针刺治疗儿童语言障碍的临床及实验研究

【作者】 张全明；

【导师】 靳瑞；

【作者基本信息】 广州中医药大学 ， 针灸学， 2001， 博士

【摘要】 语言障碍（language disorder）是指口语、书面语、手势语等交流能力的缺陷。发生于儿童期的语言障碍包括发育性语言障碍、听力语言障碍、智力迟缓儿童的语言障碍，孤独症儿童语言障碍、脑性瘫痪儿童语言障碍等。本病发病率高、治疗难度大。本文从文献、临床、实验三方面对儿童语言障碍进行了研究。一、文献研究 本文从《内经》、《难经》推本溯源，论述了传统中医学对语言障碍及其治疗的杰出贡献；从成人及儿童失语症的研究历史、语言功能的大脑定位及侧化的研究、语言的进化、发育、信息的处理等方面探讨了语言及其神经机制等现代研究进展；分别对儿童听力语言障碍、智力迟缓儿童语言障碍、孤独症儿童语言障碍、脑性瘫痪儿童语言障碍从发病原因、发病机理、诊断、治疗及预后等方面进行了现代研究概述。为本病的临床及实验研究打下了基础。二、临床研究 由于引起儿童语言障碍的病因不同，本研究分别观察了针刺治疗对不同原因所致的儿童语言障碍的疗效，并进行了有关机理的探讨。（一）针刺治疗智力迟缓儿童语言障碍80例临床观察 本组病例针刺组80例，总有效率77.5％；综合治疗组40例，总有效率82.5％；语言训练组52.5％。以针刺结合语言训练的综合组疗效最佳。针刺组疗效与语言障碍症状分类有关，C群疗效最好，B群、A群次之。针刺组总智商（FIQ）、言语智商（VIQ）、操作智商（PIQ） 针刺治疗儿童语官障碍的临床及实验研究治疗前后自身比较及组间比较，均有明显提高，提示针刺通过提高智力迟缓）L童的智商改善语言及其他认知能力。（二）针刺治疗孤独症儿童语言障碍20例临床研究 本组病例，针刺组 2 0例，总有效率 6 5％；药物对照组 10例，总有效率30％（P叩．01），针刺组疗效明显优于药物对照组。针刺对孤独症儿童语言障碍的图片词汇智商门 值）及社会适应行为商数（ADQ）有明显的改善作用。通过对本组患）L事件相关诱发电位的研究，提示针刺能有效地缩短孤独症儿童无任务 P3潜伏期，活跃 P3波幅，提高其认知能力。（三）针刺治疗脑性瘫痪儿童语言障碍76例临床观察 本组病例针刺组 76例，总有效率 86．吕％，药物对照组 22例，总有效率 59．1％。针刺疗效与年龄有关，早期治疗疗效最好，6岁以内是治疗的最佳时期；其次，针刺疗效与语言障碍的类型有关，对语言迟缓、构音障碍疗效较好，对失语疗效较差。（四）针刺治疗儿童听力语言障碍60例临床观蔡 本组病例针刺组 6 0例，总有效率 7 8．3％，药物对照组 3 6例，总有效率41．7％；针刺组患）L治疗后仍R阈值下降明显，与对照组相比P叩．05。对患儿脑干听觉诱发电位（肘旺）的研究表明：针刺能缩短患儿波潜伏期及波间期，从而改善患儿的听觉功能，改善语言障碍。三．实验研究（一）针刺对脑缺血大鼠幼鼠语言相关脑区及早基困表达的影响 本研究通过双重结扎颈总动脉复制脑缺血动物模型，分别观察针刺治疗后语言相关脑区的C－fOS基固表达情况，结果正常组各脑区未见明显表达，假手术组亦未发现有明显表达，模型组动物各脑区有少量细胞中等水平的表达。针刺组诱导CJOS基因产物（fOS）在有关脑区明显表达，说明针刺治疗后GfOO基困表达的数目明显增高，呈较高水平表达。（二）针刺对脑缺血大鼠幼鼠语言相关脑区自由基损伤的影响 2 针刺治疗儿童语言障碍的临床及实验研究 针刺对脑缺血幼龄大鼠语言相关脑区SOD、LPO、GSH千X具有一定的调节作用，针刺对模型动物针刺治疗后动物脑区与未经治疗的模型组比较SOD、LPO、GSH斗X含量均有明显升高，而u 显著下降。提示针刺增强脑内肥H－PX和 SOD的活性，清除 LPO，减轻了脂质过氧化对脑组织的损害。更多还原

【Abstract】 Language barrier is the defect of tongue written language finger alphabet etc intercourse disability. Language barrier occur in childhood include developing language barrier, audition language barrier, slow intelligence children language barrier, autism children language barrier, children brain paralysis language barrier. The incidence of the disease is high , it is difficult to cure. The article set about the study of children language barrier from three directionsliterature, clinic and e x per i men t. 1. literature study From the original literature ((nei jing) ((nan jing ,the article discuss the great contribution of TCM to language barrier and its treatment. From the history of adult and children aphasia, the study of the brain orientation of language function ,language evolution developing ,deaLing with information, etc, we discuss the modern research advance of the language and nerve mechanism; to summarize the the modern research of children language barrier, audition language barrier, slow intelligence children language barrier, autism children language barrier, language barrier, audition language barrier, slow intelligence children language barrier ,autism children language barrier etc from etiology,diagnosis,pathology, treating and preventing. To found the basement of the clinic and experiment research. 2. Clinic research. Because the cause of children language barrier is different the study observed the curative effect of pin treatment to children language barrier by different causes separately ,and discuss the related mechanism. 2. 1 Treating slow intelligence children language barrier by pin 80 cases , is general efficiency rate is are 77.5% in clinic observation. The colligated group efficiency rate is 82. 5%, the language training group efficiency rate is 52. 5%, and the effect of the colligated group is best. There are 80 cases in the pin group ,and the general efficiency rate is 77.5%,40 cases in colligate group, the general efficiency rate is 82.5%, the efficiency rate of Language training group is 52. 5%, and the effect of integrated pin treating and language training group is best. The effect of the pin group related to the sort of symptoms. The effect of Cluster C is best, and cluster B and C take the second place of the general intelligence quotient , language quotient ,operating quotient there are obvious increasing both in the compare of forendft treatment and different pin treating guoup. It suggest that pin treatment can improve the language and other perceive ability by improve the intelligence quotient of the slow intelligence children. 2. 2 The clinic study of 20 cases children by pin treating. There are 20 cases in the pin group , the general efficiency rate is 65%, 10 cases in the control group , the general efficiency rate is 30%, the effect of the pin group is obvious better than that of the control group (P<0. 01). the pin treating obviously improve the intelligence quotient of picture and word recognize and society adapt behavior of the children autism language barrier. The study of the induced electric point related to the children affairs suggest that pin treatment can shorten the no-wask P3 latent period o更多还原