袁锡球 黄龙龙 罗根培

[摘要] 目的 探討伴胆碱能通路白质病变的皮质下脑梗死患者的失语特点。 方法 选取2018年6月至2020年6月我院神经内科住院患者中诊断为初次发病的皮层下梗死患者伴有明显言语障碍120例为研究对象，对所有入组患者行CHIPS量表检查，按评分结果分为无异常（A组，21例）、轻度异常（B组，63例）、明显异常（C组，36例）三组，对胆碱能通路的白质病变程度进行评分，对所有患者分别实施标准汉语失语量表（ABC）检查，Fazekas评分量表检查，对导致胆碱能通路损伤的白质病变ABC评分与Fazekas评分进行相关性分析。 结果 所有患者CHIPS总评分为（25.7±11.1）分，A组CHIPS评分为0分，B组CHIPS评分为（4.7±2.1）分，C组CHIPS评分为（23.2±6.8）分，三组比较，差异有统计学意义（P<0.01）; A组ABC总评分为（654.3±58.5）分，B组ABC总评分为（526.1±34.7）分，C组ABC总评分为（327.6±23.5）分，三组比较，差异有统计学意义（P<0.01）;患者Fazekas总评分为（5.4±2.8）分，A组Fazekas评分为0分，B组Fazekas评分为（2.2±0.3）分，C组Fazekas评分为（5.1±0.6）分，三组比较，差异有统计学意义（P<0.01）。 结论 皮质下脑梗死患者失语的程度可能与其白质病变中胆碱能通路的损害程度相关，CHIPS 评分可评估损害程度。

[关键词] 脑梗死;缺血性脑血管病;脑白质病变;皮质下失语症;胆碱能通路

[中图分类号] R742          [文献标识码] A          [文章编号] 1673-9701（2021）28-0009-04

Study on the characteristics of aphasia in patients with subcortical cerebral infarction along with white matter lesions within the cholinergic pathway

YUAN Xiqiu   HUANG Longlong   LUO Genpei

Neurology Department， Dongguan People′s Hospital in Guangdong Province， Dongguan   523000， China

[Abstract] Objective To investigate the characteristics of aphasia in patients with subcortical cerebral infarction along with white matter lesions within the cholinergic pathway. Methods A total of 120 patients diagnosed with primary onset subcortical infarction along with prominent language impairment in the inpatients of the Neurology Department of our hospital from June 2018 to June 2020 were selected. The CHIPS scale examination was performed on all the enrolled patients. According to the scoring results， they were divided into three groups： no abnormality （group A， 21 cases）， mild abnormality （group B， 63 cases）， and obvious abnormality （group C， 36 cases）. The degrees of white matter lesions within the cholinergic pathway were scored， and all patients were tested with the standard Chinese aphasia scale （ABC） and the Fazekas score scale. The correlation analysis between the ABC scores and the Fazekas scores for white matter lesions causing cholinergic pathway damage was performed. Results The total CHIPS scores of all patients were （25.7±11.1） points; the CHIPS score of group A was 0 points， while the CHIPS score of group B was （4.7±2.1） and the CHIPS score of group C was （23.2±6.8） points. The differences among the three groups were statistically significant （P<0.01）. The total ABC scores of group A were （654.3±58.5） points， while the total ABC scores of group B were （526.1±34.7） points and the total ABC scores of group C were （327.6±23.5） points. The differences among the three groups were also statistically significant （P<0.01）. The total Fazekas scores of the patients were （5.4±2.8） points， with Fazekas scores of 0 points for group A， （2.2±0.3） points for group B， and （5.1±0.6） points for group C. The differences among the three groups were also statistically significant （P<0.01）. Conclusion The degrees of aphasia in patients with subcortical cerebral infarction may be associated with the degrees of damage to the cholinergic pathway within the white matter lesions， and the CHIPS scores can assess the degree of damage.

[Key words] Cerebral infarction; Ischemic cerebrovascular disease; White matter lesions; Subcortical aphasia; Cholinergic pathway

卒中后失语是由急性脑血管疾病导致大脑语言中枢受损后出现的高级神经功能障碍，表现为听、说、读、写能力中某些方面或某几个方面的障碍[1-2]。失语症系由大脑优势半球皮层经典语言区病变所致，基底节区、丘脑等皮层下结果被认为是语言不能区，随着影像学检查技术的不断发展及应用，皮质下结构损害所致的失语症越来越多地被识别[3-4]，神经学、心理学、康复学领域的相关研究者表示，近年来对皮质下脑梗死失语患者的研究比较深入，尽管各类研究已经初窥人是如何通过脑部神经反射实现语言表达的，但对于皮下质结构在其中所起的作用仍未完全明确，各类报道对其作用机制的论述都不尽相同，语言过程、皮下质结构的内在联系尚无明确定论[5-6]。……