基于功能性磁共振探讨调神导气法对小儿抽动秽语综合征后认知功能障碍的影响  

Effect of Regulating Shen and Guiding Qi Therapy on Cognitive Dysfunction of TS in Children Based on Functional Magnetic Resonance Imaging

作　　者：李崖雪[1] 白雪 宣威[1] LI Yaxue;BAI Xue;XUAN Wei(The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150040,China;Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学附属第一医院,黑龙江哈尔滨150040 [2]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《针灸临床杂志》2023年第3期10-15,共6页Journal of Clinical Acupuncture and Moxibustion

基　　金：黑龙江省自然科学基金面上项目,编号:H2015033;黑龙江省中医药科研项目,编号:ZHY2020-106。

摘　　要：目的:基于功能性磁共振探讨调神导气法对小儿抽动秽语综合征(TS)后认知功能障碍的影响。方法:将符合纳入标准的60例抽动秽语综合征患儿按照随机数字法分为对照组和观察组(各30例)。两组患者均予以基础治疗,对照组在基础治疗上加用常规推拿治疗,治疗组在对照组基础上加用调神导气法(推拿+热敏灸)治疗,10 d为1个疗程,3个疗程后对总疗效、耶鲁综合抽动严重程度量表(YGTSS)、蒙特利尔认知评估量表(MoCA)、血清5-羟色胺(5-HT)、多巴胺(DA)水平和功能磁共振(ALFF值)等指标进行临床评价和机制探讨。结果:治疗后,治疗组总有效率高于对照组,差异具有统计学意义(P<0.05);治疗后,治疗组的YGTSS评分降低情况优于对照组,差异具有统计学意义(P<0.05);治疗后,治疗组的MoCA评分增高情况优于对照组,差异具有统计学意义(P<0.05);治疗后,治疗组血清5-HT、DA水平降低情况优于对照组,差异具有统计学意义(P<0.05);治疗后,两组患者前额叶、岛叶和纹状体ALFF指标降低。结论:调神导气法治疗小儿抽动秽语综合征后认知功能障碍可有效改善临床抽搐症状及认知功能,降低患者血清5-HT、DA水平,基于fMRI成像观察TS患者,推测TS发病机制与前额叶、纹状体与岛叶脑区的神经元异常活动相关,调神导气法的治疗作用可能与抑制该脑区的异常神经元活动相关。Objective:To investigate the effect of Regulating Shen and Guiding Qi therapy on cognitive dysfunction in children with Tourette s syndrome(TS)based on functional magnetic resonance imaging.Methods:A total of 60 children with TS,who met the inclusion criteria,were randomly divided into the control group(n=30)and the observation group(n=30).Both groups were given basic treatment.The control group was treated with routine Tuina;on which basis,the observation group was also treated with Regulating Shen and Guiding Qi therapy(Tuina plus heat-sensitive moxibustion).10 days were taken as one course of treatment.After three courses of treatment,the total curative effect,the score of Yale Global Tic Severity Scale(YGTSS)and Montreal Cognitive Assessment(MoCA),the serum levels of 5-hydroxytryptamine(5-HT)and dopamine(DA),the value of functional magnetic resonance(ALFF value)and other indicators were measured for clinical evaluation and mechanism speculation.Results:The effective rate of the observation group was higher than that of the control group(P<0.05).The decrease of YGTSS score was more significant in the observation group than that in the control group(P<0.05).The increase of MoCA score was more significant in the observation group than that in the control group after the treatment(P<0.05).The decreases in the serum levels of 5-HT and DA were more significant in the observation group than those in the control group after the treatment(P<0.05).The ALFF indexes of prefrontal lobe,insula,and striatum decreased after the treatment in the two groups(P<0.05).Conclusion:Regulating Shen and Guiding Qi therapy can effectively improve the clinical symptoms of convulsions and cognitive function,and reduce the serum levels of 5-HT and DA in treatment of cognitive dysfunction in children with TS.The onset of TS may be related to the abnormal activity of neurons in prefrontal lobe,striatum,and insula based on fMRI imaging observation,and the therapeutic effect of Regulating Shen and Guiding Qi therapy might be achieved by inhib

关 键 词：推拿 调神导气 抽动秽语综合征 认知功能障碍 

分 类 号：R246.4[医药卫生—针灸推拿学]