基于格兰杰因果探讨缺血性卒中后偏瘫患者针刺脑效应机制  

Exploration on the Brain Mechanism Underlying Acupuncture Effects in Hemiplegic Patients after Ischemic Stroke Based on Granger Causality

作　　者：许天骄 陆梦馨 李媛媛[3] 张慕昭 邹忆怀[3] 方继良[1] XU Tianjiao;LU Mengxin;LI Yuanyuan;ZHANG Muzhao;ZOU Yihuai;FANG Jiliang(Guang'anmen Hospital of China Academy of Chinese Medical Sciences,Beijing 100053,China;Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China;Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]首都医科大学附属北京朝阳医院,北京100020 [3]北京中医药大学东直门医院,北京100700

出　　处：《中国中医药信息杂志》2025年第4期135-140,共6页Chinese Journal of Information on Traditional Chinese Medicine

基　　金：国家自然科学基金(82174331、82174282)。

摘　　要：目的运用功能磁共振成像(fMRI),讨论“手足十二针”对缺血性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2018年12月-2023年3月于北京中医药大学东直门医院脑病一区、脑病二区、针灸一区的住院患者,采用随机数字表法将患者分为真穴组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1寸针刺,每日1次,连续干预10 d。干预完成,剔除干预过程脱落、核磁数据质量不合格、临床量表不完整受试者,进行数据处理分析。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(ROI),比较2组治疗前后组内、组间格兰杰因果(GC)关系变化和量表评分差异。结果真穴组干预后CAU.R→PreCG.R、AMYG.R→PAL.R的GC较干预前增强,真穴组干预后THA.L→PAL.L、AMYG.R→THA.R较干预前减弱(P<0.05);假穴组干预后AMYG.R→PUT.L的GC较干预前增强,假穴组干预后THA.L→PreCG.R、AMYG.L→CAU.L较干预前减弱(P<0.05);真穴组干预前THA.R→PAL.L的GC较假穴组干预前增强,真穴组干预前CAU.L→PreCG.R、PUT.L→PreCG.R较假穴组干预前减弱(P<0.05);真穴组干预后CAU.R→PreCG.R、THA.L→PreCG.R、AMYG.R→CAU.L、THA.L→PAL.R、AMYG.L→THA.L的GC较假穴组干预后增强,真穴组干预后AMYG.R→AMYG.L较假穴组干预后减弱(P<0.05)。结论“手足十二针”激发右侧运动环路发生优先代偿、双侧基底节重塑和对丘脑兴奋-抑制平衡调节作用,改善运动功能障碍和神经缺损程度;针刺经穴较非经非穴处更多激发脑区活性,提示穴位特异性。Objective To discuss the effects of the“twelve needles for hands and feet”acupuncture on the brain response mechanism and acupoint specificity in hemiplegic patients after ischemic stroke using fMRI.Methods Totally 43 inpatients from Dongzhimen Hospital of Beijing University of Chinese Medicine from December 2018 to March 2023 were included.The included patients were randomly divided into a true acupoint group of 23 cases and a fake acupoint group of 20 cases using the random number table method for clinical scale evaluation and magnetic resonance scanning.The true acupoint group received“twelve needles for hands and feet”acupuncture;the fake acupoint group was treated with acupuncture by opening 1 inch next to the meridian point,once a day,for consecutive 10 d.Intervention completed,excluding subjects who fell out during the intervention process,had unsatisfactory MRI data quality and had incomplete clinical scales,and conducting data processing and analysis.Bilateral anterior central gyrus(PreCG),amygdala(AMYG),caudate nucleus(CAU),putamen lenticularis(PUT),pallidus lenticularis(PAL)and thalamus(THA)were selected as regions of interest(ROI),and the changes in Granger causality(GC)and differences in scale scores between the two groups before and after treatment were compared.Results After intervention in the true acupoint group,the GC of CAU.R→PreCG.R,AMYG.R→PAL.R was stronger than before intervention,and the GC of THA.L→PAL.L,AMYG.R→THA.R in the true acupoint group was weaker than before intervention(P<0.05);after intervention with fake acupoints,the GC of AMYG.R→PUT.L in the false acupoint group was stronger than before intervention,and the GC of THA.L→PreCG.R,AMYG.L→CAU.L was weaker than before intervention(P<0.05);the GC of THA.R→PAL.L before intervention was stronger than false acupoint group,the GC of CAU.L→PreCG.R,PUT.L→PreCG.R before intervention was weaker than fake acupoint group(P<0.05);the GC of CAU.R→PreCG.R,THA.L→PreCG.R,AMYG.R→CAU.L,THA.L→PAL.R,AMYG.L→THA.L af

关 键 词：卒中 偏瘫 功能磁共振 格兰杰因果 手足十二针 脑效应 

分 类 号：R277.71[医药卫生—中医学]