卒中后运动性失语症患者的语言损伤特点分析

Analysis of Language Impairment Characteristics in Patients with Post-Stroke Broca's Aphasia

目的本研究旨在采用中国失语症语言评估量表(Chinese aphasia language battery,CALB)对卒中后运动性失语症(post-stroke Broca’s aphasia,PSBA)患者进行语言功能的详细评估,分析卒中后运动性失语症患者的语言损伤特点。方法连续入组2021年3月—2022年12月就诊于首都医科大学附属北京天坛医院神经病学中心和康复医学科的PSBA患者,根据失语商分数分为轻、中、重度组,同时招募同时间段内年龄、受教育程度相匹配的受试者作为健康对照组。采用CALB评估两组受试者语言功能。比较PSBA组和健康对照组以及轻、中、重度组PSBA患者CALB评分的差异。结果PSBA组共纳入患者35例(轻度15例,中度12例,重度8例),健康对照组纳入36例。①PSBA组在CALB命名分量表的分项任务表现方面,除音调理解外,评分均低于健康对照组;轻度、中度和重度3组患者在对证命名(高频、低频词汇)、复述(假词、真词)任务方面差异存在统计学意义;在高频词汇的命名和理解方面,评分明显优于低频词汇,在整体分析和轻度组患者中尤为明显。在不同范畴名词词汇(动物、服装、身体部位、果蔬、工具、颜色)的表现方面,差异并不具有统计学意义。名词和动词分析发现,患者在名词命名和理解的正确率方面优于动词,但各组的差异均不具有统计学意义。在动词分类分析方面,患者在不带宾动词的表现方面优于带宾动词,在不同论元结构动词的表现方面,三元动词的命名和理解能力最差。②在动词语义和语句分量表的表现方面,患者所有的任务表现评分均低于健康对照组;不同严重程度的患者在动词命名、论元结构产出、语句启动产出方面差异存在统计学意义;在论元结构产出方面,论元结构越多的语句,患者产出的正确率越低,在整体分析及轻度组中尤为明显。结论PSBA患者在整体语言通路上存在不同程度的损害,其中语音输入通路的损害较输出通路轻。在不同范畴词汇表现方面,患者处理动词的困难大于名词,名词中低频词汇处理损害重于高频名词;在动词处理方面,论元结构越复杂的动词,患者的表现越差。

Objective The aim of this study was to analyze the language impairment characteristics in patients with post-stroke Broca’s aphasia(PSBA)using the Chinese aphasia language battery(CALB).Methods Patients with PSBA who attended the Neurology Center and Department of Rehabilitation Medicine of Beijing Tiantan Hospital,Capital Medical University,from March 2021 to December 2022 were consecutively enrolled and divided into mild,moderate and severe groups according to the aphasia quotient.Normal controls(NC)with matching age and education level in the same time period were also recruited.CALB was used to assess language function.To compare the differences in CALB scores between the PSBA group and the healthy control group,as well as the mild,moderate,and severe groups of PSBA patients.Results Totals of 35 PSBA patients(15 mild,12 moderate and 8 severe)and 36 NC were included in this study.①PSBA group performed significantly worse than normal controls on subtasks of the naming battery,except for the tone recognition task.Patients in the mild,moderate,and severe groups differed significantly on the confrontation naming(high-frequency and low-frequency words)and repetition(non-word and word repetition)tasks.PSBA patients performed significantly better with high-frequency words in naming and understanding than low-frequency words,especially in the overall analysis and in the mild group.No statistically significant differences were found in the performance of different categories of nouns(animals,clothing,body parts,fruits and vegetable,tools,and colors).The analysis of nouns and verbs revealed that PSBA patients performed better with nouns than verbs in terms of naming and understanding,but the statistical differences were not significant in any of the groups.The analysis of verbs revealed that patients performed better on intransitive verbs than on transitive verbs,and the worst naming and understanding of three-argument verbs was found in the performance of verbs with different argument structures.②PSBA patients’performance on the assessment of verbs and sentences was lower than normal controls on all tasks.Patients with PSBA of different severity levels had performance differences in verb naming,argument structure and sentence production.In terms of argument structure production,it was found that verbs with more complex argument structure,PSBA patients showed lower correct rate compared to verbs with less complex entries.This was particularly evident in the overall analysis and in the mild group.Conclusions PSBA patients have varying degrees of impairment in the overall language processing pathway,with the voice input pathway being less impaired than the output pathway.In terms of different category lexical performance,patients had greater difficulty in processing verbs than nouns,lower frequency lexical processing impairment in nouns was heavier than high frequency nouns.With verbs,the more arguments structure that a verb had,the worse the patients'performance was.