针刺阳陵泉对不同病程缺血性脑卒中偏瘫患者脑效应机制研究  

The Brain Effect Mechanism of Acupuncture at Yanglingquan in Patients with Different Durations of Hemiplegia Due to Ischemic Stroke

作　　者：史昕玥 邹忆怀[1] 杜钟名 王雅惠 陈琛 陆梦馨 陈天竹 刘若一 SHI Xinyue;ZOU Yihuai;DU Zhongming;WANG Yahui;CHEN Chen;LU Mengxin;CHEN Tianzhu;LIU Ruoyi(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing University of Chinese Medicine,Beijing 100105,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学,北京100105

出　　处：《安徽中医药大学学报》2022年第6期53-58,共6页Journal of Anhui University of Chinese Medicine

基　　金：国家自然科学基金项目(81873257)。

摘　　要：目的基于功能磁共振成像技术探究针刺阳陵泉对不同病程缺血性脑卒中偏瘫患者的脑效应机制。方法将纳入的40例缺血性脑卒中单侧偏瘫患者分为长、短病程组,在功能磁共振成像扫描期间给予受试者针刺患侧阳陵泉干预。选取双侧半球运动相关脑区[辅助运动区(supplementary motor area,SMA)、背侧运动前区(dorsal premotor area,PMd)、腹侧运动前区(ventral premotor area,PMv)、初级运动区(primary motor area,M1)]共计8个种子点,计算并比较静息态及针刺态下每对种子点间的功能连接度的变化及与Fugl-Meyer运动功能评定量表(Fugl-Meyer assessment,FMA)评分的相关性。结果静息态时长病程组患侧PMv与健侧SMA之间功能连接度明显强于短病程组(P<0.05);长病程组健侧SMA与健侧PMv之间功能连接度在接受针刺后减弱(P<0.05),短病程组双侧SMA之间、健侧SMA与患侧PMv之间、患侧SMA与患侧PMd之间、双侧PMv之间功能连接度在接受针刺后增强(P<0.05)。长病程组中,针刺态时下肢FMA评分与健侧PMd-健侧M1的功能连接度呈负相关(r=-0.411,P<0.05);短病程组中,静息态时下肢FMA评分与健侧PMd-健侧M1、患侧PMv-患侧M1的功能连接度呈负相关(r=-0.588及r=-0.542,P<0.05);在全组中,静息态时下肢FMA评分及全身FMA总分与患侧PMv-患侧M1的功能连接度呈负相关(r=-0.432及r=-0.319,P<0.05)。结论健侧SMA-PMv可作为长病程偏瘫患者接受针刺的效应靶点,双侧SMA、健侧SMA与患侧PMv、患侧SMA与患侧PMd、双侧PMv可作为短病程偏瘫患者接受针刺的效应靶点,这些可作为判断脑卒中偏瘫患者肢体运动功能康复预后的神经生物学指标。Objective To investigate the brain effect mechanism of acupuncture at Yanglingquan in patients with different durations of hemiplegia due to ischemic stroke based on functional magnetic resonance imaging(fMRI).Methods A total of 40 patients with unilateral hemiplegia due to ischemic stroke were enrolled and divided into long duration group and short duration group,and all subjects were given acupuncture at Yanglingquan at the ipsilateral side during MRI scanning.A total of eight seed points were selected in motor-related brain regions(SMA,PMd,PMv,M1)in both hemispheres;the changes in functional connectivity between each pair of seed points in the resting state and the acupuncture state were calculated and compared,and their correlation with Fugl-Meyer Assessment(FMA)score was analyzed.Results In the resting state,compared with the short duration group,the long duration group had a significantly stronger functional connectivity between ipsilateral PMv and contralateral SMA(P<0.05);for the long duration group,the functional connectivity between contralateral SMA and contralateral PMv in the acupuncture state was significantly weaker than that in the resting state(P<0.05),while the short duration group had a significantly stronger functional connectivity between SMA at both sides,between contralateral SMA and ipsilateral PMv,between ipsilateral SMA and ipsilateral PMd,and between PMv at both sides in the acupuncture state than in the resting state(P<0.05).In the long duration group,FMA score of lower extremities was negatively correlated with the functional connectivity between contralateral PMd and contralateral M1 in the acupuncture state(r=-0.411,P<0.05);in the short duration group,FMA score of lower extremities was negatively correlated with the functional connectivity between contralateral PMd and contralateral M1 and between ipsilateral PMv and ipsilateral M1 in the resting state(r=-0.588 and-0.542,P<0.05);in the whole group,FMA scores of lower extremities and whole body were negatively correlated with the fun

关 键 词：功能磁共振成像 脑卒中 偏瘫 脑功能重塑 阳陵泉 功能连接度 

分 类 号：R743.3[医药卫生—神经病学与精神病学]