维吾尔语失语症特点及其检查法的标准化研究和维吾尔族、汉族正常人脑激活区差异性的fMRI研究

发布时间：2018-05-20 15:06

本文选题：维吾尔语 + 失语症检查法　；参考：《新疆医科大学》2013年博士论文

【摘要】：第一部分：维吾尔语失语症检查法的标准化研究目的：维吾尔语失语症检查法是翻译汉语失语检查法,按照维吾尔语词句用语的习惯和规则进行少量修改,适用于维吾尔语语言环境,并能用于维吾尔语失语症的诊断和治疗评估用途的评定量表。本部分主要研究维吾尔语失语症检查法的信度和效度。方法：把高素荣的汉语失语检查法翻译成维吾尔语,根据维吾尔语语言特点在某些方面做了适当改动(如复述、听字辨认和书写),但总体结构不变。应用专家评议法对维吾尔语失语症检查法进行了3轮评议及修定,经语言调适和预测试,并再次进行了维汉回译。把它应用于检测了134例维吾尔族正常人和104例维吾尔族脑卒中后失语患者的语言功能,语言功能评定由1名经过培训的维吾尔族研究生于患者入院时进行评定,其中30例患者于一周后再次对其语言功能进行评定。汇总数据运用因子分析法、Spearman秩相关性分析等方法检验维吾尔语失语症检查法的结构效度、内在信度、重测信度和分半信度。结果：维汉回译后,与汉语失语检查法的差异率小于10%。结构效度：KMO值为0.917,bartlett球形检验的P值小于0.005,说明适合因子分析,以主成分分析法及最大方差正交旋转法,按3个因子提取公因子,分别命名为阅读因子、书写因子,听理解因子,共解释了81.03%的方差。内在信度：将量表内容的24方面拆分为四部分,口语表达、听理解、阅读和书写,分别计算各部分的Cronbach α为0.969、0.922、0.966、0.924,总Cronbach α系数为0.978。重测信度：除书写方面的2个项目的相关系数低于0.7外,量表其他22项的重测相关系数都大于0.8。维吾尔语失语症检测量表的分半信度为0.906。结论：本研究认为维吾尔语失语症检查法具有良好的效度、信度；能对维吾尔语失语症进行诊断和分类,定量地反映维吾尔语失语症患者的语言功能状况,适合在临床康复中应用。第二部分：各型维吾尔语失语症的病态语言特点研究目的：旨在通过对维吾尔族失语症病例进行系统地观察和评定,应用神经心理学方法,系统分析各型维吾尔语失语症的病态语言特点,并与汉语失语症进行比较,分析二者病态语言特点的差异性；初步分析各型维吾尔语失语症、失语后书写障碍类型与脑损害部位的关系,为临床维吾尔语失语症的诊断和康复提供理论依据。方法：采用维吾尔语失语症检查法评定符合纳入和排除标准的104例维吾尔族脑卒中后失语症患者,汉语失语检查法评定81例汉语失语症患者,用传统的神经心理学方法对其评定结果的听、说、读、写进行系统分析,并比较二者的差异性。结果：(1)运动性失语表现为非流利性失语口语,呈电报式,实质词为主,语音障碍明显,理解较好,复述障碍,阅读和书写亦有不同程度障碍。经皮质运动性失语总体上与运动性失语类似,但复述好。(2)感觉性失语表现为流利性失语口语,出现较多错语及新语,理解严重障碍,复述、命名、阅读和书写障碍。经皮质感觉性失语总体与感觉性失语类似但复述好。(3)经皮质混合性失语可以看作经皮质运动性失语和经皮质感觉性失语并存,非流利型失语口语,错语较明显,听理解障碍虽重,但较感觉性失语轻,复述功能保留,但不完整。(4)命名性失语表现为流利性失语口语,严重命名障碍,理解、复述、阅读、书写障碍轻。(5)完全性失语者所有的语言功能均严重受损,大多数患者仅能发刻板单音或单词,仅理解1-2个简单指令。(6)基底节性失语多为轻至中度口语流畅性障碍,说话费力缓慢,词与词间缺乏连贯性,构音障碍,理解轻度障碍,复述可正常,阅读及书写中度障碍。(7)丘脑性失语多表现为低音调,语量减少,找词困难,构音中度障碍,命名和理解轻度障碍,复述可正常。维吾尔语人的语言优势半球与汉人一样都在左侧大脑半球,其中62.5%的失语症是由经典的语言中枢病变引起,以运动性失语、完全性失语和经皮质混合性失语较为符合。维吾尔语失语症后书写障碍类型与汉语的基本一致,包括语言性书写障碍和非语言性书写障碍两大类。维、汉两组均以失语性书写障碍多见,其病灶部位分布较广;维语组中失用性失写累及左顶叶,惰性失写累及左额叶及其深部白质,镜像书写病变部位散在分布于左额、顶叶和基底节区。结论：各型维吾尔语失语症的病态语言特点不同,但同一类型维吾尔语、汉语失语症的病态语言特点基本一致。不同的维吾尔语书写障碍类型有不同的病理书写特点,但同一类型维吾尔语、汉语书写障碍的病理书写特点基本一致。维吾尔族人的语言优势半球与汉人的一样在左侧大脑半球；各型维吾尔语失语症、失语后书写障碍类型与脑损伤部位有一定关系。第三部分：维吾尔族、汉族正常人脑激活区差异性的fMRI研究目的：应用fMRI中的BOLD技术,采用两种语言任务探索母语为吾尔语正常人的脑语言功能区。同时比较维汉正常人在执行两种语言任务时的脑激活差异区。方法：选择健康志愿者30例,母语为维吾尔语者15例,母语为汉语者15例,均为右利手,语言功能正常。使用美国公司GE signa3.OT超导磁共振成像系统,用8通道头线圈接收信号。首先用3D薄层扫描序列,获取颅脑横轴位T1加权像,再用梯度回波平面成像序列,进行BOLD信号的数据采集。语言任务采用视觉呈现的方式,每个受试者在进行扫描时执行两种语言任务：语义辨别和动词产生，，对照时注视屏幕上显示“+”号,采用默读方法完成试验任务。用SPM5进行后处理。影像分析使用SPM5进行个体分析和组分析,统计阈值设为矫正的p-≤0.05,且体素≥6,FDR校正之后认为差异有统计学意义。组内和组间数据采用单样本和双样本t检验进行统计学分析。结果：维吾尔语正常人语义辨别任务激活脑区主要在左侧额中回、顶上小叶、枕下回、右侧枕中回有不同程度的激活,左侧大脑半球激活脑区明显多于右侧大脑半球。维、汉正常人语义辨别任务时激活的差异脑区主要在左侧扣带回(BA23)和楔前叶,维吾尔语组在这两个区域表现出显著正激活,而汉语组在该区激活相对较弱,两者差异具有统计学意义。维吾尔语正常人动词产生任务激活脑区主要为双侧额下回、额中回、顶下小叶、前扣带回、辅助运动区、左侧基底节区、中央前回、左侧颞上回、颞中回、梭状回及海马旁回、左侧顶上小叶、双侧岛叶、枕叶及小脑,左侧大脑半球激活脑区明显多于右侧大脑半球。维、汉正常人在执行动词产生任务时,维吾尔语组左侧顶下小叶、左颞下回(BA37)、左侧梭状回和海马旁回等局部脑区可见明显的正激活,汉语组相对激活较弱；而汉语组右颞上回(BA38)可见明显的正激活,维吾尔语组则相对激活较弱。结论：维吾尔语和汉语的语义辨别、动词产生激活脑区不完全相同。左侧扣带回在维吾尔语语义加工中可能更多参与语音加工。汉字加工处理可能比维文加工有更多的右半球参与。
[Abstract]:Part one: standardization of Uyghur aphasia examination.
Objective: the Uygur aphasia examination method is the translation of Chinese aphasia. According to the habits and rules of Uygur language and sentence, it is suitable for Uygur language environment and can be used in the assessment of diagnosis and treatment evaluation of Uygur aphasia. This part mainly studies Uygur aphasia examination. The reliability and validity of the law. Methods: to translate Gao Surong's Chinese aphasia examination into Uygur language. According to the characteristics of Uygur language, appropriate changes (such as retelling, hearing recognition and writing) are made, but the overall structure is unchanged. 3 rounds of evaluation and revision of the Uygur aphasia examination method are carried out by the method of expert review. The language function of 134 Uygur normal people and 104 Uygur post apoplexy aphasia patients was tested, and the language function assessment was assessed by 1 trained Uygur people when the patients were admitted to the hospital, and 30 of them were repeated one week later. Evaluation of language function. Summary data using factor analysis, Spearman rank correlation analysis and other methods to test the structural validity, intrinsic reliability, retest reliability and half reliability of Uygur aphasia examination method. Results: the difference rate between Chinese aphasia and Chinese aphasia was less than 10%. structure validity after Uygur retranslation: KMO value was 0.917, Bartlett ball The P value of form test is less than 0.005, indicating suitable factor analysis, using principal component analysis and maximum variance orthogonal rotation, extracting common factors according to 3 factors, named reading factor, writing factor, listening comprehension factor, and explaining the variance of 81.03%. Intrinsic reliability: the 24 aspects of the content of the scale are divided into four parts, oral expression and listening. The Cronbach alpha of each part was calculated as 0.969,0.922,0.966,0.924, and the total Cronbach alpha coefficient was 0.978. retest reliability, respectively. The correlation coefficient of the other 22 items in the other 22 items of the scale was greater than that of the 0.8. Uygur language loss detection scale, and the semi confidence of the other 22 items was 0.906. conclusion: 0.906. conclusion: This study suggests that Uygur aphasia examination has good validity and reliability. It can diagnose and classify Uygur aphasia and quantitatively reflect the language function of Uygur aphasia patients, which is suitable for clinical rehabilitation.
The second part is about the ill language characteristics of Uygur aphasia.
Objective: through systematic observation and evaluation of Uygur aphasia cases, the pathological language characteristics of Uygur aphasia were systematically analyzed by using neuropsychological methods, and compared with Chinese aphasia, the difference between the two pathological language characteristics was analyzed, and the preliminary analysis of various Uygur aphasia and aphasia The relationship between the type of writing disorder and the site of brain damage provides a theoretical basis for the diagnosis and rehabilitation of clinical Uygur aphasia. Methods: 104 Uygur post-stroke aphasia patients were assessed by the Uygur aphasia examination, and 81 cases of Chinese aphasia were evaluated by Chinese language loss examination. Traditional neuropsychological methods were used to analyze the results of listening, speaking, reading and writing, and comparing the differences between the two. Results: (1) sports aphasia was characterized by non fluency aphasia, telegraph, substance, phonetic disorder, understanding, rehearsal, reading and writing. Sports aphasia is similar to sports aphasia as a whole, but rehearsal. (2) sensory aphasia is characterized by fluent aphasia, more miswords and neologisms, serious disorders, rehearsal, naming, reading and writing disorders. Cortical sensory aphasia is similar to sensorimotor and rehearsal. (3) a mixed aphasia can be seen. The coexistence of cortical motor aphasia and cortical sensory aphasia, non fluent aphasia, the wrong language is more obvious, the hearing understanding is heavy, but less than sensory aphasia, the rehearsal function is retained, but incomplete. (4) named aphasia is fluent aphasia, serious nomenclature, understanding, rehearsal, reading, and writing disorder. (5) completeness All the language functions of the aphasia are severely damaged. Most patients can only make stereotyped monosyllabic words or words and only understand 1-2 simple instructions. (6) basal ganglia aphasia is mostly mild to moderate oral fluency disorder, slow speech effort, lack of coherence between words and words, dysarthria, understanding of mild disorders, rehearsal normal, moderate reading and writing. (7) thalamic aphasia is characterized by hypothalamic aphasia, low tone, reduced language, difficulty finding, moderate dysarthria, naming and understanding of mild disorders, and retelling normal. The verbal dominance of Uygur people is in the left hemisphere like the Han people, and 62.5% of the aphasia is caused by the classical language central lesions, with athletic aphasia, and the end of the language. Total aphasia and cortical mixed aphasia are more consistent. The type of dyslexia after Uygur aphasia is basically the same as that in Chinese, including two major categories of language disorder and nonverbal writing disorder. The two groups of Uygur, Han and Han are more common in aphasia and are more widely distributed in the lesion, and the loss of use in the Uygur language group is involved in the left top. The lotion of the left frontal lobe and the deep white matter in the left frontal lobe and its deep part are scattered in the left forehead, the parietal lobe and the basal ganglia. Conclusion: the pathological language characteristics of all types of Uygur aphasia are different, but the same type of Uygur language in Uygur language is basically the same. Different types of Uygur language disorders are different. There are different characteristics of pathological writing, but the same type of Uygur language, the pathological writing characteristics of Chinese writing disorders are basically the same. The language dominance hemisphere of Uygur people in the left hemisphere is the same as that of Han people; all types of Uygur aphasia, the type of post aphasia writing disorder has a certain relationship with the brain injury.
The third part: fMRI study on the difference of brain activation region between Uygur and Han normal people.
Objective: to use the BOLD technology in fMRI and to explore the brain function area of the normal people of our language with two language tasks, and to compare the brain activation differences between the normal people of the Han Dynasty and the two language tasks. Methods: 30 healthy volunteers were selected, 15 were Uygur, and 15 were Chinese, all were right hand. The function of the language is normal. Using the GE signa3.OT superconducting magnetic resonance imaging system of the United States company, the signal is received with the 8 channel head coil. First, the 3D thin layer scanning sequence is used to obtain the T1 weighted image of the craniocerebral transverse axis, and then the gradient echo plane imaging sequence is used to collect the data of the BOLD signal. Two language tasks were performed during the scanning process: semantic discrimination and verb generation, while the contrast was observed on the screen, "+" was displayed on the screen. The test task was completed by the method of silent reading. The post processing was performed with SPM5. The image analysis used SPM5 for individual analysis and group analysis. The statistical threshold was set to the correct p- < 0.05, and the voxel was more than 6. After the FDR correction, it was considered to be corrected. The differences were statistically significant. The data were statistically analyzed by single sample and double sample t test. Results: the activation brain areas of the Uygur normal people were mainly in the left middle frontal gyrus, the upper lobule, the lower occipital gyrus, the right occipital gyrus in different degrees of activation, the left cerebral hemisphere activated more brain regions than the right side. The difference of brain regions activated in the semantic discrimination task of the cerebral hemisphere. The normal people of the Han people is mainly in the left cingulate gyrus (BA23) and the front of the wedge. The Uygur language group shows significant positive activation in these two regions, while the Chinese group is relatively weak in the area, and the difference between the two is statistically significant. The normal Uygur verb generates the task to activate the brain area. Mainly for bilateral inferior frontal gyrus, middle frontal gyrus, anterior cingulate gyrus, auxiliary motor area, left basal ganglia, anterior central gyrus, left temporal gyrus, middle temporal gyrus, fusiform gyrus and paraphippocampal gyrus, left apical lobule, bilateral insula, occipital lobe and cerebellum, left cerebral hemisphere more active than right cerebral hemisphere. The left apical lobule, left temporal gyrus (BA37), left fusiform gyrus and parahippocampal gyrus were visible positive activation in the Uygur language group, while the relative activation of the Chinese group was weaker, while the right temporal gyrus (BA38) in the Chinese group was obviously positive and the Uygur language group was relatively weak. Conclusion: Uygur and Chinese Semantic discrimination shows that the active brain regions are not exactly the same. The left cingulate gyrus may be more involved in speech processing in Uygur semantic processing. The processing of Chinese characters may be more involved in the right hemisphere than the processing of the Uygur language.
【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R749.13

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