卒中后失语症患者失语症类型及严重程度影响因素的回顾性分析

Retrospective analysis of factors influencing the type and severity of aphasia in patients with post-stroke aphasia

目的:通过回顾性研究,分析卒中后失语症患者的相关临床资料包括病灶部位、性质、性别、年龄及学历与失语症类型及其严重程度的关系。方法:收集2019年1月1日~2021年12月31日在我院康复医学科住院的首次卒中后失语症(PSA)患者的性别、年龄、学历、卒中类型、病程等临床资料、影像学资料、西方失语成套测验(WAB)评定结果。分析失语症类型、WAB评分与临床资料相关性。结果:PSA患者最常见损伤部位为左侧皮层损伤(31例,33.3%),其次为左侧基底节区损伤(28例,30.1%)。WAB严重程度与损伤部位相关,皮层+皮层下同时存在损伤的患者其WAB失语商、自发言语、听理解、命名得分更低(P<0.05);进一步比较发现,皮层+皮层下同时存在损伤比单单皮层损伤的患者其失语商、自发言语、听理解、命名评分更低(P<0.05),皮层+皮层下同时损伤患者的失语商和全部WAB单项评分(自发言语、听理解、复述、命名)明显低于仅皮层下损伤患者(P<0.05),也比其他部位损伤的患者有更差的失语商、听理解、命名得分(P<0.05)。缺血性卒中组完全性失语占比较出血性卒中组明显增高(P<0.05),缺血性卒中组患者失语商明显低于出血性卒中组患者(P<0.05),单项分数中,自发言语、听理解、复述方面,缺血性卒中组明显低于出血性卒中组(P<0.05),而2组间命名的单项得分差异无统计学意义。年龄、性别和学历不影响失语症类型、WAB得分。结论:PSA最常见于左侧皮层、基底节损伤,PSA类型、严重程度受病灶部位和卒中性质影响而不是年龄、性别和学历,皮层+皮层下同时存在损伤病灶更易导致严重失语症状。

Objective:To analyze the relevant clinical data of post-stroke aphasia patients,including the relationship between lesion location,nature,gender,age,education,and the type and severity of aphasia.Methods:Clinical and imaging data,as well as WAB evaluation results,were collected from patients with post-stroke aphasia in the Inpatient Department of the Rehabilitation Medicine Department of our hospital from January 1,2019 to December 31,2021.The correlation between aphasia types,WAB scores,and clinical data was analyzed.Results:The most common site of injury in patients with post-stroke aphasia was left cortical injury(31 cases,33.3%),followed by left basal ganglia injury(28 cases,30.1%).The severity of WAB was related to the location of the injury,and WAB with simultaneous cortical and subcortical damage had lower scores in terms of AQ,self speaking,listening comprehension,and naming(P<0.05).Further pairwise comparison revealed that patients with cortical and subcortical injuries had lower AQ,self speaking comprehension,auditory comprehension,and naming scores(P<0.05)than those with single subcortical injuries.AQ and overall WAB scores(self speaking,auditory comprehen-sion,retelling,and naming)were significantly lower than those with only subcortical injuries(P<0.05),and patients with other site injuries also had poorer AQ,auditory comprehension,and naming scores(P<0.05).The proportion of complete aphasia among patients with ischemic stroke was significantly higher than that of hemorrhagic stroke,with a statistically significant dif ference(P<0.05).The AQ of patients with isc-hemic stroke was significantly lower than that of patients with hemorrhagic stroke(P<0.05).In terms of self speaking,listening comprehension,and retelling,the scores in ischemic stroke were significantly lower than those of hemorrhagic stroke(P<0.05),but named individual scores between the two groups had no significant differences.Age,gender and education did not affect the type of aphasia and WAB score.Conclusion:PSA is most commonly associated with damage to the left cortex and basal ganglia.The type and severity of PSA are influenced by the location of the lesion and the nature of the stroke,rather than age,gender and education.The presence of damaged lesions in both the cortex+subcortical regions is more likely to lead to severe aphasia symptoms.