Correlation between language impairment and cholinergic pathway damage in patients with acute basal ganglia infarction
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摘要:
目的探讨不同程度的胆碱能通路损害对基底节区脑梗塞患者语言功能的影响。 方法纳入2018年10月~2020年10月神经内科住院的初次发病并伴有语言障碍的急性基底节区脑梗塞患者135例，所有患者均进行胆碱能通路高信号评分量表（CHIPS）检查，根据评分高低分为A组（轻度异常，CHIPS评分1~3分，n=42）、B组（中度异常，CHIPS评分4~7分，n=53）和C组（重度异常，CHIPS评分≥8，n=40），对3组患者分别实施标准汉语失语量表（ABC）检查，并运用Logistic回归寻找伴胆碱能通路损害的基底节区脑梗塞患者语言损害的相关因素；对3组患者的标准汉语失语量表各计算项目行单向方差分析，评估3组患者ABC量表各分项目得分的差异性。 结果ABC量表包括谈话、理解、复述、命名、阅读、书写、结构与视空间、运用、计算等项目，A组得分为25.05±1.72、204.67±5.14、91.36±5.19、78.31±2.34、50.48±4.56、87.07±3.22、14.48±1.31、27.31±1.89、22.24±1.67）；B组得分为18.51±1.35、198.85±8.68、86.94±3.77、76.57±2.43、46.64±3.65、85.21±3.25、13.62±1.24、28.08±1.82、22.19±1.42；C组得分为16.35±2.09、195.42±7.03、85.95±2.88、72.93±4.23、44.35±3.41、83.58±2.91、12.73±2.17、27.80±1.78、21.85±1.71。经单因素方差分析，在谈话、理解、命名、阅读、书写、结构与视空间6个项目得分差异有统计学意义（P < 0.05）；C组与A组的复述项目差异有统计学意义（P < 0.05），C组与B组差异无统计学意义（P=0.244）；3组在运用、计算项目得分差异无统计学意义（P>0.05）。回归分析发现年龄、高同型半胱氨酸及梗塞体积是梗塞患者出现语言功能损害的危险因素（P < 0.05）。 结论基底节区脑梗塞患者语言损害的程度可能与其胆碱能通路的损害程度相关，年龄、高同型半胱氨酸及梗塞体积为基底节区脑梗塞患者出现语言功能损害的危险因素。 -
关键词:
- 基底节区脑梗塞 /
- 失语 /
- 胆碱能通路 /
- 标准汉语失语检查量表
Abstract:ObjectiveTo investigate the influence of different degrees of cholinergic pathway damage on the language function of patients with cerebral infarction in the basal ganglia. MethodsWe included 135 cases of acute basal ganglia cerebral infarction with initial onset and speech disorder in the Department of Neurology from October 2018 to October 2020. All patients were operated with the Cholinergic Pathway High Signal Scale (CHIPS) Check, according to the score. They were divided into group A (mild abnormality, CHIPS score 1-3 points, 42 cases), group B (moderate abnormality, CHIPS score 4-7 points, 53 cases) and group C (severe abnormality, CHIPS score ≥8, 40 cases). Three groups of patients were tested with the standard Chinese Aphasia Scale (ABC). Logistic regression was used to find the related factors of language damage in patients with basal ganglia cerebral infarction with cholinergic pathway damage. One-way analysis of variance was performed on each calculation item of the standard Chinese Aphasia Scale of the three groups of patients to evaluate the differences in the scores of the ABC scales of the three groups. ResultsABC scale score: (talk; comprehension; retelling; naming; reading; writing; structure and visual space; application; calculation): Group A (25.05±1.72; 204.67±5.14; 91.36±5.19; 78.31±2.34; 50.48±4.56; 87.07± 3.22; 14.48±1.31; 27.31±1.89; 22.24±1.67); Group B (18.51±1.35; 198.85±8.68; 86.94±3.77; 76.57±2.43; 46.3.25±3.65; 85.21±3.65; 1.24; 28.08±1.82; 22.19±1.42); Group C (16.35±2.09; 195.42±7.03; 85.95±2.88; 72.93±4.23; 44.35±3.41; 83.58±2.91; 12.73±2.17; 27.80±1.78; 21.85 ± 1.71). After one-way analysis of variance comparison, there are differences in the scores of 6 items in conversation, comprehension, naming, reading, writing, structure and visual space Statistical significance among three groups. In the retelling item, the difference between group C and group A was significant, and the difference between group C and group B was not significant (P=0.244). There was no significant difference in the scores of the three groups in use and calculation. Regression analysis found that age, high homocysteine, and infarct volume were risk factors for language impairment. ConclusionThe degree of language impairment in patients with cerebral infarction in the basal ganglia may be related to the degree of damage in the cholinergic pathway. Age, high homocysteine and infarct volume are risk factors for language impairment in patients with cerebral infarction in the basal ganglia. -
图 1 胆碱能通路示意图
A: 低外囊层面; B: 高外囊层面; C: 放射冠层面; D: 半卵圆中心层面.
Figure 1. Schematic diagram of cholinergic pathway.
图 2 语言功能损害患者常见的梗塞位置
A: 左侧侧脑室; B: 右侧侧脑室; C: 左侧放射冠区; D: 右侧放射冠区; E: 左侧内囊后肢; F: 右侧内囊后肢.
Figure 2. High incidence of infarction in patients with language impairment.
图 3 语言功能损害患者听写、空间画图及自主书写项目
A: 听写部首“亻”音译错写为“单人”“, 钥匙”字形错写; B、D: 听写“跑步”字形错写；E：听写“树”错写为“木”; C、F: 空间结构画图形状错误, 无法描绘出图形空间立体结构; G: 写病情项目中患者的语句结构简单, 缺乏主谓宾结构.
Figure 3. Dictation, spatial drawing and autonomous writing of patients with language impairment.
表 1 有语言功能损害与无语言功能损害组的临床特征比较
Table 1. Comparison of clinical features between Group with and without language impairment
指标 所有患者(n=202) 语言损害组(n=135) 非语言损害组(n=67) t/χ2 P 年龄（岁, Mean±SD） 64.13±9.59 66.97±8.30 58.40±9.52 8.95 0.003 收缩压（mmHg, Mean±SD） 154.24±14.06 154.71±14.58 153.13±12.61 0.37 0.546 舒张压（mmHg, Mean±SD） 86.12±4.72 86.36±4.86 85.63±4.44 0.43 0.514 高血糖（mmol/L, Mean±SD） 5.90±0.58 5.86± 0.56 5.97± 0.62 2.28 0.137 高LDL-C（mmol/L, Mean±SD） 3.30±2.15 3.42±0.40 3.06±0.69 4.37 0.038 高尿酸（μmol/L, Mean±SD） 286.28±80.07 290.10±82.08 278.56±75.87 2.41 0.122 高Hcy（mmol/L, Mean±SD） 13.87±4.14 14.96±3.65 11.68±4.23 5.05 0.026 梗塞体积（mm2, Mean±SD） 335.56±510.70 440.47±595.69 124.18±77.74 21.29 0.000 教育年限（年, Mean±SD） 7.45±2.58 7.32±1.68 8.65±2.21 1.85 0.216 性别[男, n(%)] 122(60.3） 81(60.0) 41 (61.1) 0.03 0.870 饮酒史[男, n(%)] 108(53.4） 79(58.5) 29(43.2) 4.17 0.041 吸烟史[男, n(%)] 112(55.4） 76(56.2) 36(53.73) 0.12 0.730 LDL-C: 低密度脂蛋白; Hcy: 同型半胱氨酸. 
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表 2 语言功能损害患者的相关影响因素Logistic回归分析
Table 2. Logistic regression analysis of related influencing factors in patients with language impairment
指标 P OR 95% 置信区间 下限 上限 年龄 0.000 0.871 0.820 0.924 饮酒史 0.124 1.928 0.835 4.452 梗塞体积 0.000 0.990 0.985 0.994 高血脂 0.660 1.031 0.901 1.180 高同型半胱氨酸 0.000 0.781 0.689 0.885 高尿酸 0.525 1.002 0.996 1.007
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表 3 患者ABC量表评分比较
Table 3. Comparison of standard ChineseAphasia Checklist scores among the patients (Mean±SD)
指标 所有患者（n=135） A组（n=42） B组（n=53） C组（n=40） 谈话 19.90±3.96 25.05±1.72 18.51±1.35 16.35±2.09 理解 199.64±8.07 204.67±5.14 198.85±8.68 195.42±7.03 复述 88.02±4.63 91.36±5.19 86.94±3.77 85.95±2.88 命名 76.03±3.72 78.31±2.38 76.57±2.43 72.93±4.23 阅读 47.16±4.56 50.48±4.56 46.64±3.65 44.35±3.41 书写 85.30±3.40 87.07±3.22 85.21±3.25 83.58±2.91 结构与视空间 13.62±1.72 14.48±1.31 13.62±1.24 12.73±2.17 运用 27.76±1.85 27.31±1.89 28.08±1.82 27.80±1.78 计算 22.10±1.59 22.24±1.67 22.19±1.42 21.85±1.71 A组: 胆碱能通路轻度异常组; B组: 胆碱能通路中度异常组; C组: 胆碱能通路重度异常组.
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表 4 患者的ABC评分量表各分项目得分方差分析
Table 4. Analysis of variance of each sub-item score of theABC scoring scale for the patients
评分项目 分组 P 95%置信区间 下限 上限 谈话 A组 B组 0.000 5.84 7.24 C组 A组 0.000 -9.45 -7.95 C组 B组 0.000 -2.87 -1.45 理解 A组 B组 0.000 2.86 8.78 C组 A组 0.000 -12.41 -6.07 C组 B组 0.026 -6.43 -0.42 复述 A组 B组 0.000 2.76 6.07 C组 A组 0.000 -7.18 -3.63 C组 B组 0.244 -2.67 0.69 阅读 A组 B组 0.000 2.24 5.43 C组 A组 0.000 -7.83 -4.42 C组 B组 0.006 -3.91 -0.68 命名 A组 B组 0.007 0.49 3.00 C组 A组 0.000 -6.72 -4.05 C组 B组 0.000 -4.91 -2.37 书写 A组 B组 0.005 0.58 3.15 C组 A组 0.000 -4.87 -2.13 C组 B组 0.014 -2.93 -0.33 结构与视空间 A组 B组 0.011 0.20 1.50 C组 A组 0.000 -2.45 -1.06 C组 B组 0.008 -1.56 -0.24 运用 A组 B组 0. 081 -1.43 0.08 C组 A组 0.229 -0.31 1.29 C组 B组 0.475 -1.04 0.49 计算 A组 B组 0.881 -0.60 0.70 C组 A组 0.285 -1.19 0.51 C组 B组 0.353 -1.21 0.74
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