摘要目的:探讨不同类型言语障碍患儿的语言能力发育特征及其影响因素。方法:病例对照研究，选取2021年1月至2023年11月在首都儿科研究所附属儿童医院保健中心语言-言语门诊初次就诊并诊断为言语障碍的262例患儿，其中语音障碍患儿作为语音障碍组、言语流畅障碍患儿作为语畅障碍组。选取同期于儿童保健中心体检的100名健康儿童作为健康组，均进行梦想普通话听力理解和表达能力标准化评估（DREAM-C）检查及问卷调查。采用单因素方差分析和LSD检验比较3组儿童整体语言、听力理解、语言表达、语义、句法能力的发育水平；根据DREAM-C评估结果将言语障碍组患儿分为语言发展正常组及落后组，通过 χ2检验、多因素Logistic回归分析言语障碍患儿语言能力发展的影响因素。 结果:语音障碍组患儿145例，其中男110例、女35例，年龄（5.9±1.0）岁；语畅障碍组患儿117例，其中男91例、女26例，年龄（5.8±1.0）岁；健康组儿童100名，其中男75名、女25名，年龄（5.7±1.2）岁。3组儿童在DREAM-C评估中整体语言、语言表达、句法分数差异均有统计学意义（92±18比96±11、98±11，81±18比84±14、88±13，87±16比89±11 、91±10， F=5.46、4.69、3.68，均 P<0.05）；两两比较显示语音障碍组整体语言、语言表达、句法能力均低于健康组儿童，差异均有统计学意义（均 P<0.01），整体语言能力低于语畅障碍组儿童，差异有统计学意义（ P<0.05）。语音障碍组、语畅障碍组和健康组整体语言、语言表达能力落后发生率差异均有统计学意义［15.9%（23/145）比20.5%（24/117）、7.0%（7/100），46.2%（67/145）比39.3%（46/117）、26.0%（26/100）， χ 2=7.93、10.28，均 P<0.05］，其中语畅障碍组整体语言落后发生率最高，语音障碍组语言表达能力落后发生率最高。言语障碍患儿语言发展落后的发生率是44.3%（116/262）。无亲子阅读、每日屏幕时间≥1 h、过早屏幕暴露（小于1.5岁）均为言语障碍儿童语言能力发展的危险因素（ OR=1.87、2.18、2.01，95% CI 1.07~3.27、1.23~3.86、1.17~3.45，均 P<0.05）；无家族相关病史为语言能力发展的保护因素（ OR=0.37，95% CI 0.17~0.81， P<0.05）。 结论:言语障碍患儿容易并发语言发展落后，以语言表达和句法能力落后为主，其语言发展与家族相关病史、亲子阅读、屏幕时间等因素有关，应关注言语障碍患儿语言能力发展。

abstractsObjective:To investigate the features and influencing factors of language in children with various types of speech disorders.Methods:A case-control study was carried out, 262 children with speech disorder had been diagnosed at the language-speech clinic of the Center of Children′s Healthcare, Children′s Hospital, Capital Institute of Pediatrics from January 2021 to November 2023, the children with speech sound disorder as the speech sound disorder group, the children with developmental stuttering as the stuttering group. There were 100 typically-developed children who underwent physical checkups at the Center of Healthcare during the same period as the healthy group. All children experienced a standardized evaluation of language with diagnostic receptive and expressive assessment of mandarin‐comprehensive(DREAM-C) and questionnaire, One-way ANOVA and LSD test were conducted to compare the differences in overall language, receptive language, expressive language, semantics, and syntax scores among 3 groups of children. According to the results of DREAM-C, the children with speech disorder were divided into language normal group and language delay group. Chi‐square test and multivariate Logistic regression were implemented to analyze the association between the linguistic development of children with speech disorder and potential influential factors.Results:There were 145 children in the speech sound disorder group, including 110 males and 35 females respectively, with an age of (5.9±1.0) years; 117 children in the stuttering group, including 91 males and 26 females, with an age of (5.8±1.0) years; 100 children in the healthy group, including 75 males and 25 females, with an age of (5.7±1.2) years. The variations in overall language, expressive language, and syntax scores among 3 groups of children were statistically significant (92±18 vs.96±11 vs. 98±11, 81±18 vs. 84±14 vs. 88±13, 87±16 vs. 89±11 vs. 91±10, F=5.46, 4.69, 3.68, all P<0.05). Pairwise comparison revealed that the speech sound disorder group had lower scores in overall language, expressive language, and syntactic compared to the healthy group, and the differences were statistically significant (all P<0.01) and the overall language score was lower than that of children with stuttering ( P<0.05). In terms of overall language and expressive language, there was a statistically significant difference in the incidence of language delay among the three groups of children (15.9% (23/145) vs. 20.5% (24/117) vs. 7.0% (7/100), 46.2% (67/145) vs. 39.3% (46/117) vs. 26.0% (26/100); χ2=7.93, 10.28; both P<0.05). In terms of overall language, the stuttering group took up the highest proportion. In terms of expressive language, the speech sound disorder group accounted for the highest amount. The incidence of language delay in children with speech disorder was 44.3% (116/262). Non-parent-child reading, daily screen time ≥1 hour and screen exposure before 1.5 years of age are risk factors for the development of language in children with speech disorder ( OR=1.87, 2.18, 2.01; 95% CI 1.07-3.27, 1.23-3.86, 1.17-3.45; all P<0.01). Negative family history are protective factors for the progress of language ability ( OR=0.37, 95% CI 0.17-0.81, P<0.05). Conclusions:Children with speech disorder tend to have easy access to language delay, especially in expressive language and syntax. The occurrence of language delay in children with speech disorder is tightly connected with factors such as the family medical history, parent-child reading, screen time, etc. Attention should be paid to the development of language in children who suffer from speech disorder.