中医药对缺血性卒中患者功能网络连接影响的研究进展
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摘要
缺血性脑卒中是以运动、认知等神经功能损伤为主的缺血性脑病,恢复患者神经功能对预后极其重要。脑功能网络用于描述脑网络各节点或各脑区之间的连接关系,反应人的运动、认知功能等。脑默认网络属于功能网络,是指大脑静息态下存在一系列自发的、有组织的脑功能活动,该网络被认为与人的认知过程密切相关。脑功能网络在功能核磁共振上的突出观察指标定义为功能连接,部分脑区的功能连接异常就表征着该功能网络出现异常,可能与疾病的发生发展有密切关系。中医药治疗缺血性脑卒中患者,可有效调节大脑功能网络的功能连接,从而在治疗中发挥重要作用。本文以大脑功能网络为基本点,阐述中医药对缺血性脑卒中患者静息态神经功能网络及其功能连接影响的研究进展。
Schemic stroke is an ischemic encephalopathy with neurological impairment such as motor and cognitive impairment. It is very important to restore the neurological function of patients for prognosis. Functional brain networks are used to describe the connections between the nodes or brain regions of the brain network, reflecting human motor and cognitive functions. The brain default network(DMN) belongs to the functional network, which refers to the existence of a series of spontaneous and organized brain functional activities in the resting state of the brain, which is considered to be closely related to the cognitive process of human beings. The prominent observation index of functional nuclear magnetic resonance(fMRI) is defined as functional connection(FC). The abnormal functional connectivity in some brain regions indicates that the functional network is abnormal and may be closely related to the occurrence and development of the disease. Chinese medicine treatment of ischemic stroke patients, can effectively regulate the functional connectivity of the brain function network, thus playing an important role in the treatment. This paper, based on the brain function network, describes the progress in the study of the influence of traditional Chinese medicine on the resting state neural function network and its functional connection in ischemic stroke patients.
Schemic stroke is an ischemic encephalopathy with neurological impairment such as motor and cognitive impairment. It is very important to restore the neurological function of patients for prognosis. Functional brain networks are used to describe the connections between the nodes or brain regions of the brain network, reflecting human motor and cognitive functions. The brain default network(DMN) belongs to the functional network, which refers to the existence of a series of spontaneous and organized brain functional activities in the resting state of the brain, which is considered to be closely related to the cognitive process of human beings. The prominent observation index of functional nuclear magnetic resonance(fMRI) is defined as functional connection(FC). The abnormal functional connectivity in some brain regions indicates that the functional network is abnormal and may be closely related to the occurrence and development of the disease. Chinese medicine treatment of ischemic stroke patients, can effectively regulate the functional connectivity of the brain function network, thus playing an important role in the treatment. This paper, based on the brain function network, describes the progress in the study of the influence of traditional Chinese medicine on the resting state neural function network and its functional connection in ischemic stroke patients.
引文
1中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014.中华神经科杂志, 2015, 48(4):246-257.
2 李焰生.解读2013年美国卒中学会《急性缺血性卒中患者早期处理指南》.神经病学与神经康复学杂志, 2013, 10(1):1-4.
3 孟文婷,李东翔,佟玲.缺血性脑卒中的治疗研究进展.中国新药杂志, 2016, 25(10):1114-1120.
4 张学威.缺血性脑卒中患者功能磁共振研究.北京:北京协和医学院硕士研究生学位论文, 2014.
5 许军程,韩俊洲.利用静息态功能磁共振成像研究缺血性脑卒中患者康复治疗后运动功能网络连接的变化.影像技术, 2015, 27(1):43-44 +27.
6 Li W, Li Y, Zhu W, et al. Changes in brain functional network connectivity after stroke. Neural Regeneration Research, 2014, 9(1):51-60.
7 Raichle M E, Macleod A M, Snyder A Z, et al. A default mode of brain function. Proc Natl Acad Sci USA, 2001, 98(2):676-682.
8 Turner R, Howseman A, Rees G E, et al. Functional magnetic resonance imaging of the human brain:data acquisition and analysis. Experimental Brain Research, 1998, 123(1-2):5-12.
9 Lichtman J W, Sanes J R. Ome sweet ome:What can the genome tell us about the connectome? Curr Opin Neurobiol, 2008, 18:346-353
10 Lehrer J. Neuroscience:Making connections. Nature, 2009, 457:524-527
11 Sporns O, Tononi G, Kotter R. The human connectome:A structural description of the human brain. PLoS Comput Biol, 2005, 1:42
12 Varela, Lachaux F, Rodriguez J P, et al. The brainweb:Phase synchronization and large-scale integration. Nat Rev Neurosci, 2001, 2:229-239
13 Liang X, Wang J H, He Y. Human connectome:Structural and functional brain networks(in Chinese). Chinese Sci Bull(Chinese Ver), 2010, 55:1565-1583, doi:10. 1360/972009-2150
14 Wang J H, Wang L, Zang Y F, et al. Parcellation-dependent smallworld brain functional networks:A resting-state fMRI study. Hum Brain Mapp, 2009, 30:1511-1523.
15 刘晓明,李俐莹,蔡巍,等.电场场域可视性复杂网络模型研究.电工技术学报, 2016, 31(3):89-96.
16 Biswal B, Yetkin F Z, Haughton V M, et al. Functional connectivity in the motor cortex of resting human brain using echoplanar MRI. J Magn Reson Med. 1995;34(4):537-541.
17 Grefkes C, Gereon R F. Reorganization of cerebral networks after stroke:new insights from neuroimaging with connectivity approaches. Brain.2011, 134(5):1264-1276.
18 Bullmore E, Sporns O. The economy of brain network organization. Nat Rev Neurosci. 2012, 13(5):336–349.
19 石庆丽,燕浩,陈红燕,等.正常人脑静息态功能磁共振的脑功能连接.中国康复理论与实践, 2014, 20(6):543-547.
20 Van M M P, Van D M K, Wang K, et al. Recovery of sensorimotor function after experimental stroke correlates with restoration of restingstate interhemispheric functional connectivity. J Neurosci. 2010, 30(11):3964–3972.
21 Mintzopoulos D, Astrakas L G, Khanicheh A, et al. Connectivity alterations assessed by combining fMRI and MR-compatible hand robots in chronic stroke. Neuroimage. 2009, 47(Suppl 2):T90–T97.
22 Barkhof F, Haller S, Rombouts S A. Resting-state functional MR imaging:a new window to the brain:Radiology, 2014, 272(1):29-49.
23 蔡秀英.补益活血丸治疗脑梗死后轻度认知功能障碍的临床研究.中国民间疗法, 2014, 22(2):32-33.
24 Park J Y, Kim Y H, Chang W H, et al. Significance of longitudinal changes in the default-mode network for cognitive recovery after stroke.European Journal of Neuroscience, 2014, 40(4):2715-2722.
25 Liu J, Qin W, Wang H, et al. Altered spontaneous activity in the defaultmode network and cognitive decline in chronic subcortical stroke.Journal of the Neurological Sciences, 2014, 347(1-2):193-198.
26 Lassallelagadec S, Sibon I, Dilharreguy B, et al. Subacute default mode network dysfunction in the prediction of post-stroke depression severity.Radiology, 2012, 264(1):218-224.
27 张晨,张敬,孟亮亮,等.脑梗死患者脑默认网络改变的功能磁共振研究.中华老年心脑血管病杂志, 2015, 17(3):287-290.
28 Ogawa S. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA, 1990, 87:9868-9872
29 李越秀.轻度认知障碍患者基于影像的功能网络连接改变.中华医学会(Chinese Medical Association)、中华医学会神经病学分会.中华医学会第十七次全国神经病学学术会议论文汇编(下).中华医学会(Chinese Medical Association)、中华医学会神经病学分会, 2014:2.
30 Westlake K P, Nagarajan S S. Functional connectivity in relation to motor performance and recovery after stroke. Front Syst Neurosci. 2011,5:8.
31 Zhang G, Yin H, Zhou Y L, et al. Capturing Amplitude Changes of LowFrequency Fluctuations in Functional Magnetic Resonance Imaging Signal:A Pilot Acupuncture Study on NeiGuan(PC6). Journal of Alternative&Complementary Medicine, 2012, 18(4):387.
32 Jiang Y, Wang H, Liu Z, et al. Manipulation of and Sustained Effects on the Human Brain Induced by Different Modalities of Acupuncture:An fMRI Study. Plos One, 2013, 8(6):e66815.
33 Rong-lin Cai, Guo-ming Shen, Hao Wang, et al. Brain functional connectivity network studies of acupuncture:a systematic review on resting-state fMRI. Journal of Integrative Medicine, 2018, 16(1):26-33.
34 You Y, Bai L, Dai R, et al. Altered Hub Configurations within Default Mode Network following Acupuncture at ST36:A Multimodal Investigation Combining fMRI and MEG. Plos One, 2013, 8(5):e64509.
35 Shi Y, Zhang S, Li Q, et al. A study of the brain functional network of Deqi via acupuncturing stimulation at BL40 by rs-fMRI. Complementary Therapies in Medicine, 2016, 25:71-77.
36 Tao J, Liu J, Egorova N, et al. Increased Hippocampus-Medial Prefrontal Cortex Resting-State Functional Connectivity and Memory Function after Tai Chi Chuan Practice in Elder Adults. Frontiers in Aging Neuroscience, 2016, 8:25.
37 Chen J, Wang J, Huang Y, et al. Modulatory Effect of Acupuncture at Waiguan(TE5)on the Functional Connectivity of the Central Nervous System of Patients with Ischemic Stroke in the Left Basal Ganglia. Plos One, 2014, 9(6):e96777.
38 Fu C H, Li K S, Ning Y Z, et al. Altered effective connectivity of resting state networks by acupuncture stimulation in stroke patients with left hemiplegia:A multivariate granger analysis. Medicine, 2017, 96(47):e8897.
39 Wu P, Zhou Y M, Liao C X, et al. Structural Changes Induced by Acupuncture in the Recovering Brain after Ischemic Stroke. EvidenceBased Complementary and Alternative Medicine, 2018, 2018(9913):1-8.
40 Xin Z, Liu X T, Kang D Y. Traditional Chinese Patent Medicine for Acute Ischemic Stroke:An Overview of Systematic Reviews Based on the GRADE Approach. Medicine, 2016, 95(12):e2986.
41 Zhao H, Yang D, Shi M, et al. Clinical efficacy and safety of traditional Chinese medicine combined with Western Medicine in patients with diabetic acute ischemic stroke.中医杂志(英文版), 2014, 34(2):145-149.
42 Wei D, Xie D, Li H, et al. The positive effects of Xueshuan Xinmai tablets on brain functional connectivity in acute ischemic stroke:a placebo controlled randomized trial. Scientific Reports, 2017, 7(1).
43 赵波沣,胡元明,陈树平.功能磁共振成像对针刺联合中医药治疗脑梗死疗效评价.中国医学装备, 2017, 14(7):72-75.
44 Li Y, Wang Y, Liao C, et al. Longitudinal Brain Functional Connectivity Changes of the Cortical Motor-Related Network in Subcortical Stroke Patients with Acupuncture Treatment. Neural Plasticity, 2017,(2017-12-11), 2017, 2017:5816263.
2 李焰生.解读2013年美国卒中学会《急性缺血性卒中患者早期处理指南》.神经病学与神经康复学杂志, 2013, 10(1):1-4.
3 孟文婷,李东翔,佟玲.缺血性脑卒中的治疗研究进展.中国新药杂志, 2016, 25(10):1114-1120.
4 张学威.缺血性脑卒中患者功能磁共振研究.北京:北京协和医学院硕士研究生学位论文, 2014.
5 许军程,韩俊洲.利用静息态功能磁共振成像研究缺血性脑卒中患者康复治疗后运动功能网络连接的变化.影像技术, 2015, 27(1):43-44 +27.
6 Li W, Li Y, Zhu W, et al. Changes in brain functional network connectivity after stroke. Neural Regeneration Research, 2014, 9(1):51-60.
7 Raichle M E, Macleod A M, Snyder A Z, et al. A default mode of brain function. Proc Natl Acad Sci USA, 2001, 98(2):676-682.
8 Turner R, Howseman A, Rees G E, et al. Functional magnetic resonance imaging of the human brain:data acquisition and analysis. Experimental Brain Research, 1998, 123(1-2):5-12.
9 Lichtman J W, Sanes J R. Ome sweet ome:What can the genome tell us about the connectome? Curr Opin Neurobiol, 2008, 18:346-353
10 Lehrer J. Neuroscience:Making connections. Nature, 2009, 457:524-527
11 Sporns O, Tononi G, Kotter R. The human connectome:A structural description of the human brain. PLoS Comput Biol, 2005, 1:42
12 Varela, Lachaux F, Rodriguez J P, et al. The brainweb:Phase synchronization and large-scale integration. Nat Rev Neurosci, 2001, 2:229-239
13 Liang X, Wang J H, He Y. Human connectome:Structural and functional brain networks(in Chinese). Chinese Sci Bull(Chinese Ver), 2010, 55:1565-1583, doi:10. 1360/972009-2150
14 Wang J H, Wang L, Zang Y F, et al. Parcellation-dependent smallworld brain functional networks:A resting-state fMRI study. Hum Brain Mapp, 2009, 30:1511-1523.
15 刘晓明,李俐莹,蔡巍,等.电场场域可视性复杂网络模型研究.电工技术学报, 2016, 31(3):89-96.
16 Biswal B, Yetkin F Z, Haughton V M, et al. Functional connectivity in the motor cortex of resting human brain using echoplanar MRI. J Magn Reson Med. 1995;34(4):537-541.
17 Grefkes C, Gereon R F. Reorganization of cerebral networks after stroke:new insights from neuroimaging with connectivity approaches. Brain.2011, 134(5):1264-1276.
18 Bullmore E, Sporns O. The economy of brain network organization. Nat Rev Neurosci. 2012, 13(5):336–349.
19 石庆丽,燕浩,陈红燕,等.正常人脑静息态功能磁共振的脑功能连接.中国康复理论与实践, 2014, 20(6):543-547.
20 Van M M P, Van D M K, Wang K, et al. Recovery of sensorimotor function after experimental stroke correlates with restoration of restingstate interhemispheric functional connectivity. J Neurosci. 2010, 30(11):3964–3972.
21 Mintzopoulos D, Astrakas L G, Khanicheh A, et al. Connectivity alterations assessed by combining fMRI and MR-compatible hand robots in chronic stroke. Neuroimage. 2009, 47(Suppl 2):T90–T97.
22 Barkhof F, Haller S, Rombouts S A. Resting-state functional MR imaging:a new window to the brain:Radiology, 2014, 272(1):29-49.
23 蔡秀英.补益活血丸治疗脑梗死后轻度认知功能障碍的临床研究.中国民间疗法, 2014, 22(2):32-33.
24 Park J Y, Kim Y H, Chang W H, et al. Significance of longitudinal changes in the default-mode network for cognitive recovery after stroke.European Journal of Neuroscience, 2014, 40(4):2715-2722.
25 Liu J, Qin W, Wang H, et al. Altered spontaneous activity in the defaultmode network and cognitive decline in chronic subcortical stroke.Journal of the Neurological Sciences, 2014, 347(1-2):193-198.
26 Lassallelagadec S, Sibon I, Dilharreguy B, et al. Subacute default mode network dysfunction in the prediction of post-stroke depression severity.Radiology, 2012, 264(1):218-224.
27 张晨,张敬,孟亮亮,等.脑梗死患者脑默认网络改变的功能磁共振研究.中华老年心脑血管病杂志, 2015, 17(3):287-290.
28 Ogawa S. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA, 1990, 87:9868-9872
29 李越秀.轻度认知障碍患者基于影像的功能网络连接改变.中华医学会(Chinese Medical Association)、中华医学会神经病学分会.中华医学会第十七次全国神经病学学术会议论文汇编(下).中华医学会(Chinese Medical Association)、中华医学会神经病学分会, 2014:2.
30 Westlake K P, Nagarajan S S. Functional connectivity in relation to motor performance and recovery after stroke. Front Syst Neurosci. 2011,5:8.
31 Zhang G, Yin H, Zhou Y L, et al. Capturing Amplitude Changes of LowFrequency Fluctuations in Functional Magnetic Resonance Imaging Signal:A Pilot Acupuncture Study on NeiGuan(PC6). Journal of Alternative&Complementary Medicine, 2012, 18(4):387.
32 Jiang Y, Wang H, Liu Z, et al. Manipulation of and Sustained Effects on the Human Brain Induced by Different Modalities of Acupuncture:An fMRI Study. Plos One, 2013, 8(6):e66815.
33 Rong-lin Cai, Guo-ming Shen, Hao Wang, et al. Brain functional connectivity network studies of acupuncture:a systematic review on resting-state fMRI. Journal of Integrative Medicine, 2018, 16(1):26-33.
34 You Y, Bai L, Dai R, et al. Altered Hub Configurations within Default Mode Network following Acupuncture at ST36:A Multimodal Investigation Combining fMRI and MEG. Plos One, 2013, 8(5):e64509.
35 Shi Y, Zhang S, Li Q, et al. A study of the brain functional network of Deqi via acupuncturing stimulation at BL40 by rs-fMRI. Complementary Therapies in Medicine, 2016, 25:71-77.
36 Tao J, Liu J, Egorova N, et al. Increased Hippocampus-Medial Prefrontal Cortex Resting-State Functional Connectivity and Memory Function after Tai Chi Chuan Practice in Elder Adults. Frontiers in Aging Neuroscience, 2016, 8:25.
37 Chen J, Wang J, Huang Y, et al. Modulatory Effect of Acupuncture at Waiguan(TE5)on the Functional Connectivity of the Central Nervous System of Patients with Ischemic Stroke in the Left Basal Ganglia. Plos One, 2014, 9(6):e96777.
38 Fu C H, Li K S, Ning Y Z, et al. Altered effective connectivity of resting state networks by acupuncture stimulation in stroke patients with left hemiplegia:A multivariate granger analysis. Medicine, 2017, 96(47):e8897.
39 Wu P, Zhou Y M, Liao C X, et al. Structural Changes Induced by Acupuncture in the Recovering Brain after Ischemic Stroke. EvidenceBased Complementary and Alternative Medicine, 2018, 2018(9913):1-8.
40 Xin Z, Liu X T, Kang D Y. Traditional Chinese Patent Medicine for Acute Ischemic Stroke:An Overview of Systematic Reviews Based on the GRADE Approach. Medicine, 2016, 95(12):e2986.
41 Zhao H, Yang D, Shi M, et al. Clinical efficacy and safety of traditional Chinese medicine combined with Western Medicine in patients with diabetic acute ischemic stroke.中医杂志(英文版), 2014, 34(2):145-149.
42 Wei D, Xie D, Li H, et al. The positive effects of Xueshuan Xinmai tablets on brain functional connectivity in acute ischemic stroke:a placebo controlled randomized trial. Scientific Reports, 2017, 7(1).
43 赵波沣,胡元明,陈树平.功能磁共振成像对针刺联合中医药治疗脑梗死疗效评价.中国医学装备, 2017, 14(7):72-75.
44 Li Y, Wang Y, Liao C, et al. Longitudinal Brain Functional Connectivity Changes of the Cortical Motor-Related Network in Subcortical Stroke Patients with Acupuncture Treatment. Neural Plasticity, 2017,(2017-12-11), 2017, 2017:5816263.