针刺治疗卒中后偏瘫M1区-基底节-丘脑环路代偿-重塑脑效应机制研究  

Research on Compensatory and Remodeling Brain Effect Mechanism of Acupuncture Treatment on the M1-Basal Ganglia-Thalamic Circuit in Poststroke Hemiplegia

作　　者：许天骄 陆梦馨 李媛媛[1] 张慕昭 武琳璐 邹忆怀[1] XU Tianjiao;LU Mengxin;LI Yuanyuan;ZHANG Muzhao;WU Linlu;ZOU Yihuai(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]首都医科大学附属北京朝阳医院,北京100020

出　　处：《山东中医杂志》2025年第2期184-190,共7页Shandong Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81873257);北京市自然科学基金项目(编号:7182104)。

摘　　要：目的:运用功能磁共振成像(fMRI),讨论“手足十二针”对卒中后偏瘫患者脑效应机制的影响和经穴特异性。方法:纳入43例卒中后偏瘫患者为观察组、28例健康人为对照组,观察组按随机数字表法分为真穴组23例、假穴组20例,进行临床量表评价和核磁扫描。真穴组予“手足十二针”针刺;假穴组予经穴旁开0.5寸针刺。选取双侧中央前回(PreCG)、杏仁核(AMYG)、尾状核(CAU)、豆状壳核(PUT)、豆状苍白球(PAL)、丘脑(THA)作为感兴趣区,比较真穴组干预后、假穴组干预后以及观察组干预前与对照组组间格兰杰因果关系(GC)变化。结果:观察组干预前AMYG.R→PreCG.R、PreCG.R→AMYG.R、CAU.L→AMYG.R、AMYG.R→CAU.L、PAL.R→CAU.R的GC强于对照组,观察组干预前PreCG.L→PreCG.R、PAL.L→PreCG.R、AMYG.R→PUT.L、PreCG.R→PAL.L、CAU.L→THA.R弱于对照组(P<0.05)。真穴组干预后AMYG.R→CAU.L、PAL.R→CAU.R、AMYG.R→PAL.R强于对照组,真穴组干预后PreCG.L→PreCG.R、PUT.L→AMYG.R弱于对照组(P<0.05)。假穴组干预后PAL.R→CAU.R、AMYG.L→THA.R的GC强于对照组,假穴组干预后PreCG.L→PreCG.R、AMYG.L→PAL.L、AMYG.R→THA.R的GC弱于对照组(P<0.05)。结论:右侧运动环路在卒中发生前期,存在优先代偿的侧化倾向;双侧基底节重塑及对丘脑兴奋-抑制平衡调节可能是单侧运动环路损伤后自适应运动控制发挥的基础;针刺经穴较非经非穴处更多激发脑区活性,提示穴位具有特异性。Objective:To explore the effect of“twelve needles for hands and feet”acupuncture on the M1-basal ganglia-thalamic loop effect connection in patients with poststroke hemiplegia using functional magnetic resonance imaging(fMRI),and to investigate the specificity of acupoint selection and the mechanism behind brain effect.Methods:Forty-three patients with post-stroke hemiplegia were included as trial group,and twenty-eight healthy individuals were included as the control group.The trial group were divided into a true acupoint group of 23 cases and a sham acupoint group of 20 cases according to the random number table method.Both groups underwent clinical evaluation and magnetic resonance imaging.The true acupoint group received“twelve needles for hands and feet”acupuncture,while the sham acupoint group received acupuncture 0.5 cun away from the meridian point.Regions of interest included the bilateral anterior central gyrus(PreCG),amygdala(AMYG),caudate nucleus(CAU),putamen(PUT),globus pallidus(PAL),and thalamus(THA).Changes in Granger causality(GC)and differences in scale scores were compared between the two groups before and after treatment.Results:Before the intervention,the GC from AMYG.R→PreCG.R,PreCG.R→AMYG.R,CAU.L→AMYG.R,AMYG.R→CAU.L,and PAL.R→CAU.R in the trial group was stronger than in the control group.Before the intervention,the GC from PreCG.L→PreCG.R,PAL.L→PreCG.R,AMYG.R→PUT.L,PreCG.R→PAL.L,and CAU.L→THA.R in the trial group was weaker than in the control group(P<0.05).After the intervention,in the true acupoint group,the GC from AMYG.R→CAU.L,PAL.R→CAU.R,and AMYG.R→PAL.R was stronger than in the control group.After the intervention,in the true acupoint group,the GC from PreCG.L→PreCG.R and PUT.L→AMYG.R was weaker than in the control group(P<0.05).After the intervention,in the sham acupoint group,the GC from PAL.R→CAU.R and AMYG.L→THA.R was stronger than in the control group,while the GC from PreCG.L→PreCG.R,AMYG.L→PAL.L,and AMYG.R→THA.R was weaker than in

关 键 词：卒中后偏瘫 功能磁共振成像 格兰杰因果 针刺 脑效应机制 

分 类 号：R246[医药卫生—针灸推拿学]