基于静息态fMRI对头针、重复经颅磁刺激治疗上肢运动功能障碍脑梗死的机制研究  

Resting-state fMRI study on the mechanism of scalp acupuncture and repeated transcranial magnetic stimulation in cerebral infarction patients with upper limb motor dysfunction

作　　者：曹玉婷 梁育源 赵宁 CAO Yuting;LIANG Yuyuan;ZHAO Ning(不详;Rehabilitation Medicine Department,Sixth Affiliated Hospital of Shenzhen University,Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen 518000,China)

机构地区：[1]华中科技大学协和深圳医院/深圳大学第六附属医院康复医学科,广东深圳518000 [2]湖南中医药大学研究生院,湖南长沙410000 [3]深圳大学第六附属医院/华中科技大学协和深圳医院康复医学科,广东深圳518000

出　　处：《中国中西医结合影像学杂志》2022年第2期141-145,175,共6页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金面上项目(81874499);华中科技大学协和深圳医院(南山医院)院内课题(2019004)。

摘　　要：目的:基于静息态fMRI体素镜像同伦连接(VMHC)探讨头针、重复经颅磁刺激(rTMS)治疗上肢运动功能障碍脑梗死潜在的神经生理学机制。方法:筛选脑梗死后上肢运动功能障碍患者共576例,最终纳入34例,根据治疗方法分为头针组9例、rTMS组13例、头针联合rTMS组12例,3组均在常规康复治疗的基础上,予以2周的头针、rTMS及头针联合rTMS干预。干预前后行静息态fMRI扫描。统计VMHC在治疗前后的差异。结果:经Alphasim校正显示,头针组双侧背外侧额上回、额中回、辅助运动区、颞中回、颞下回、角回、小脑、距状裂的VMHC均较干预前增强(均P<0.05);rTMS组双侧颞下回、角回的VMHC均较干预前增强(均P<0.05);头针联合rTMS组双侧背外侧额上回、颞极、小脑均较干预前减弱(均P<0.05)。结论:头针和rTMS治疗上肢运动功能障碍脑梗死的神经生理学机制可能是通过改善不同脑区的半球间功能连接实现的。Objective:To explore the potential neuroimaging mechanism of scalp acupuncture and repetitive transcranial magnetic stimulation(rTMS)in cerebral infarction patients with upper limb motor dysfunction based on the resting state fMRI voxel-mirrored homotopic connectivity(VMHC)technique.Methods:A total of 576 patients with upper limb motor dysfunction after cerebral infarction were screened,and finally 34 patients were included,9 patients were in the scalp acupuncture group,13 patients in the rTMS group and 12 patients in the scalp acupuncture combined TMS group.On the basis of routine rehabilitation,the patients in three groups were treated with scalp acupuncture,rTMS or combined therapy for 2 weeks respectively.The differences of VMHC with resting-state fMRI scanning before and after treatment were observed.Results:The VMHC of bilateral frontal superior gyrus,middle frontal gyrus,supplementary motor area,temporal middle gyrus,temporal inferior gyrus,angular gyrus,cerebellum and talar fissure in scalp acupuncture group was increased after intervention(all P<0.05);the VMHC of bilateral temporal inferior gyrus,angular gyrus in rTMS group was increased after intervention(both P<0.05);the VMHC of bilateral frontal superior gyrus,temporal pole,cerebellum in combined group was decreased after intervention(all P<0.05).Conclusion:The neuroimaging mechanism of scalp acupuncture and rTMS in cerebral infarction patients with upper limb motor dysfunction may be through the change of VMHC in different brain regions.

关 键 词：大脑梗死 头针 经颅磁刺激 磁共振成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]