基于MR ASL探讨针刺心包经、心经穴对脑梗死恢复期患者ROI-CBF的影响
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摘要
目的:观察针刺手厥阴心包经穴、手少阴心经穴对脑梗死恢复期患者各感兴趣区脑血流量(Cerebral Blood Flow,CBF)的影响,为两经治疗缺血性脑血管疾病提供了部分影像学依据。方法:选取2015年10月至2017年8月湖南中医药大学第一附属医院收治的满足纳入标准的脑梗死恢复期患者27例作为研究对象,按照随机数字表方法随机分为心包经组(n=14)和心经组(n=13),选取脑梗死恢复期患者梗死灶、梗死灶旁及对侧镜像区为感兴趣区(Region of Interest,ROI),以ROI-CBF为观察指标,分别对受试者针刺前、针刺即刻及出针后3个时间段进行ASL扫描,运用磁共振成像自带的软件对图像进行后续处理,测量出ROI-CBF,从而分析2组受试者不同时间段下各ROI-CBF的差异。结果:1)心包经组能够提高各组ROI-CBF,差异有统计学意义(P <0. 05),以针刺即刻与针刺后续效应明显;在针刺即刻和出针后时间段,心包经组对各ROI-CBF效应存在差异,CBF效应依次为:镜像区效应>梗死灶旁区效应>梗死灶区效应,差异有统计学意义(P <0. 05)。2)心经组能够提高各组ROI-CBF,差异有统计学意义(P <0. 05),以针刺后续效应为主;在针刺即刻和出针后时间段,心经组对镜像区与梗死灶旁区CBF效应无明显区别,但两者均与梗死灶区CBF效应存在差异,CBF效应依次为:镜像区效应≈梗死灶旁区效应>梗死灶区效应,差异有统计学意义(P <0. 05)。3) 2组对各组ROI-CBF效应增高不一致,心包经组改善CBF效应优于心经组,差异有统计学意义(P <0. 05)。结论:1)针刺心包经/心经穴均能有效提高梗死灶区、梗死灶旁区、镜像区CBF; 2)在同一时间段,针刺两经对梗死灶区、梗死灶旁区、镜像区CBF存在差异,心包经穴效应优于心经穴,提示临床上可以择优选取心包经穴治疗缺血性脑卒中。
Objective: To observe the effects of acupuncturing acupoints of the Pericardium Meridian of Hand-Jueyin and the Heart Meridian of Hand-Shaoyin on cerebral blood flow( CBF) in various regions of interest( ROI) of patients with cerebral infarction during convalescence period,providing some imaging evidence for the treatment of ischemic cerebrovascular diseases. Methods: A total of 27 subjects who met the inclusion criteria in The First Affiliated Hospital of Hunan University of Chinese Medicine from October 2015 to August 2017 were randomly divided into Pericardium Meridian group with 14 cases and Heart Meridian group with 13 cases. The infarction focal area of the cerebral infarction,the peripheral infarction focal area and the opposite mirror area were used as the ROI during the convalescence of cerebral infarction. Taking ROI-CBF as the observation indicator,ASL scanning was used before acupuncture,immediately after acupuncture and after needle extraction to obtain the ROI-CBF,using the software that comes with NMR to post-process images and analyze the differences of ROI-CBF in each period. Results: 1) Each ROI-CBF in the Pericardial Meridian group can be improved( P < 0. 05). The effects of immediately after acupuncture and after needle extraction was obvious; at the time of immediately after acupuncture and after needle extraction,there was a difference among each ROI-CBF effect in the Pericardial Meridian group. The CBF effect was in turn by the opposite mirror area effect > the peripheral infarction focal area effect > infarction focal area effect( P < 0. 05). 2) Each ROI-CBF in the Heart Meridian Group was improved( P < 0. 05),mainly with the follow-up effects of acupuncture; At the time of immediately after acupuncture and after needle extraction,there was no significant CBF effects difference between the opposite mirror area and the peripheral infarction focal area,but the difference in the infarction focal area was found. The CBF effect was in turn by the opposite mirror area effect ≈ the peripheral focal area effect> the infarction focal area effect( P < 0. 05). 3) The increase of each ROI-CBF effect in the 2 groups was inconsistent,and the improvement of CBF effect in the Pericardial Meridian group was better than that in the Heart Meridian group( P < 0. 05). Conclusion: 1) Acupuncture at the Peripheral Meridian or Heart Meridian acupoints can effectively improve CBF in the infarction focal area,the peripheral infarction focal area and the opposite mirror area. 2) At the same period of the acupuncture at the two meridians,there are differences among each CBF of the infarction focal area,the peripheral infarction focal area and the opposite mirror area.The Pericardial Meridian effect is better than that of the Heart Meridian. It suggests a clinical preference for the Pericardium Meridian to treat ischemic stroke.
Objective: To observe the effects of acupuncturing acupoints of the Pericardium Meridian of Hand-Jueyin and the Heart Meridian of Hand-Shaoyin on cerebral blood flow( CBF) in various regions of interest( ROI) of patients with cerebral infarction during convalescence period,providing some imaging evidence for the treatment of ischemic cerebrovascular diseases. Methods: A total of 27 subjects who met the inclusion criteria in The First Affiliated Hospital of Hunan University of Chinese Medicine from October 2015 to August 2017 were randomly divided into Pericardium Meridian group with 14 cases and Heart Meridian group with 13 cases. The infarction focal area of the cerebral infarction,the peripheral infarction focal area and the opposite mirror area were used as the ROI during the convalescence of cerebral infarction. Taking ROI-CBF as the observation indicator,ASL scanning was used before acupuncture,immediately after acupuncture and after needle extraction to obtain the ROI-CBF,using the software that comes with NMR to post-process images and analyze the differences of ROI-CBF in each period. Results: 1) Each ROI-CBF in the Pericardial Meridian group can be improved( P < 0. 05). The effects of immediately after acupuncture and after needle extraction was obvious; at the time of immediately after acupuncture and after needle extraction,there was a difference among each ROI-CBF effect in the Pericardial Meridian group. The CBF effect was in turn by the opposite mirror area effect > the peripheral infarction focal area effect > infarction focal area effect( P < 0. 05). 2) Each ROI-CBF in the Heart Meridian Group was improved( P < 0. 05),mainly with the follow-up effects of acupuncture; At the time of immediately after acupuncture and after needle extraction,there was no significant CBF effects difference between the opposite mirror area and the peripheral infarction focal area,but the difference in the infarction focal area was found. The CBF effect was in turn by the opposite mirror area effect ≈ the peripheral focal area effect> the infarction focal area effect( P < 0. 05). 3) The increase of each ROI-CBF effect in the 2 groups was inconsistent,and the improvement of CBF effect in the Pericardial Meridian group was better than that in the Heart Meridian group( P < 0. 05). Conclusion: 1) Acupuncture at the Peripheral Meridian or Heart Meridian acupoints can effectively improve CBF in the infarction focal area,the peripheral infarction focal area and the opposite mirror area. 2) At the same period of the acupuncture at the two meridians,there are differences among each CBF of the infarction focal area,the peripheral infarction focal area and the opposite mirror area.The Pericardial Meridian effect is better than that of the Heart Meridian. It suggests a clinical preference for the Pericardium Meridian to treat ischemic stroke.
引文
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[19]何素娟,夏云,吕梓瑜,等.电针手厥阴心包经穴对脑梗死恢复期患者脑血流动力学即刻效应的影响[J].新中医,2016,48(5):43-45.
[20]吕梓瑜,何素娟,娄必丹,等.电针手少阴心经穴对脑梗死恢复期患者脑血流动力学即刻干预效应的研究[J].中医药导报,2016,22(4):69-71.
[21]王红民.心经与心包经主病新解[N].中国中医药报,2013-10-21(4).
[22]田浩梅,张泓,张娟.针灸对缺血性脑卒中相关保护作用机制的研究概况[J].湖南中医药大学学报,2012,32(7):75-78.
[23]Astrup J,Siesjo BK,Symon L.Thresholds in cerebral ischemia-the ischemic penumbra[J].Stroke,1981,12(6):723-725.
[24]Heiss WD.The ischemic penumbra:correlates in imaging and implications f-or treatment of ischemic stroke[J].Cerebrovasc Dis,2011,32(4):307-320.
[2]石文英,李平,常小荣,等.电针心经穴与非经非穴对rs-f MRI脑功能连接的影响[J].针刺研究,2017,42(3):229-234.
[3]Pollock JM,Tan H,Krall RA,et al.Arterial spin-labeled MR perfusion Imaging:clinical applications[J].Magn Reson Imaging Clin NAm,2009,17(2):315-338.
[4]Chalela JA,Alsop DC,Gonzalez-Atavales JB,et al.Mag-netic resonance perf-usion imaging in acute ischemic stroke using continuous arterial spin labeling[J].Stroke,2000,31(3):680-687.
[5]Kim S-G.Quantification of relative cerebral blood flow change by flow-se-nsitive alternating inversion recovery(FAIR)technique:pplication to functional mapping[J].Magneticresonance in medicine,1995,34(3):293-301.
[6]Deter JA,Alsop DC,Vives LR,et al.Noninvasive MRI evaluation of cerebra blood flow in cerebrovascular disease[J].Neurology,1998,50(3):633-641.
[7]Chalela JA,Alosp OC,Gonzalez lavales JB,el al.Magnelic Iesonance perfusi on imaging in acute ischemic stroke using conlinuous arterial spin labeling DJ[J].Stroke,2000,31(3):680-687.
[8]De Vis JB,Hendlikse J,Petersen ET,et al.Arterial spin-labelling perfusion MRI and outcome in neonates with hypoxic-ischemc encephalopathy[J].Eur Radiol,2015,25(1):113-121.
[9]Wintermark P,Hansen A,Warfield SK,et al.Near-in-frared spectroscopy versu-s magnetic resonance imaging to study brain perfusion in newbornts with hypoxic-ischemic encephalopathy treated with hypothermia[J].Neuroimage,2014,85(1):287-293.
[10]hang S,Zhang SX,Yao YH,et al.The application of three-dimension arteri-al spin labeling(3D-ASL)in ischemic cerebrovascular disease[J].Radiol Practice,2015,30(2):119-123.
[11]张国庆,韩为,王文静,等.基于动脉质子自旋标记技术探讨通督调神针刺对短暂性脑缺血发作患者脑血流的影响[J].安徽中医药大学学报,2017,36(1):46-49.
[12]林春涛,林敏,钱琦,等.ASL在缺血性脑卒中治疗疗效评价中的应用[J].浙江中医药大学学报,2015,39(4):292-295.
[13]雷茹.利用ASL技术对头针治疗缺血性轻型卒中的临床疗效观察[D].合肥:安徽中医药大学,2015.
[14]周美启,周逸平.心主二经论[J].中国针灸,2004,4(24):52-54.
[15]章薇.电针对MCAO大鼠心脑组织IL-1P及转换酶基因表达的影响[D].长沙:湖南中医学院,2004.
[16]谭文刚.血管内机械取栓治疗急性脑梗死疗效观察[J].新乡医学院学报,2019,36(1):85-88.
[17]Widenfalk J,Lipson A,Juhran M,et al.Vascular endothelial growth factor imp-roves functional outcome and decreases secondary degeneration in experimental spinal cord contusion injury[J].Neuroscience,2003,120(4):951-960.
[18]陈芳,杨玲,王晓明,等.不同频率重复经颅磁刺激治疗恢复期脑梗死患者疗效观察[J].新乡医学院学报,2016,33(6):480-482.
[19]何素娟,夏云,吕梓瑜,等.电针手厥阴心包经穴对脑梗死恢复期患者脑血流动力学即刻效应的影响[J].新中医,2016,48(5):43-45.
[20]吕梓瑜,何素娟,娄必丹,等.电针手少阴心经穴对脑梗死恢复期患者脑血流动力学即刻干预效应的研究[J].中医药导报,2016,22(4):69-71.
[21]王红民.心经与心包经主病新解[N].中国中医药报,2013-10-21(4).
[22]田浩梅,张泓,张娟.针灸对缺血性脑卒中相关保护作用机制的研究概况[J].湖南中医药大学学报,2012,32(7):75-78.
[23]Astrup J,Siesjo BK,Symon L.Thresholds in cerebral ischemia-the ischemic penumbra[J].Stroke,1981,12(6):723-725.
[24]Heiss WD.The ischemic penumbra:correlates in imaging and implications f-or treatment of ischemic stroke[J].Cerebrovasc Dis,2011,32(4):307-320.