脑卒中后维-汉双语运动性失语症损伤和恢复的多模磁共振影像研究

Xinjiang has been carrying out more than 50 years of bilingual education for ethnic minorities, and has formed a variety of bilingual types, the most common among them is "Uyghur‐ Chinese" type. With the increasing of bilingual population , the incidence of bilingual aphasia also increases, but about the injury and recovery mechanism of "Uyghur‐ Chinese" bilingual aphasia is still blank. Past research suggests that there is complex relations between the language types as well as bilingual languages and bilingual brain mechanisms, which make the damage and recovery mode of bilingual aphasia more complicated. Wang Yun ling found that the range and degree of brain activation is different, when the "Uyghur‐ Chinese" bilinguals perform different language task. In the fMRI study of Uygur, Chinese monolingual normal group and patients group, we also found brain activation areas of two group are different. We also collected 9 cases of "Uyghur‐ Chinese" bilingual aphasia patients initially, preliminary analyzed the L1 and L2 aphasia types and recovery mode, and it fully embodies the complex relations between the language type and the bilingual brain mechanism. In this study, we will carry out Language function evaluation for "Uyghur‐Chinese" bilinguals and Uyghur, Chinese monolingual BA patients, on the basis of this, combine MRI multiple modal imaging scan three time points, integrate Multi-level and various information which is from structural changes to the brain function, from the structural connection to functional connectivity, and interpret "Uyghur‐Chinese" bilingual BA’s language barrier damage and recovery mode and its differences, through comparison and the longitudinal comparison with neuropsychological test results.

新疆对少数民族实施50余年的双语教育，形成多种双语类型，其中“维‐汉”最多见。随着双语人口增多，双语失语症的发病率也增加，但关于维-汉双语失语症损伤和恢复的研究尚属空白。以往双语的研究表明语言类型及语系与双语的脑机制之间存在复杂的关系，双语失语症的损伤和恢复模式更加复杂。王云玲发现维-汉双语正常人执行不同语言任务时，脑激活的范围及程度有差异。我们也发现维、汉单语正常人及失语症患者的激活脑区不同；还收集了9例维-汉双语失语症患者，分析了L1和L2的失语类型和恢复模式，充分体现了双语失语症损伤和恢复的复杂性。本研究拟在对维-汉双语及维、汉单语BA患者进行语言功能评测的基础上，联合MRI多种模态成像技术三个时间点扫描，整合从结构改变到脑区功能，从结构性连接到功能性连接等多层次、多方面的信息，通过和神经心理学测试结果对照和纵向比较阐释维-汉双语BA的语言障碍损伤和恢复模式及其差异性。

现代社会双语人口越来越多，可能会增加双语失语症的发病率。双语失语症的临床表现比单语失语症更加复杂多变，除了表现为听、说、读、写障碍外，还有两种语言的病理性混合、切换和翻译障碍等特殊表现。新疆以“维‐汉”双语失语症最多见。本研究拟在对维汉双语及维、汉单语患者进行语言功能评测的基础上，联合多种模态成像技术三个时间点扫描，整合从结构改变到脑区功能，从结构性连接到功能性连接等多层次、多方面的信息，通过和神经心理学测试结果对照和纵向比较阐释维汉双语的语言障碍损伤和恢复模式及其差异性。我们对人群组（健康组、患者组）和语言组（汉语组、维语组）进行了全脑激活图像的主效应分析，健康组和患者组对比结果显示：健康组在左侧额上回、左侧缘上回、左侧梭状回、左侧舌回、脑干和右侧中央前回出现了显著的激活，而患者组没有发现比健康组显著的激活脑区。汉语组和维语组对比结果发现：汉语组在右侧扣带回和右侧顶上小叶的激活强度显著大于维语组，而维语组没有比汉语组显著激活的脑区。又经过分组叠加分析后，对语言组和人群组进行了全脑的交互作用分析表明，语言组和人群组在左右枕叶外侧、右侧中央前回等区域的交互作用具有统计学差异。简单效应分析结果：维语健康组和患者组相比，健康组在右侧额中回有显著激活，汉语健康组和患者组相比，健康组在左侧枕叶外侧和中央前回有显著激活，其他简单效应分析没有统计学差异。以上结果证实了人类复杂的语言功能并不是独立进行的，而是由广泛的皮层区域共同参与完成，而且提示汉语和维语存在不同的语言处理路径，维语加工处理有明显的功能偏侧化，而汉语加工处理比维语加工处理涉及更多的右脑。也说明是否患有失语症和不同语种都会影响动词产生的神经机制，还需结合参与处理动词产生这一复杂语言形式的大脑区域的功能连接做进一步的分析。这将为维、汉单语及双语失语症的定位诊断、优化康复治疗方案以及疗效评价和转归提供依据。