应用SPECT分子影像技术研究针刺治疗儿童孤独症的疗效
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摘要
目的
在可视化条件下,应用SPECT分子影像技术①探讨CA患儿大脑受损主要核团和大脑皮质的位点和程度;②阐述在固定穴位组合、刺激频率和刺激强度时,针刺在脑内的应答和效应靶点;③证实针刺疗程效果,为针刺治疗CA提供客观评价依据。
方法
⑴依据《临床技术操作规范·核医学分册》有关规定的标准对研究中所用的主要设备SPECT仪、分子探针99Tcm-ECD的主要质量控制项目进行了检验并校正。
⑵随机选择北京大学深圳医院门诊就诊的CA患儿,性别不限,符合CCMD-3R 75.1、ICD-10 F84.0和DSM-IV 299.00三个诊断标准列出的诊断细目,ABC量表评分>57分,符合以上标准的患儿纳入观察组进行针刺前第1次SPECT显像;
⑶使用HANS数码针灸仪,针刺穴位双侧合谷、曲池、足三里和三阴交穴;刺激强度上肢10~15mA,下肢20~25mA;刺激频率2/15Hz;刺激时间每天2次,每次每侧肢体30min,针刺治疗12个月以上,病历资料完整,能够按照医生要求坚持治疗及定期复诊的CA患儿行第2次SPECT显像。
⑷治疗后根据复诊及患儿家属的日记评估症状,ABC量表评分下降>5分为治疗有效;影像视觉分析依据《核医学诊断与治疗规范》阅片要点;定量分析采用ROI技术提取针刺治疗前后2次SPECT断层影像同部位计数率,代入BFCR%生理数学模型计算,设BFCR%≥15%为针刺显效,15%>BFCR%≥10%为针刺有效;统计学分析采用治疗前后配对t检验。
结果
⑴SPECT仪的常规质量控制项目固有泛源均匀性、固有空间分辨率、旋转中心校正、横断层像素线性关系等均符合质量控制标准;分子探针99Tcm-ECD外观无色、清亮透明,无颗粒悬浮物及杂质,PH值5.5~6.2。放射化学纯度为90.61%~99.23%。
⑵完成治疗的55例患儿,男49例,女6例,治疗前年龄4.50±2.39岁,治疗前SPECT显像见226处局灶性脑血流灌注和功能低下区,其中48例患儿同时显现左侧(或双侧)额前、左侧语言运动区(Broca)和左侧(或双侧)颞叶异常,占患儿总数的87.27%;针刺疗程12~48个月,平均治疗17.89±8.09个月;
⑶治疗后年龄6.02±2.55岁,患儿的社交障碍、言语障碍、刻板行为均有明显好转,ABC量表评分下降5分以上的患儿达72.7%,视觉分析示第1次SPECT显像所示的226处病灶区的脑血流灌注和功能部分(或明显)改善;定量分析,左额前、右额前、左Broca区、左颞叶、右颞叶Fe和Fb比较差异显著(t=5.01,t=2.32,t=5.82,t=4.54,t=2.90,p值均<0.05);BFCR%计算针刺治疗CA显效48.67%,针刺治疗CA有效9.29%;总有效率达57.96%。
结论
CA患儿大脑受损以左侧(或双侧)额叶前部、左侧Broca区、左侧(或双侧)颞叶多见;针刺治疗CA疗效确切;SPECT分子影像技术可以作为评价针刺治疗CA疗效的有力工具。
Objectives
Under the condition of visualization and through SPECT molecular imaging,①to explore the targets and extent of brain impairment in children with childhood autism (CA),②to describe the the effect of target response with fixed acupuncture point and fixed frequency and intensity of stimulation and③to confirm the theraputic effect of acupuncture in children with CA and provide an objective basis for evaluation of CA acupuncture treatment.
Materials and Methods
⑴According to the standards of "Clinical Skills & Nuclear Medicine practices", the main equipment of SPECT instrument and the molecular probe of 99Tcm-ECD used in this study were examined and corrected.
⑵According to the diagnostic criteria of CCMD-3R 75.1, ICD-10 F84.0 and DSM-IV 299.00, 55 cases of CA were clinically diagnosed from Peking University Shenzhen Hospital outpatients and included in this study, with ABC rating score >57 and without sex being limited. The CA children got the first SPECT imaging with the molecular probe of 99Tcm-ECD before acupuncture treatment.
⑶In the treatment, electric HANS digital acupuncture device was used and the fixed acupuncture point of bilateral Hegu, Quchi, Foot Three Li and Sanyinjiao were chosen for stimulation, with the stimulation intensity of 10~15 mA in the upper limbs and 20~25 mA in the lower limbs, and the stimulation frequency of 2/15Hz. the acupuncture treatment for each CA child was acquired two times in one day, stimulation time needed 30min for either site of limbs and the treatment process last for more than 12 months. After the acupuncture treatment, the CA children who had complete medical records and regular return visit in accordance with physician referral requirement got the second SPECT imaging.
⑷After treatment, according to records return visit and the CA parents’diaries to assess symptom CA children, ABC rating score decreased more than 5 points was determined as effective. Visual assessment was according to the standards of "Nuclear Medicine Diagnosis and Treatment Guidelines". ROI technique was used in the process of quantity assessment. radioactivity counts of the same brain site in the SPECT transverse images were extracted for the calculation using the BFCR% physiological mathematical model. BFCR%≥15% was determined as acupuncture treatment effect is significant and 15%>BFCR%≥10% as effective. In the statistical analysis student t test was used.
Results
⑴The SPECT instrument inherent source uniformity, intrinsic spatial resolution, the rotation center and the transverse sections of pixel linear were all in accordance to the routine quality control standars.99Tcm-ECD injection was colorless, clear and transparent, no particles suspended solids and impurities, with PH value 5.5 ~ 6.2 and radiochemical purity 90.61% ~ 99.23%.
⑵55 cases of CA children accomplished the treatment program, of which 49 cases were male and 6 were female. Before treatment, the mean age of the CA children were 4.50±2.39y and 226 focal hypoperfusion and hypofunction regions were found in the SPECT images. In 48 cases of CA children (87.27%), left ( or bilateral) prefrontal lobe, left Broca area, and left side (or bilateral) temporal lobe showed dysfunction. The course of acupuncture treatment was from 12 to 48 months, with mean 17.89±8.09 months.
⑶After treatment, the CA children were 6.02±2.55y, with social communication, speech disorder and stereotyped behavior significantly improved, and ABC rating scores decreased by 5 points or more in 72.7% of CA children. Visual analysis showed that the cerebral blood flow and function in the lesion areas displayed in the first of SPECT imaging improved obviously or partially. Quantitative analysis showed that Fe and Fb of the left prefrontal lobe, right prefrontal lobe, left Broca area, left temporal lobe, right temporal lobe had significant differences (t=5.01, 2.32, 5.82, 4.54, 2.90, with p<0.05). According to the results of BFCR% calculation, for acupuncture treatment effect 48.67% was significant and 9.29% was effective,and the total effective is 57.96%.
Conclusions
The impaired nucleus and brain cortexes were mostly in the left ( or bilateral) prefrontal lobe, left Broca area, and left side (or both) temporal lobe. The approach of acupuncture treatment in CA is effective.SPECT molecular neuroimaging techniques can be used as the powerful tool to evaluate the efficacy of CA acupuncture treatment with the accuracy.
在可视化条件下,应用SPECT分子影像技术①探讨CA患儿大脑受损主要核团和大脑皮质的位点和程度;②阐述在固定穴位组合、刺激频率和刺激强度时,针刺在脑内的应答和效应靶点;③证实针刺疗程效果,为针刺治疗CA提供客观评价依据。
方法
⑴依据《临床技术操作规范·核医学分册》有关规定的标准对研究中所用的主要设备SPECT仪、分子探针99Tcm-ECD的主要质量控制项目进行了检验并校正。
⑵随机选择北京大学深圳医院门诊就诊的CA患儿,性别不限,符合CCMD-3R 75.1、ICD-10 F84.0和DSM-IV 299.00三个诊断标准列出的诊断细目,ABC量表评分>57分,符合以上标准的患儿纳入观察组进行针刺前第1次SPECT显像;
⑶使用HANS数码针灸仪,针刺穴位双侧合谷、曲池、足三里和三阴交穴;刺激强度上肢10~15mA,下肢20~25mA;刺激频率2/15Hz;刺激时间每天2次,每次每侧肢体30min,针刺治疗12个月以上,病历资料完整,能够按照医生要求坚持治疗及定期复诊的CA患儿行第2次SPECT显像。
⑷治疗后根据复诊及患儿家属的日记评估症状,ABC量表评分下降>5分为治疗有效;影像视觉分析依据《核医学诊断与治疗规范》阅片要点;定量分析采用ROI技术提取针刺治疗前后2次SPECT断层影像同部位计数率,代入BFCR%生理数学模型计算,设BFCR%≥15%为针刺显效,15%>BFCR%≥10%为针刺有效;统计学分析采用治疗前后配对t检验。
结果
⑴SPECT仪的常规质量控制项目固有泛源均匀性、固有空间分辨率、旋转中心校正、横断层像素线性关系等均符合质量控制标准;分子探针99Tcm-ECD外观无色、清亮透明,无颗粒悬浮物及杂质,PH值5.5~6.2。放射化学纯度为90.61%~99.23%。
⑵完成治疗的55例患儿,男49例,女6例,治疗前年龄4.50±2.39岁,治疗前SPECT显像见226处局灶性脑血流灌注和功能低下区,其中48例患儿同时显现左侧(或双侧)额前、左侧语言运动区(Broca)和左侧(或双侧)颞叶异常,占患儿总数的87.27%;针刺疗程12~48个月,平均治疗17.89±8.09个月;
⑶治疗后年龄6.02±2.55岁,患儿的社交障碍、言语障碍、刻板行为均有明显好转,ABC量表评分下降5分以上的患儿达72.7%,视觉分析示第1次SPECT显像所示的226处病灶区的脑血流灌注和功能部分(或明显)改善;定量分析,左额前、右额前、左Broca区、左颞叶、右颞叶Fe和Fb比较差异显著(t=5.01,t=2.32,t=5.82,t=4.54,t=2.90,p值均<0.05);BFCR%计算针刺治疗CA显效48.67%,针刺治疗CA有效9.29%;总有效率达57.96%。
结论
CA患儿大脑受损以左侧(或双侧)额叶前部、左侧Broca区、左侧(或双侧)颞叶多见;针刺治疗CA疗效确切;SPECT分子影像技术可以作为评价针刺治疗CA疗效的有力工具。
Objectives
Under the condition of visualization and through SPECT molecular imaging,①to explore the targets and extent of brain impairment in children with childhood autism (CA),②to describe the the effect of target response with fixed acupuncture point and fixed frequency and intensity of stimulation and③to confirm the theraputic effect of acupuncture in children with CA and provide an objective basis for evaluation of CA acupuncture treatment.
Materials and Methods
⑴According to the standards of "Clinical Skills & Nuclear Medicine practices", the main equipment of SPECT instrument and the molecular probe of 99Tcm-ECD used in this study were examined and corrected.
⑵According to the diagnostic criteria of CCMD-3R 75.1, ICD-10 F84.0 and DSM-IV 299.00, 55 cases of CA were clinically diagnosed from Peking University Shenzhen Hospital outpatients and included in this study, with ABC rating score >57 and without sex being limited. The CA children got the first SPECT imaging with the molecular probe of 99Tcm-ECD before acupuncture treatment.
⑶In the treatment, electric HANS digital acupuncture device was used and the fixed acupuncture point of bilateral Hegu, Quchi, Foot Three Li and Sanyinjiao were chosen for stimulation, with the stimulation intensity of 10~15 mA in the upper limbs and 20~25 mA in the lower limbs, and the stimulation frequency of 2/15Hz. the acupuncture treatment for each CA child was acquired two times in one day, stimulation time needed 30min for either site of limbs and the treatment process last for more than 12 months. After the acupuncture treatment, the CA children who had complete medical records and regular return visit in accordance with physician referral requirement got the second SPECT imaging.
⑷After treatment, according to records return visit and the CA parents’diaries to assess symptom CA children, ABC rating score decreased more than 5 points was determined as effective. Visual assessment was according to the standards of "Nuclear Medicine Diagnosis and Treatment Guidelines". ROI technique was used in the process of quantity assessment. radioactivity counts of the same brain site in the SPECT transverse images were extracted for the calculation using the BFCR% physiological mathematical model. BFCR%≥15% was determined as acupuncture treatment effect is significant and 15%>BFCR%≥10% as effective. In the statistical analysis student t test was used.
Results
⑴The SPECT instrument inherent source uniformity, intrinsic spatial resolution, the rotation center and the transverse sections of pixel linear were all in accordance to the routine quality control standars.99Tcm-ECD injection was colorless, clear and transparent, no particles suspended solids and impurities, with PH value 5.5 ~ 6.2 and radiochemical purity 90.61% ~ 99.23%.
⑵55 cases of CA children accomplished the treatment program, of which 49 cases were male and 6 were female. Before treatment, the mean age of the CA children were 4.50±2.39y and 226 focal hypoperfusion and hypofunction regions were found in the SPECT images. In 48 cases of CA children (87.27%), left ( or bilateral) prefrontal lobe, left Broca area, and left side (or bilateral) temporal lobe showed dysfunction. The course of acupuncture treatment was from 12 to 48 months, with mean 17.89±8.09 months.
⑶After treatment, the CA children were 6.02±2.55y, with social communication, speech disorder and stereotyped behavior significantly improved, and ABC rating scores decreased by 5 points or more in 72.7% of CA children. Visual analysis showed that the cerebral blood flow and function in the lesion areas displayed in the first of SPECT imaging improved obviously or partially. Quantitative analysis showed that Fe and Fb of the left prefrontal lobe, right prefrontal lobe, left Broca area, left temporal lobe, right temporal lobe had significant differences (t=5.01, 2.32, 5.82, 4.54, 2.90, with p<0.05). According to the results of BFCR% calculation, for acupuncture treatment effect 48.67% was significant and 9.29% was effective,and the total effective is 57.96%.
Conclusions
The impaired nucleus and brain cortexes were mostly in the left ( or bilateral) prefrontal lobe, left Broca area, and left side (or both) temporal lobe. The approach of acupuncture treatment in CA is effective.SPECT molecular neuroimaging techniques can be used as the powerful tool to evaluate the efficacy of CA acupuncture treatment with the accuracy.
引文
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[1]贾少微,孙涛涛,樊蓉,等.针刺治疗儿童孤独症单光子发射计算机断层成像术可视化研究.中国中西医结合杂志, 2008, 28(10): 886-889.
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[3]王子才,钱冬梅,盛晓尉,等.用ABC量表分析儿童孤独症.临床儿科杂志, 2002, 20 (2) : 80-81.
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[8]吴晖,吴忠义.三位一体中医疗法治疗孤独症.医药产业资讯. 2006, 14(3): 87-88.
[9]琚玮,封玉.针刺、推拿为主治疗儿童孤独症语言障碍13例.中医研究. 2009, 2(4): 54-55.
[10]李慧敏.针刺为主治疗儿童孤独症临床研究.中国针灸. 2004, 24(5): 317-318.
[11]严愉芬,韦永英,陈玉华,等.针刺对儿童孤独症康复训练的影响.中国针灸. 2007, 27(7): 503-505.
[12]奚玉凤,刘媛媛,艾宙,等.增智开窍针法对孤独症儿童语言功能的干预作用.上海针灸杂志, 2007, 26(5): 7-8.
[13]袁青,汪睿超,吴至凤,等.靳三针治疗重度自闭症疗效对照观察.中国针灸, 2009, 29(3): 177-180.
[14]刘振寰张宏雁张春涛等.头针治疗小儿孤独症疗效观察.上海针灸杂志,2009, 28(11): 637-638.
[15]毛颖梅,谢倩,刘红艳.应用游戏治疗提高孤独症儿童社交能力的个案研究.中国康复理论与实践. 2007, 13(9): 826-828.
[16]张全明,余瑞英,庞坚,周雅芳,周茵.针刺对孤独症儿童语言障碍和智能的改善作用.中国临床康复, 2005, 9(28): 112-113.
[17]王春南,商淑云,魏晓红.电针配合行为疗法对孤独症患儿社会适应行为能力的影响.上海针灸杂志, 2006, 25(12): 19-20.
[18] Ren YG, Guo CC, Jia SW. Effect of acupuncture single after brachial plexus blockade on cerebral blood perfusion and brain cell function. Chin J Integr Med, 2003, 9(1): 11-15.
[19]贾少微,王凡.用SPECT研究针刺对脑血流量和脑功能的影响.中国针灸, 1996, 16(12): 1-4.