with aphasia. Methods Eight patients with post-stroke aphasia were divided into two groups: stroke (7 ± 2) days (T1), (30 ± 7) days (T2) and (90 ± 7) Three language functional tests and functional magnetic resonance examinations were performed respectively, and the healthy control group only performed the above examinations once. Use xjview software to show brain activation map. Results The case group had different degrees of language dysfunction in T1, of which the most obvious was the fluency of spontaneous speech and the impairment of naming. In the case group, the differences of the aphasia index in T1, T2 and T3 were all statistically significant (F = 122.96, P <0.001). The independent sample t-test showed that the aphasia index of T1, T2 and T3 in the case group was significantly different from that in the control group (P <0.05). However, the scores of spontaneous discoloration and picture naming test in T3 The difference between the control group was not statistically significant (t = 0.71, 1.26; P = 0.243,0.487). In the name of the picture, the healthy control group mainly for the activation of the left linguistic area, while bilateral frontal lobe in the next back, left frontal gyrus, left temporal gyrus, left fusiform gyrus, bilateral pillow A significant activation was observed back. However, in T1 group, the cases showed activation-reduced bilateral activation pattern, in which the left inferior frontal gyrus, the left middle anterior gyrus and the right upper frontal gyrus activated more significantly. In both T2 and T3, the activated bilateral left-sided activation pattern appears, but the activation of T3 is higher than that of T2. The increased activation of Broca region from T1 to T2 was positively correlated with the improvement of aphasia (r = 0.916, P = 0.001), while the activation of left superior temporal gyrus from T2 to T3 and the improvement of aphasia index There was a positive correlation (r = 0.873, P = 0.005). Conclusion The main manifestations of cross-Aphasia are non-fluent aphasia, and the majority of patients’ language function gradually recovered 3 months after onset. The cross-lingual aphasics reorganization is mainly achieved through the functional upregulation of the left hemisphere linguistic region and the up-regulation is positively correlated with the improvement of speech ability, which indicates that the left hemisphere plays an important role in the language recovery of cross -phadphabetic patients effect.