针刺对缺血性中风患者静息状态下脑功能及脑结构影响的研究
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摘要
目的
以静息状态下复杂的脑功能及脑结构为切入点,以健康受试者和缺血性脑中风患者为研究载体,从脑功能、脑结构的角度揭示针刺治疗缺血性中风的中枢机制,为针刺治疗缺血性中风的临床应用提供科学的可视化依据。
方法
1.采用BOLD-fMRI成像技术,以静息态脑局部一致性为观测指标,以10例健康被试者(A组)和20例缺血性中风患者为研究对象,其中20例中风患者随机分为针刺治疗组(B组)、常规治疗组(C组)。比较B组、C组中风患者治疗前、后与A组健康受试者的异同。将中风患者Reho明显变化脑区与临床NDS、FMA量表评分进行相关分析,从脑功能角度探讨针刺治疗中风的中枢机制。
2.采用VBM测量方法,以静息态脑灰质密度为观测指标,研究对象、分组及治疗均同第一部分。观察B组与C组中风患者治疗前、后脑灰质密度的动态变化及与A组健康受试者的异同。将中风患者脑灰质密度明显变化的脑区与临床NDS、FMA、Barthel指数评分进行相关性分析,从脑结构的角度分析针刺治疗中风的中枢机制,为针刺对脑功能的改变提供重要的物质基础。
结果
1.两组缺血性中风患者临床各量表评价结果：①两组组内比较：B组、C组治疗前后组内NDS、FMA、Barthel指数评分比较均具有统计学差异(P<0.01)；B组、C组治疗结束后、12周后随访组内NDS、FMA量表评分改善值比较具有显著差异(P<0.01),而Barthel指数无差异(P>0.05)。②两组组间比较：B组、C组治疗前组间NDS、FMA、Barthel指数评分比较均无差异(P>0.05)；治疗后NDS量表评分无差异(P>0.05)、而FMA、Barthel指数评分有差异(P<0.05)；B组、C组治疗结束后、12周后随访组间NDS、FMA量表评分改善值比较具有差异(P<0.01；P<0.05),而Barthel指数评分改善值比较均无差异(P>0.05)。
2.针刺对缺血性中风患者脑功能影响的研究结果：B组及C组中风患者治疗前与A组健康者相比,多个脑功能区Reho发生变化；B组及C组中风患者治疗后与A组健康者相比,基底节区(SG)、小脑、初级运动区(M1)、运动前区(PMA)、辅助运动区(SMA)、顶下小叶(IPL)ReHo信号变化明显。选择基底节(尾状核)、小脑、M1、SMA、PMA、IPL为重点研究区域,探讨B组与C组中风患者以上区域脑ReHo信号改变和临床NDS、FMA量表评分的相关性。结果显示：基底节(尾状核)、小脑ReHo信号改变与NDS量表评分呈负相关(P<0.05；P<0.01),M1、PMA、SMA、IPLReHo信号改变与NDS量表评分呈正相关(P<0.05；P<0.01)；M1、SMA、IPL与FMA量表评分呈负相关(P<0.05；P<0.01),而PMA、基底节(尾状核)、小脑与FMA量表评分无相关性(P>0.05)。
3.针刺对缺血性中风患者脑结构影响的研究结果： B组及C组中风患者治疗前与A组健康者相比,多个脑区灰质密度异常,B组及C组中风患者治疗后,脑灰质密度有所改善。其中尾状核、扣带回、中央前回、楔叶脑灰质密度改变明显。将两组中风患者中央前回、扣带回、楔叶、基底节(尾状核)脑灰质密度改变与临床NDS、FMA及Barthel指数评分进行相关分析。结果显示：楔叶、中央前回灰质密度变化与NDS评分呈正相关(P<0.01；P<0.05),基底节(尾状核)、扣带回灰质密度变化与NDS评分呈负相关(P<0.01；P<0.05)；楔叶灰质密度变化与FMA、Barthel指数评分呈负相关(P<0.01),基底节(尾状核)灰质密度变化与FMA、Barthel指数评分呈显著正相关(P<0.01),而中央前回、扣带回与FMA、Barthel指数评分无相关性(P>0.05)。
结论
1.从临床量表评价进一步证实：常规加针刺治疗中风优于单独的常规治疗。
2.静息状态下缺血性中风患者存在脑功能区异常,基底节区是缺血性中风患者运动功能损害的主要脑区,是针刺治疗缺血性中风患者的中心靶点。
3.脑初级运动区、运动前区、辅助运动区、顶下小叶是缺血性中风患者静息态脑功能重组及代偿的关键区域,是针刺治疗中风患者重要的调制区域。
4.静息状态下缺血性中风患者存在广泛的脑结构异常,灰质密度的异常改变是中风患者脑结构异常的主要特征,也是脑功能异常的物质基础。
5.对静息状态下“默认网络”及“运动网络”关键区域脑灰质密度的调节是实现针刺治疗缺血性中风的核心机制。
Objective
Taking the complex brain function and brain structure in the resting-state as an entry point, taking healthy volunteers and patients with ischemic stroke as the research subjects, The research explored the central mechanisms of ischemic stroke from the perspective of brain function and brain structure, aiming at providing evidences for acupuncture to treat ischemic stroke.
Methods
1. BOLD-fMRI technology was adopted and regional homogeneity was observed in the research. We choosed10healthy volunteers (A group) and20patients with ischemic stroke as participants. The20paralytics were divided into acupuncture treatment group (B group) and traditional treatment group (C group), observe the dynamic change of regional homogeneity of the whole brain for both B and C groups before and after treatment. compared A with B and C group.Then correlation analysis was carried for the brain region of ischemic stroke with sinificant Reho change and NDS、FMA scale index, aiming at explore the brain mechanisms for acupuncture to treat ischemic stroke from the brain function perspective.
2.Based on VBM measurement technology, Cerebral gray matter concentration was measured, and the reasearch object、groups division and treatment were the same as part one. observe the dynamic change of gray matter concentration of the whole brain and various encephalic regions for both B and C groups before and after treatment. compared A with B and C group. Then correlation analysis was carried for the brain region of ischemic stroke with sinificant gray matter concentration change and NDS、FMA、Barthel scale index, aiming at analyzing the brain mechanisms for acupuncture to treat ischemic stroke from the brain structure perspective and providing inportant material basis for acupuncture influencing alteration of brain function.
Results
1. Results for clinical evaluation scales for both B and C groups①Intragroup comparision:as for the clinical evaluation indexes (NDS, FMA, Barthel), there was significant difference statistically between before and after treatment for both B and C groups (P<0.01). the intragroup improvement indexes of NDS and FMA scale were also significant statistically12weeks later (P<0.01), but not for Barthel indexes (P>0.05).②ntergroup comparision:There was no significant difference between B and C group before treatment as for.the indexes of NDS, FMA and Barthel (P>0.05); After the treatment, there was no significant difference for NDS scale index (P>0.05). As for FMA and Barthel indexes, the difference was significant statistically (P <0.05). the intergroup improvement indexes of NDS and FMA scale were also significant statistically12weeks later (P<0.01; P<0.05), but not for Barthel indexes (P>0.05).
2. Results of acupuncture influencing alteration of brain function, before treatment, compared with healthy volunteers (A group), the abnormality of regional homogeneity occurred in many encephalic regions for both B and C groups. After treatment, compared with healthy volunteers (A group), regional homogeneity signal changed obviously in SG and cerebellum,M1, PMA, SMA and IPL for both B and C groups. SG、cerebellum、M1、SMA、PMA and IPL were chosen as important encephalic regions in the research, aiming at exploring the correlation of Reho signal in the above-mentioned sections and clinical scale (NDS、FMA) between B and C groups. Results indicated:there was negative correlation between the signal change of SG and cerebellum and NDS scale indexes (P<0.05;(P<0.01). There were positive correlations between the signal change of many encephalic regions (such as M1、 PMA, SMA, IPL) and NDS scale indexes (P<0.05; P<0.01).The Reho signal change of M1、SMA and IPL was negatively correlated with FMA scale indexes (P<0.05; P<0.01). Whereas the ReHo signal of PMA%SG and cerebellum were irrespective of FMA scale indexes (P>0.05).
3. Results of acupuncture influencing alteration of brain structure:before treatment, compared with healthy volunteers (A group), the abnormality of cerebral gray matter concentration occurred in many encephalic regions for both B and C groups, the abnormality of the gray matter concentration occurred in such encephalic regions as precentral gyrus (BA4)、inferior parietal lobule (BA40)、cuneus (BA18), precuneus (BA7)、cingulate gyrus (BA24、32). After treatment, the gray matter concentration in the above-mentioned encephalic regions improved for both B and C groups. The correlation analysis was carried between the gray matter concentration alteration in many encephalic regions (such as SG、BA4、BA24、BA32、 BA18).and clinical scale indexes (such as NDS、FMA and Barthel) for both B and C groups. Results indicated:the gray matter concentration alteration in BA4and BA18were positively correlated with NDS scale index (P<0.01; P<0.05), whereas the gray matter concentration alteration in SG and BA24.,32were negatively correlated with NDS scale index (P<0.01; P<0.05). There was negative correlation between gray matter concentration alteration in BA18and FMA, Barthel scale indexes (P<0.01). the gray matter concentration change in SG was positively significantly correlated with FMA、Barthel scale indexes (P<0.01), whereas the gray matter concentration alteration in BA4and BA24%32were irrespective of FMA、Barthel scale indexes (P>0.05).
Conclusion
1. Based on the evaluation of clinical scale, the conclusion that the efficacy of traditional and acupuncture treating ischemic stroke was superior to traditional treatment only.
2. Abnormality of regional homogeneity in the resting-state occurred in many encephalic regions of patients with ischemic stroke, SG was the main encephalic region which resulted in motor function injuries, thus became the main theraputic target.
3.M1、PMA、SMA and IPL were the critical regions for patients with ischemic stroke to accomplish reorganization and compensation of the brain function in the resting-state, thus which became the important focus for acupuncture treating patients with ischemic stroke.
4. The abnormality of brain structure in the resting-state occurred commonly among patients with ischemic stroke, the abnormal alteration of gray matter concentration was the main characteristic among the abnormality of brain structure of patients with ischemic stroke, which also became the material basis of the abnormality of brain function.
5. The modulation of gray matter concentration in the rest-state in critical regions such as "default network" and "motor network" was the core mechanism for acupuncture treating patients with ischemic stroke.
以静息状态下复杂的脑功能及脑结构为切入点,以健康受试者和缺血性脑中风患者为研究载体,从脑功能、脑结构的角度揭示针刺治疗缺血性中风的中枢机制,为针刺治疗缺血性中风的临床应用提供科学的可视化依据。
方法
1.采用BOLD-fMRI成像技术,以静息态脑局部一致性为观测指标,以10例健康被试者(A组)和20例缺血性中风患者为研究对象,其中20例中风患者随机分为针刺治疗组(B组)、常规治疗组(C组)。比较B组、C组中风患者治疗前、后与A组健康受试者的异同。将中风患者Reho明显变化脑区与临床NDS、FMA量表评分进行相关分析,从脑功能角度探讨针刺治疗中风的中枢机制。
2.采用VBM测量方法,以静息态脑灰质密度为观测指标,研究对象、分组及治疗均同第一部分。观察B组与C组中风患者治疗前、后脑灰质密度的动态变化及与A组健康受试者的异同。将中风患者脑灰质密度明显变化的脑区与临床NDS、FMA、Barthel指数评分进行相关性分析,从脑结构的角度分析针刺治疗中风的中枢机制,为针刺对脑功能的改变提供重要的物质基础。
结果
1.两组缺血性中风患者临床各量表评价结果：①两组组内比较：B组、C组治疗前后组内NDS、FMA、Barthel指数评分比较均具有统计学差异(P<0.01)；B组、C组治疗结束后、12周后随访组内NDS、FMA量表评分改善值比较具有显著差异(P<0.01),而Barthel指数无差异(P>0.05)。②两组组间比较：B组、C组治疗前组间NDS、FMA、Barthel指数评分比较均无差异(P>0.05)；治疗后NDS量表评分无差异(P>0.05)、而FMA、Barthel指数评分有差异(P<0.05)；B组、C组治疗结束后、12周后随访组间NDS、FMA量表评分改善值比较具有差异(P<0.01；P<0.05),而Barthel指数评分改善值比较均无差异(P>0.05)。
2.针刺对缺血性中风患者脑功能影响的研究结果：B组及C组中风患者治疗前与A组健康者相比,多个脑功能区Reho发生变化；B组及C组中风患者治疗后与A组健康者相比,基底节区(SG)、小脑、初级运动区(M1)、运动前区(PMA)、辅助运动区(SMA)、顶下小叶(IPL)ReHo信号变化明显。选择基底节(尾状核)、小脑、M1、SMA、PMA、IPL为重点研究区域,探讨B组与C组中风患者以上区域脑ReHo信号改变和临床NDS、FMA量表评分的相关性。结果显示：基底节(尾状核)、小脑ReHo信号改变与NDS量表评分呈负相关(P<0.05；P<0.01),M1、PMA、SMA、IPLReHo信号改变与NDS量表评分呈正相关(P<0.05；P<0.01)；M1、SMA、IPL与FMA量表评分呈负相关(P<0.05；P<0.01),而PMA、基底节(尾状核)、小脑与FMA量表评分无相关性(P>0.05)。
3.针刺对缺血性中风患者脑结构影响的研究结果： B组及C组中风患者治疗前与A组健康者相比,多个脑区灰质密度异常,B组及C组中风患者治疗后,脑灰质密度有所改善。其中尾状核、扣带回、中央前回、楔叶脑灰质密度改变明显。将两组中风患者中央前回、扣带回、楔叶、基底节(尾状核)脑灰质密度改变与临床NDS、FMA及Barthel指数评分进行相关分析。结果显示：楔叶、中央前回灰质密度变化与NDS评分呈正相关(P<0.01；P<0.05),基底节(尾状核)、扣带回灰质密度变化与NDS评分呈负相关(P<0.01；P<0.05)；楔叶灰质密度变化与FMA、Barthel指数评分呈负相关(P<0.01),基底节(尾状核)灰质密度变化与FMA、Barthel指数评分呈显著正相关(P<0.01),而中央前回、扣带回与FMA、Barthel指数评分无相关性(P>0.05)。
结论
1.从临床量表评价进一步证实：常规加针刺治疗中风优于单独的常规治疗。
2.静息状态下缺血性中风患者存在脑功能区异常,基底节区是缺血性中风患者运动功能损害的主要脑区,是针刺治疗缺血性中风患者的中心靶点。
3.脑初级运动区、运动前区、辅助运动区、顶下小叶是缺血性中风患者静息态脑功能重组及代偿的关键区域,是针刺治疗中风患者重要的调制区域。
4.静息状态下缺血性中风患者存在广泛的脑结构异常,灰质密度的异常改变是中风患者脑结构异常的主要特征,也是脑功能异常的物质基础。
5.对静息状态下“默认网络”及“运动网络”关键区域脑灰质密度的调节是实现针刺治疗缺血性中风的核心机制。
Objective
Taking the complex brain function and brain structure in the resting-state as an entry point, taking healthy volunteers and patients with ischemic stroke as the research subjects, The research explored the central mechanisms of ischemic stroke from the perspective of brain function and brain structure, aiming at providing evidences for acupuncture to treat ischemic stroke.
Methods
1. BOLD-fMRI technology was adopted and regional homogeneity was observed in the research. We choosed10healthy volunteers (A group) and20patients with ischemic stroke as participants. The20paralytics were divided into acupuncture treatment group (B group) and traditional treatment group (C group), observe the dynamic change of regional homogeneity of the whole brain for both B and C groups before and after treatment. compared A with B and C group.Then correlation analysis was carried for the brain region of ischemic stroke with sinificant Reho change and NDS、FMA scale index, aiming at explore the brain mechanisms for acupuncture to treat ischemic stroke from the brain function perspective.
2.Based on VBM measurement technology, Cerebral gray matter concentration was measured, and the reasearch object、groups division and treatment were the same as part one. observe the dynamic change of gray matter concentration of the whole brain and various encephalic regions for both B and C groups before and after treatment. compared A with B and C group. Then correlation analysis was carried for the brain region of ischemic stroke with sinificant gray matter concentration change and NDS、FMA、Barthel scale index, aiming at analyzing the brain mechanisms for acupuncture to treat ischemic stroke from the brain structure perspective and providing inportant material basis for acupuncture influencing alteration of brain function.
Results
1. Results for clinical evaluation scales for both B and C groups①Intragroup comparision:as for the clinical evaluation indexes (NDS, FMA, Barthel), there was significant difference statistically between before and after treatment for both B and C groups (P<0.01). the intragroup improvement indexes of NDS and FMA scale were also significant statistically12weeks later (P<0.01), but not for Barthel indexes (P>0.05).②ntergroup comparision:There was no significant difference between B and C group before treatment as for.the indexes of NDS, FMA and Barthel (P>0.05); After the treatment, there was no significant difference for NDS scale index (P>0.05). As for FMA and Barthel indexes, the difference was significant statistically (P <0.05). the intergroup improvement indexes of NDS and FMA scale were also significant statistically12weeks later (P<0.01; P<0.05), but not for Barthel indexes (P>0.05).
2. Results of acupuncture influencing alteration of brain function, before treatment, compared with healthy volunteers (A group), the abnormality of regional homogeneity occurred in many encephalic regions for both B and C groups. After treatment, compared with healthy volunteers (A group), regional homogeneity signal changed obviously in SG and cerebellum,M1, PMA, SMA and IPL for both B and C groups. SG、cerebellum、M1、SMA、PMA and IPL were chosen as important encephalic regions in the research, aiming at exploring the correlation of Reho signal in the above-mentioned sections and clinical scale (NDS、FMA) between B and C groups. Results indicated:there was negative correlation between the signal change of SG and cerebellum and NDS scale indexes (P<0.05;(P<0.01). There were positive correlations between the signal change of many encephalic regions (such as M1、 PMA, SMA, IPL) and NDS scale indexes (P<0.05; P<0.01).The Reho signal change of M1、SMA and IPL was negatively correlated with FMA scale indexes (P<0.05; P<0.01). Whereas the ReHo signal of PMA%SG and cerebellum were irrespective of FMA scale indexes (P>0.05).
3. Results of acupuncture influencing alteration of brain structure:before treatment, compared with healthy volunteers (A group), the abnormality of cerebral gray matter concentration occurred in many encephalic regions for both B and C groups, the abnormality of the gray matter concentration occurred in such encephalic regions as precentral gyrus (BA4)、inferior parietal lobule (BA40)、cuneus (BA18), precuneus (BA7)、cingulate gyrus (BA24、32). After treatment, the gray matter concentration in the above-mentioned encephalic regions improved for both B and C groups. The correlation analysis was carried between the gray matter concentration alteration in many encephalic regions (such as SG、BA4、BA24、BA32、 BA18).and clinical scale indexes (such as NDS、FMA and Barthel) for both B and C groups. Results indicated:the gray matter concentration alteration in BA4and BA18were positively correlated with NDS scale index (P<0.01; P<0.05), whereas the gray matter concentration alteration in SG and BA24.,32were negatively correlated with NDS scale index (P<0.01; P<0.05). There was negative correlation between gray matter concentration alteration in BA18and FMA, Barthel scale indexes (P<0.01). the gray matter concentration change in SG was positively significantly correlated with FMA、Barthel scale indexes (P<0.01), whereas the gray matter concentration alteration in BA4and BA24%32were irrespective of FMA、Barthel scale indexes (P>0.05).
Conclusion
1. Based on the evaluation of clinical scale, the conclusion that the efficacy of traditional and acupuncture treating ischemic stroke was superior to traditional treatment only.
2. Abnormality of regional homogeneity in the resting-state occurred in many encephalic regions of patients with ischemic stroke, SG was the main encephalic region which resulted in motor function injuries, thus became the main theraputic target.
3.M1、PMA、SMA and IPL were the critical regions for patients with ischemic stroke to accomplish reorganization and compensation of the brain function in the resting-state, thus which became the important focus for acupuncture treating patients with ischemic stroke.
4. The abnormality of brain structure in the resting-state occurred commonly among patients with ischemic stroke, the abnormal alteration of gray matter concentration was the main characteristic among the abnormality of brain structure of patients with ischemic stroke, which also became the material basis of the abnormality of brain function.
5. The modulation of gray matter concentration in the rest-state in critical regions such as "default network" and "motor network" was the core mechanism for acupuncture treating patients with ischemic stroke.
引文
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