头针对脑梗死后脑灰质损伤干预作用的影像学研究
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摘要
目的采用基于体素形态学方法,研究脑梗死患者脑灰质结构损伤变化特点及头针疗法的干预作用。方法选取健康志愿者16名和脑梗死患者16例,将脑梗死患者随机分为头针组、对照组各8例,健康志愿者为正常组。所有患者行T1结构像扫描。采用VBM8软件包进行图像后处理,分别比较头针组、对照组治疗前后与正常组脑灰质结构差异。结果脑梗死后患者较正常组在扣带回、楔前叶、楔叶、中央前回、脑岛等14个脑区存在脑灰质结构损伤,主要分布于患侧脑区。治疗两周后头针组较正常组在双侧舌回、后扣带回,左侧楔叶,右侧楔前叶等8个脑区仍存在灰质结构损伤,其中舌回和后扣带回2个脑区属新发脑灰质损伤。治疗两周后对照组较正常组在双侧前扣带、尾状核、楔叶、脑岛、额下回、额内侧回、楔前叶、旁中央小叶、颞上回、颞中回、舌回,右侧中央后回、后扣带回、中央前回、额中回等共计23个脑区存在脑灰质结构损伤,其中舌回、后扣带回、中央后回等9个脑区属新发脑灰质损伤。结论脑梗死后脑灰质结构存在广泛损伤,随病程延长灰质体积可逐渐减少,联合应用头穴针刺疗法能有效抑制脑梗后脑灰质损伤的进程。
Objective To study features of brain gray matter injury in cerebral infarction patients and intervention of scalp acupuncture by using voxel-based morphology. Methods A total of 16 cerebral infarction patients were recruited in this study,and assigned to the scalp acupuncture group and the control group,8 in each group. Another 16 healthy volunteers were recruited as a normal group. All patients received scanning of T1 structure. Images were managed using VBM8 Software package. Difference of the gray matter structure was compared among the scalp acupuncture group,the control group,and the healthy volunteers. Results Compared with healthy volunteers,gray matter injury of cerebral infarction patients mainly occurred in 14 brain regions such as cingulate gyrus,precuneus,cuneus,anterior central gyrus,insular lobe,and so on. They were mainly distributed in affected side. Two weeks after treatment when compared with healthy volunteers,gray matter injury of cerebral infarction patients in the scalp acupuncture group still existed in 8 brain regions such as bilateral lingual gyrus,posterior cingulate gyrus,left cuneus,right precuneus,and so on. New gray matter injury occurred in lingual gyrus and posterior cingulate gyrus. Two weeks after treatment when compared with healthy volunteers,gray matter injury of cerebral infarction patients in the control group existed in 23 brain regions: bilateral anterior cingulum,caudate nucleus,cuneate lobe,insular lobe,inferior frontal gyrus,medial frontal gyrus,precuneus,paracentral lobule,superior temporal gyrus,middle temporal gyrus,lingual gyrus,right postcentral gyrus,posterior cingulate gyrus,precentral gyrus,middle frontal gyrus,and so on. New gray matter injury still existed in 9 cerebral regions such as lingual gyrus,posterior cingulate gyrus,postcentral gyrus,and so on. Conclusions Brain gray matter structure is widely injured after cerebral infarction. Brain gray matter volume gradually decreased as time went by. Combined use of scalp acupuncture might inhibit the progression of gray matter in-jury more effectively.
Objective To study features of brain gray matter injury in cerebral infarction patients and intervention of scalp acupuncture by using voxel-based morphology. Methods A total of 16 cerebral infarction patients were recruited in this study,and assigned to the scalp acupuncture group and the control group,8 in each group. Another 16 healthy volunteers were recruited as a normal group. All patients received scanning of T1 structure. Images were managed using VBM8 Software package. Difference of the gray matter structure was compared among the scalp acupuncture group,the control group,and the healthy volunteers. Results Compared with healthy volunteers,gray matter injury of cerebral infarction patients mainly occurred in 14 brain regions such as cingulate gyrus,precuneus,cuneus,anterior central gyrus,insular lobe,and so on. They were mainly distributed in affected side. Two weeks after treatment when compared with healthy volunteers,gray matter injury of cerebral infarction patients in the scalp acupuncture group still existed in 8 brain regions such as bilateral lingual gyrus,posterior cingulate gyrus,left cuneus,right precuneus,and so on. New gray matter injury occurred in lingual gyrus and posterior cingulate gyrus. Two weeks after treatment when compared with healthy volunteers,gray matter injury of cerebral infarction patients in the control group existed in 23 brain regions: bilateral anterior cingulum,caudate nucleus,cuneate lobe,insular lobe,inferior frontal gyrus,medial frontal gyrus,precuneus,paracentral lobule,superior temporal gyrus,middle temporal gyrus,lingual gyrus,right postcentral gyrus,posterior cingulate gyrus,precentral gyrus,middle frontal gyrus,and so on. New gray matter injury still existed in 9 cerebral regions such as lingual gyrus,posterior cingulate gyrus,postcentral gyrus,and so on. Conclusions Brain gray matter structure is widely injured after cerebral infarction. Brain gray matter volume gradually decreased as time went by. Combined use of scalp acupuncture might inhibit the progression of gray matter in-jury more effectively.
引文
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[16]慎宰莹.应用功能磁共振成像(f MRI)对头针治疗中风偏瘫后脑功能重塑机制研究[D].北京:北京中医药大学,2013.
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[18]Fan F,Zhu C,Chen H,et al.Dynamic brain structural changes after left hemisphere subcortical stroke[J].Hum Brain Mapp,2013,34(8):1872-1881.
[19]Gauthier LV,Taub E,Perkins C,et al.Remodeling the brain:plastic structural brain changes produced by different motor therapies after stroke[J].Stroke,2008,39(5):1520-1525.
[2]Brodtmann A,Pardoe H,Li Q,et al.Changes in regional brain volume three months after stroke[J].J Neurol Sci,2012,322(1-2):122-128.
[3]Gauthier LV,Taub E,Mark VW,et al.Atrophy of spared gray matter tissue predicts poorer motor recovery and rehabilitation response in chronic stroke[J].Stroke,2012,43(2):453-457.
[4]Wei W,Bai L,Wang J,et al.A longitudinal study of hand motor recovery after subacute stroke:a study combined FMRI with diffusion tensor imaging[J].PLo S One,2013,8(5):e64154.
[5]Tuladhar AM,Snaphaan L,Shumskaya E,et al.Default mode network connectivity in stroke patients[J].PLo S One,2013,8(6):265-272.
[6]崔方圆,邹忆怀,谭中建,等.中风偏瘫肢体运动功能恢复和头针疗效水平的f MRI与DTI研究[J].北京中医药大学学报(中医临床版),2013,20(4):34-38.
[7]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点(1995)[J].临床和实验医学杂志,2013,12(7):559.
[8]中华全国中医学会针灸学会针灸分会头针协作组.头针穴名标准化方案说明[J].新疆中医药,1985,3(2):32-34.
[9]武莹莹,张敬,汪洋,等.不同部位脑梗死所致脑灰质结构改变[J].中国医学影像技术,2014,30(3):334-338.
[10]Kraemer M,Schormann T,Hagemann G,et al.Delayed shrinkage of the brain after ischemic stroke:preliminary observations with voxel-guided morphometry[J].Neuroimaging,2004,14(3):265-272.
[11]邢立红.脑梗死后初级运动皮层和锥体束结构改变的动态MRI研究[D].天津:天津医科大学,2014.
[12]Yin D,Yan X,Fan M,et al.Secondary degeneration detected by combining voxel-based morphometry and tract-based spatial statistics in subcortical strokes with different outcomes in hand function[J].Am J Neuroradiol,2013,34(7):1341-1347.
[13]Nitkunan A,Lanfranconi S,Charlton RA,et al.Brain atrophy and cerebral small vessel disease:a prospective followup study[J].Stroke,2011,42(1):133-138.
[14]Preul C,Lohmann G,Hund-Georgiadis M,et al.Morphometry demonstrates loss of cortical thickness in cerebral microangiopathy[J].J Neurol,2005,252(4):441-447.
[15]Dang C,Liu G,Xing S,et al.Longitudinal cortical volume changes correlate with motor recovery in patients after acute local subcortical infarction[J].Stroke,2013,44(10):2795-2801.
[16]慎宰莹.应用功能磁共振成像(f MRI)对头针治疗中风偏瘫后脑功能重塑机制研究[D].北京:北京中医药大学,2013.
[17]刘海龙.基于PC平台头针治疗仪的研究[D].河北:燕山大学,2005.
[18]Fan F,Zhu C,Chen H,et al.Dynamic brain structural changes after left hemisphere subcortical stroke[J].Hum Brain Mapp,2013,34(8):1872-1881.
[19]Gauthier LV,Taub E,Perkins C,et al.Remodeling the brain:plastic structural brain changes produced by different motor therapies after stroke[J].Stroke,2008,39(5):1520-1525.