方氏头针治疗早中期帕金森病的即时疗效及功能磁共振相关性的研究
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摘要
背景
帕金森病(Parkinson Disease, PD)是一种好发于中老年的中枢神经系统变性的终身疾病,目前西医没有一种药物和外科手术能明显阻止疾病的发展。大量临床及实验已经证明,中医针灸可较好地改善运动症状,并控制病情发展,但目前针灸疗效的客观性依据不足。功能磁共振作为无创、方便易行的一种观察手段在PD的诊断与疗效观察上有一定的优势。
目的
通过观察方氏头针对帕金森病患者fMRI的影响,初步探索针灸治疗帕金森病的机制,为帕金森病的针灸治疗提供理论依据。
方法
对2010-2011年间广东省中医院神经内科帕金森病门诊符合纳入标准的10例早中期帕金森病患者,予方氏头针针刺冠矢点及双侧呼循,并于治疗前后进行UPDRS评分、运动试验,以及脑功能磁共振扫描,记录治疗前与治疗后量表、计数及计时结果及脑功能磁共振数据,用t检验(符合正态分布的计量资料)和秩和检验方法对其即时疗效结果进行统计学分析,用组间配对T检验分析其对FMRI的影响。
结果
针刺治疗前后,患者双手运动均稍有改善,但差异无统计学意义(P>0.05)。
针刺治疗前后,患者转弯时间、10米行走时间及起身时间无明显改善,差异无统计学意义(P>0.05)。
针刺治疗前后,患者UPDRS第三部分评分稍有下降,但差异无统计学意义(P>0.05)。
与针刺治疗前相比(P<0.05),针刺治疗后病人双侧海马、左侧杏仁核、左侧岛叶、双侧颞上回、左侧颞中回、左侧额下回、双侧壳核、左侧尾状核、双侧苍白球、胼胝体等脑区局部一致性增高,提示方氏头针治疗前后,部分脑区存在明显差异。
结论
方氏头针针刺治疗帕金森病患者,针刺后部分运动能力稍有改善,但即时疗效不显著。
方氏头针针刺治疗帕金森病患者前后,fMRI显示针刺治疗后病人双侧海马、左侧杏仁核、左侧岛叶、双侧颞上回、左侧颞中回、左侧额下回、双侧壳核、左侧尾状核、双侧苍白球外侧部、胼胝体等脑区局部一致性增高。说明了方氏头针治疗前后部分病理脑区存在明显差异。经方氏头针针刺后脑区一致性变化可能与脑区功能变化存在相关性。方氏头针针刺冠矢点及双侧呼循可能通过改善纹状体的功能而达到改善PD症状的作用及通过改善边缘系统改善患者情感功能。
Objective
Parkinson's Disease(PD), also named as parelysis agitans, is a kind of neurodegenerative disease, which usually occurs in middle-aged or senile patients. At present, there is no medicine or surgical which is effective enough to stop the development of this disease.A large number of clinical research and experimental studies had shown that acupuncture can improve symptoms of tremor and control the progression of this disease. But the objective evidence is not sufficient. Functional magnetic resonance imaging as an observation which non-invasive and convenient, has the advantage in the diagnosis of PD and the observation of the curative effect. Therefore, by observing the impact of Fang-acupuncture of Parkinson' s patients, we elementary discuss the immediate result and mechanism of acupuncture to PD.
Methods
Chosing 10 cases of Parkinson's disease. Evaluate their UPDRS score, motion experiment and fMRI before and after treatment. Recording its scale and brain functional magnetic resonance data, using paired T test to analysis the impact of treatment on FMRI and its immediate effect. Use T test to analysis the difference between two groups.
Results
Timing motion test of both hands of post-treatment have increased than that of prior-treatment. The difference had no statistical difference(p>0.05).
Timing motion test of turning round、standing up and 10 metres walking of post-treatment haven't decreased than that of prior-treatment.
UPDRS scores of part III of post-treatment has decreased than that of prior-treatment. The difference had no statistical difference(p>0.05).
Increased ReHo were found in both Parahippocampa Gyrus、Amygdala_L、Insula_L、both Superior Temporal Gyrus、Temporal_Mid_L、both Putamens、Caudate_L、both Lateral Globus Pallidus、Corpus Callosum etc. (p<0.05).
Conclusion
The Fang-acupuncture can improve movement in PD'patients immediately to some extend. But the difference had no statistical difference(p>0.05).
The Fang-acupuncture may improve movement and sentiment by activating the related brain function.
帕金森病(Parkinson Disease, PD)是一种好发于中老年的中枢神经系统变性的终身疾病,目前西医没有一种药物和外科手术能明显阻止疾病的发展。大量临床及实验已经证明,中医针灸可较好地改善运动症状,并控制病情发展,但目前针灸疗效的客观性依据不足。功能磁共振作为无创、方便易行的一种观察手段在PD的诊断与疗效观察上有一定的优势。
目的
通过观察方氏头针对帕金森病患者fMRI的影响,初步探索针灸治疗帕金森病的机制,为帕金森病的针灸治疗提供理论依据。
方法
对2010-2011年间广东省中医院神经内科帕金森病门诊符合纳入标准的10例早中期帕金森病患者,予方氏头针针刺冠矢点及双侧呼循,并于治疗前后进行UPDRS评分、运动试验,以及脑功能磁共振扫描,记录治疗前与治疗后量表、计数及计时结果及脑功能磁共振数据,用t检验(符合正态分布的计量资料)和秩和检验方法对其即时疗效结果进行统计学分析,用组间配对T检验分析其对FMRI的影响。
结果
针刺治疗前后,患者双手运动均稍有改善,但差异无统计学意义(P>0.05)。
针刺治疗前后,患者转弯时间、10米行走时间及起身时间无明显改善,差异无统计学意义(P>0.05)。
针刺治疗前后,患者UPDRS第三部分评分稍有下降,但差异无统计学意义(P>0.05)。
与针刺治疗前相比(P<0.05),针刺治疗后病人双侧海马、左侧杏仁核、左侧岛叶、双侧颞上回、左侧颞中回、左侧额下回、双侧壳核、左侧尾状核、双侧苍白球、胼胝体等脑区局部一致性增高,提示方氏头针治疗前后,部分脑区存在明显差异。
结论
方氏头针针刺治疗帕金森病患者,针刺后部分运动能力稍有改善,但即时疗效不显著。
方氏头针针刺治疗帕金森病患者前后,fMRI显示针刺治疗后病人双侧海马、左侧杏仁核、左侧岛叶、双侧颞上回、左侧颞中回、左侧额下回、双侧壳核、左侧尾状核、双侧苍白球外侧部、胼胝体等脑区局部一致性增高。说明了方氏头针治疗前后部分病理脑区存在明显差异。经方氏头针针刺后脑区一致性变化可能与脑区功能变化存在相关性。方氏头针针刺冠矢点及双侧呼循可能通过改善纹状体的功能而达到改善PD症状的作用及通过改善边缘系统改善患者情感功能。
Objective
Parkinson's Disease(PD), also named as parelysis agitans, is a kind of neurodegenerative disease, which usually occurs in middle-aged or senile patients. At present, there is no medicine or surgical which is effective enough to stop the development of this disease.A large number of clinical research and experimental studies had shown that acupuncture can improve symptoms of tremor and control the progression of this disease. But the objective evidence is not sufficient. Functional magnetic resonance imaging as an observation which non-invasive and convenient, has the advantage in the diagnosis of PD and the observation of the curative effect. Therefore, by observing the impact of Fang-acupuncture of Parkinson' s patients, we elementary discuss the immediate result and mechanism of acupuncture to PD.
Methods
Chosing 10 cases of Parkinson's disease. Evaluate their UPDRS score, motion experiment and fMRI before and after treatment. Recording its scale and brain functional magnetic resonance data, using paired T test to analysis the impact of treatment on FMRI and its immediate effect. Use T test to analysis the difference between two groups.
Results
Timing motion test of both hands of post-treatment have increased than that of prior-treatment. The difference had no statistical difference(p>0.05).
Timing motion test of turning round、standing up and 10 metres walking of post-treatment haven't decreased than that of prior-treatment.
UPDRS scores of part III of post-treatment has decreased than that of prior-treatment. The difference had no statistical difference(p>0.05).
Increased ReHo were found in both Parahippocampa Gyrus、Amygdala_L、Insula_L、both Superior Temporal Gyrus、Temporal_Mid_L、both Putamens、Caudate_L、both Lateral Globus Pallidus、Corpus Callosum etc. (p<0.05).
Conclusion
The Fang-acupuncture can improve movement in PD'patients immediately to some extend. But the difference had no statistical difference(p>0.05).
The Fang-acupuncture may improve movement and sentiment by activating the related brain function.
引文
[1]隆呈祥整理.中华全国中医学会老年医学会.中医老年颤证诊断和疗效评定标准.北京中医学院学报,1992；15(4)：39-41.
[2]王永炎.李明富.戴锡盂等编.中医内科学[M].第6版.上海科学技术出版社。1994.37.
[3]任继学,范国梁.震颤辨治[J].江苏中医,1982；4(4)：11.
[4]隆呈祥.老年颤证的中医研究回顾与展望[J].中国中医药信息杂志,2000；7(10)：1012.,
[5]樊蓥.周仲瑛治疗震颤麻痹的经验[J].中医杂志,1996；37(11)：663.
[6]梅晨健,马莉,徐惠荣,孙士红.针刺夹脊穴治疗帕金森病的临床疗效观察[J],针灸临床杂志,2009,25(12)：13-14.
[7]施孝文.温针治疗帕金森氏症21例[J].中国针灸.2004；24(1)：24.
[8]邹勇.针剌治疗帕金森病的临床观察[J].上海针灸杂志,2006；25(1)：27-28.
[9]葛成永.针灸治疗老年性震颤的临床辨治体会：河北中医.2002；23(2)：126-127.
[10]芳村传统疗法中心编.方氏针灸创新之一-头皮针[M].
[11]郭蕴屏,冉茂东,柴雪华,头针为主治疗帕金森病42例[J].辽宁中医杂志2005,(32)4：355.
[12]杨宇.头部电针治疗帕金森病的临床研究[J],健康天地,2010,4(3)：19-20.
[13]周海东.头针加电针治疗帕金森病36例[J].四川中医,2004；23(4)：88—89.
[14]姜雪梅,黄泳,卓鹰,等.头电针治疗帕金森病的疗效观察[J].南方医科大学学报,2006；26(1)：114-116.
[15]严伟,殷建权,体针头皮针结合治疗老年性震颤的疗效观察[J].针灸临床杂志,2003,(19)7：34.
[16]陈利国.针刺治疗震颤麻痹40例临床观察[J].中医杂志,1996。(37)4：216—217.
[17]王顺,周振坤,胡丙成,等.头部电针透穴疗法治疗帕金森氏病的临床研究[J].中国针灸,2003；23(3)：4-6.
[18]陈潜,王旭针刺治疗震颤麻痹综合征[J].中国针灸,1999,(19)2：92.
[19]陈秀华,李漾,奎瑜腹针配合美多巴治疗帕金森病临床观察[J].中国针灸,2007,(27)8：562-564.
[20]文幸,李颖文,段权.腹针配合艾灸治疗强直少动型帕金森病30例疗效观察[J].广州医学院学报,2008,36(1)：59-61.
[21]任晓明.针灸治疗帕金森病的临床观察[J].浙江中医药大学学报,2008,32(4)：510,512.
[22]张汉梁,祝维峰.针刺治疗帕金森病运动障碍的临床观察[J].中国针灸,2003,23(12)：709—711.
[23]庄小兰.针刺治疗帕金森病29例临床观察[J].北京中医,1998,17(6)：31-33.
[24]张京峰,孙国胜.隔药灸神阙穴治疗帕金森病54例疗效观察[J].中国针灸,2006,25(9)：610-611.
[25]黄文燕.眼针结合中药治疗帕金森病45例[J].上海针灸,2000,19(4)：20.
[26]苏尔亮仿舌定位头针临床应用及体会[J].辽宁中医杂志,2002,(29)5：289—290.
[27]张灿灼,张春梅.补气活血、温阳通脉法治疗帕金森病临床观察[J].中国中医急症,2009,18(7)：1036-1037.
[28]李种泰,杨文波.综合疗法为主治疗帕金森病30例疗效观察[J].新中医,2005；37(10)：52-54.
[29]Shulman LM, Wen X, Weiner WJ, et al. Acupuncture therapy for the symptoms of Parkinson's disease[J]. MovDisord,2002; 17(4):799-802.
[30]奚桂芳,蔡德亨,陈国荑等.头部穴位电刺激对帕金森病震颤肌电位的影响[J].上海针灸杂志,1996；(3)：5.
[31]朱莉莉.针刺对帕金森病脑干诱发IU位影响的分析[J].江苏中医2000；21,(5)：42-43.
[32]姚丽芬,庄礼兴,唐纯志,针刺治疗对帕金森病模型大鼠的疗效及作用机制[J].实用医学杂志,2009,25(13)：2057-2058.
[33]骆仲达,陈兴华,唐纯志,等.针刺对帕金森病模型大鼠血液T淋巴细胞亚群的影响[J].中国临床康复,2004；8(10)：114-115.
[34]马骏,朱书秀.电针对帕金森病模型大鼠黑质抗氧化酶的影响[J].中国临床康复,2005,9(5)：120-121.
[35]袁红,刘平,郑春秀,王向党,张振文,李春雷,焦淑军,白丽敏,梁立武.针灸治疗帕金森病可能氧化应激作用机制的研究[J],中华保健医学杂志,2010,12(1)：45-47.
[36]王顺,蔡玉颖,尚艳杰等.头部电针透穴对帕金森病患者SOD及LPO的影响[J].中国针灸,2006；26(4)：12-14.
[37]董晓彤.王般昆.任小群等.针刺治疗震颤麻痹对患者血中LPO和SOD的影响[J].针刺研究2001；26(Ⅰ)：28.
[38]杨丹红,施茵,贾仰民.针刺结合药物治疗改善帕金森病患者症状及对血抗氧化系统的影响[J].中国临床康复,2006；10(19)：14-16.
[39]陆征宇,赵虹,陈洁,程波,宗蕾.针药并用对帕金森病小鼠纹状体DA、NE和5-羟色胺的影响[J].上海针灸杂志,2011,3(1)：56-58.
[40]陈伶利,李杰,新华,陈北阳,莫莉.针刺筋会穴阳陵泉对帕金森模型小鼠黑质TH表达的影响研究[J].中医药导报,2010,16(11)：67-69.
[41]骆仲达,陈兴华,唐纯志,等.针刺对帕金森病模型大鼠黑质神经细胞凋亡的影响[J].中华医学实践杂志,2003；2(10)：871-872.
[42]黄攀攀,马骏,王彦春,甘水咏,雷涛,朱书秀,王飞,赵莹,刺对帕金森病模型大鼠中脑黑质脑源性神经营养因子及其受体TrKB的影响[J],湖北中医学院学报.2010,12(2)：3-5.
[43]贾军,李博,孙作厘,潘艳丽,王昊闵,汪璇,王晓民.高频电针刺激对帕金森病模型大鼠的神经保护作用[J],北京中医药.2009,28(12)：972-975.
[44]王玲玲.何崇,赵玫等.针灸对帕金森病脑部血流状态的影响[J].中围针灸.1999；19(2)：115.
[45]高波.刘树伟.帕金森病的功能影像学研究进展[J].中华老年医学杂志.2005；24(5)：389-392.
[46]Dhawan V, Ma Y, Pillai V, et al. Comparative analysis of striatal FDOPA uptake in Parkinson's disease:ratio method versus graphical approach [J]. J Nucl Med,2002; 43(10):1324-1330.
[47]Pavese N, Khan NL, Seherfler C, et al. Nigrostriatal dysfunction in homozygous and heterozygous parkin gene carriers:an 18F-dopa PET progression study[J]. Mov Disord,2009,24(15)2260-2266.
[48]Lynch DR, Mozley PD, Sokol S, et al. Lack of effect of polymorphisms in dopamine metabolism related genes on imaging of TRODAT-I in striatum of asymptomatic volunteers and patients with Parkinson's disease [J]. Mov Disord, 2003; 18(7):804-812.
[49]Nunni E, Ruottinen HM, Kaasinen V, et al. Progression in Parkinson's disease:a po sitron emission tomography study with dopamine transporter ligand 18F PET[J]. Ann Neurol,2000; 47(6):804-808.
[50]HuangWS, LinSZ, Lin JC, et al. Evaluation of earty-stage Parkinson's disease with 99mTc-TRODAT-Iimaging[J]. J Nucl Med,2001; 42(9):1303-1308.
[51]Booij J, Tissingh G, Boer GJ, et al[123I]FP-CIT SPECT shows apronounced decline of striatal dopamine transporter labeling in early and advanced Parkinson's disease [J]. J Neurol Neurosurg Psychiatry,1997; 62(2):133-140.
[52]Schulz JB, Skalej M, Wedekind D, et al. Magnetic resonance imaging based volumetry differentiates idiopathic Parkinson's syndrome from multiple system atrophy and progressive supranuelear palsy[J]. Ann Neurol,1999; 45:65-74.
[53]Ghaemi M, Hilker R, Rudolf J, et al. Differentiating multiple system atropy from Parkinson' s disease:contribution of strial and midbrain MRI volumtery and multi—tracer PET imaging[J]. J Neurol Neurosurg Psychiatry,2002; 73: 511-523.
[54]Choe BY, Park JW, Lee KS, et al. Neuronal laterality in Parkinson s disease with unilateral symptom by in vivo 1H magnetic resonance spectroscopy. Invest Radiol,1998; 33(8):450-455.
[55]Gujar SK, Maheshwari S, BjOrkman-Burtscher Ⅰ, et al. Magnetic resonance spectroscopy[J]. J Neuroophthalmol,2005,25(3):217-226.
[56]Hattingen E, Magerkurth J, Pilatus U, et al. Phosphorus and proton magnetic resonance spectroscopy demonstrates mitoehondrial dys—function in early and advanced Parkinson's disease[J]. Brain,2009,132(12):3285-3297.
[57]Lucetti C, Del Dotto P, Gambaccini G, et al. Influences of dopaminergic treatment on motor cortex in Parkinson disease:a MRI/MRS study. Mov Disorder, 2007; 22 (15):2170-2175.
[58]Bluml S, Kopyov O, Jacques S, et al. Activation of neurotransplants in humans. ExpNeural,1999; 158(1):121.
[59]Yoshikawa K, Nakata Y, Yamada K, et al. Early pathological changes in the parkinsonian brain demonstrated by diffusion tensor MRI. J Neurol Neurosurg Psychiatry,2004,75:481.
[60]Chan LL, Rumpel H, Yap K, et al. Case control study of diffusion tensor imaging in Parkinson disease. J. Neurol Neurosurg Psychiatry,2007,78: 1383.
[61]刘其春.磁共振成像技术在帕金森病诊断中的作用[J],医学临床研究.2009,26(12)：2375-2378.
[62]Rieger JW,Kim A,Argyelan M,el al.Cortical functional anatomy of voluntary saccades in Parkinson disease[J]. Clin EEG Neurosci,2008,39(4):169-174.
[63]Wu T, Hallett M. A functional MRI study of automatic movements in patients with Parkinson s disease [J]. Brain,2005,128 (Pt 10):2250-2259.
[64]Ukmar M. Functional MRI in the assessment of cortical activation in subjects with Parkinson's disease[J]. Radiol Med(Torino),2006,111(1): 104-115.
[65]Moretti R, Torre P, Antonello RM, et al. Role of the cerebellum in the control of distal motor activities in patients with akinetic-rigid Parkinson disease[J]. Recenti Prog Med,2005,96(12):599-603.
[66]Eckert T, Peschel T, Heinze HJ, el al. Increased pre-SMA activation in early PD patients during simple self initiated hand movements[J]. J Neurol, 2006,253(2):199-207.
[67]Owen AM. Cognitive dysfunction in Parkinson's disease:the role of frontostriatal circuitry[J]. Neuroscientist,2004,10(6):525-537.
[68]Holden A,Wilman A,Wieler M,et al. Basal ganglia activation in Parkinson's disease[J]. Parkinsonism Relat Disord,2006,12(2):73-77.
[69]Haslinger B, Erhard P, Kampfe N, et al. Events-related functional magnetic imaging in Parkinson's disease before and after levodopa. Brain,2001; 123 (3):558-570.
[2]王永炎.李明富.戴锡盂等编.中医内科学[M].第6版.上海科学技术出版社。1994.37.
[3]任继学,范国梁.震颤辨治[J].江苏中医,1982；4(4)：11.
[4]隆呈祥.老年颤证的中医研究回顾与展望[J].中国中医药信息杂志,2000；7(10)：1012.,
[5]樊蓥.周仲瑛治疗震颤麻痹的经验[J].中医杂志,1996；37(11)：663.
[6]梅晨健,马莉,徐惠荣,孙士红.针刺夹脊穴治疗帕金森病的临床疗效观察[J],针灸临床杂志,2009,25(12)：13-14.
[7]施孝文.温针治疗帕金森氏症21例[J].中国针灸.2004；24(1)：24.
[8]邹勇.针剌治疗帕金森病的临床观察[J].上海针灸杂志,2006；25(1)：27-28.
[9]葛成永.针灸治疗老年性震颤的临床辨治体会：河北中医.2002；23(2)：126-127.
[10]芳村传统疗法中心编.方氏针灸创新之一-头皮针[M].
[11]郭蕴屏,冉茂东,柴雪华,头针为主治疗帕金森病42例[J].辽宁中医杂志2005,(32)4：355.
[12]杨宇.头部电针治疗帕金森病的临床研究[J],健康天地,2010,4(3)：19-20.
[13]周海东.头针加电针治疗帕金森病36例[J].四川中医,2004；23(4)：88—89.
[14]姜雪梅,黄泳,卓鹰,等.头电针治疗帕金森病的疗效观察[J].南方医科大学学报,2006；26(1)：114-116.
[15]严伟,殷建权,体针头皮针结合治疗老年性震颤的疗效观察[J].针灸临床杂志,2003,(19)7：34.
[16]陈利国.针刺治疗震颤麻痹40例临床观察[J].中医杂志,1996。(37)4：216—217.
[17]王顺,周振坤,胡丙成,等.头部电针透穴疗法治疗帕金森氏病的临床研究[J].中国针灸,2003；23(3)：4-6.
[18]陈潜,王旭针刺治疗震颤麻痹综合征[J].中国针灸,1999,(19)2：92.
[19]陈秀华,李漾,奎瑜腹针配合美多巴治疗帕金森病临床观察[J].中国针灸,2007,(27)8：562-564.
[20]文幸,李颖文,段权.腹针配合艾灸治疗强直少动型帕金森病30例疗效观察[J].广州医学院学报,2008,36(1)：59-61.
[21]任晓明.针灸治疗帕金森病的临床观察[J].浙江中医药大学学报,2008,32(4)：510,512.
[22]张汉梁,祝维峰.针刺治疗帕金森病运动障碍的临床观察[J].中国针灸,2003,23(12)：709—711.
[23]庄小兰.针刺治疗帕金森病29例临床观察[J].北京中医,1998,17(6)：31-33.
[24]张京峰,孙国胜.隔药灸神阙穴治疗帕金森病54例疗效观察[J].中国针灸,2006,25(9)：610-611.
[25]黄文燕.眼针结合中药治疗帕金森病45例[J].上海针灸,2000,19(4)：20.
[26]苏尔亮仿舌定位头针临床应用及体会[J].辽宁中医杂志,2002,(29)5：289—290.
[27]张灿灼,张春梅.补气活血、温阳通脉法治疗帕金森病临床观察[J].中国中医急症,2009,18(7)：1036-1037.
[28]李种泰,杨文波.综合疗法为主治疗帕金森病30例疗效观察[J].新中医,2005；37(10)：52-54.
[29]Shulman LM, Wen X, Weiner WJ, et al. Acupuncture therapy for the symptoms of Parkinson's disease[J]. MovDisord,2002; 17(4):799-802.
[30]奚桂芳,蔡德亨,陈国荑等.头部穴位电刺激对帕金森病震颤肌电位的影响[J].上海针灸杂志,1996；(3)：5.
[31]朱莉莉.针刺对帕金森病脑干诱发IU位影响的分析[J].江苏中医2000；21,(5)：42-43.
[32]姚丽芬,庄礼兴,唐纯志,针刺治疗对帕金森病模型大鼠的疗效及作用机制[J].实用医学杂志,2009,25(13)：2057-2058.
[33]骆仲达,陈兴华,唐纯志,等.针刺对帕金森病模型大鼠血液T淋巴细胞亚群的影响[J].中国临床康复,2004；8(10)：114-115.
[34]马骏,朱书秀.电针对帕金森病模型大鼠黑质抗氧化酶的影响[J].中国临床康复,2005,9(5)：120-121.
[35]袁红,刘平,郑春秀,王向党,张振文,李春雷,焦淑军,白丽敏,梁立武.针灸治疗帕金森病可能氧化应激作用机制的研究[J],中华保健医学杂志,2010,12(1)：45-47.
[36]王顺,蔡玉颖,尚艳杰等.头部电针透穴对帕金森病患者SOD及LPO的影响[J].中国针灸,2006；26(4)：12-14.
[37]董晓彤.王般昆.任小群等.针刺治疗震颤麻痹对患者血中LPO和SOD的影响[J].针刺研究2001；26(Ⅰ)：28.
[38]杨丹红,施茵,贾仰民.针刺结合药物治疗改善帕金森病患者症状及对血抗氧化系统的影响[J].中国临床康复,2006；10(19)：14-16.
[39]陆征宇,赵虹,陈洁,程波,宗蕾.针药并用对帕金森病小鼠纹状体DA、NE和5-羟色胺的影响[J].上海针灸杂志,2011,3(1)：56-58.
[40]陈伶利,李杰,新华,陈北阳,莫莉.针刺筋会穴阳陵泉对帕金森模型小鼠黑质TH表达的影响研究[J].中医药导报,2010,16(11)：67-69.
[41]骆仲达,陈兴华,唐纯志,等.针刺对帕金森病模型大鼠黑质神经细胞凋亡的影响[J].中华医学实践杂志,2003；2(10)：871-872.
[42]黄攀攀,马骏,王彦春,甘水咏,雷涛,朱书秀,王飞,赵莹,刺对帕金森病模型大鼠中脑黑质脑源性神经营养因子及其受体TrKB的影响[J],湖北中医学院学报.2010,12(2)：3-5.
[43]贾军,李博,孙作厘,潘艳丽,王昊闵,汪璇,王晓民.高频电针刺激对帕金森病模型大鼠的神经保护作用[J],北京中医药.2009,28(12)：972-975.
[44]王玲玲.何崇,赵玫等.针灸对帕金森病脑部血流状态的影响[J].中围针灸.1999；19(2)：115.
[45]高波.刘树伟.帕金森病的功能影像学研究进展[J].中华老年医学杂志.2005；24(5)：389-392.
[46]Dhawan V, Ma Y, Pillai V, et al. Comparative analysis of striatal FDOPA uptake in Parkinson's disease:ratio method versus graphical approach [J]. J Nucl Med,2002; 43(10):1324-1330.
[47]Pavese N, Khan NL, Seherfler C, et al. Nigrostriatal dysfunction in homozygous and heterozygous parkin gene carriers:an 18F-dopa PET progression study[J]. Mov Disord,2009,24(15)2260-2266.
[48]Lynch DR, Mozley PD, Sokol S, et al. Lack of effect of polymorphisms in dopamine metabolism related genes on imaging of TRODAT-I in striatum of asymptomatic volunteers and patients with Parkinson's disease [J]. Mov Disord, 2003; 18(7):804-812.
[49]Nunni E, Ruottinen HM, Kaasinen V, et al. Progression in Parkinson's disease:a po sitron emission tomography study with dopamine transporter ligand 18F PET[J]. Ann Neurol,2000; 47(6):804-808.
[50]HuangWS, LinSZ, Lin JC, et al. Evaluation of earty-stage Parkinson's disease with 99mTc-TRODAT-Iimaging[J]. J Nucl Med,2001; 42(9):1303-1308.
[51]Booij J, Tissingh G, Boer GJ, et al[123I]FP-CIT SPECT shows apronounced decline of striatal dopamine transporter labeling in early and advanced Parkinson's disease [J]. J Neurol Neurosurg Psychiatry,1997; 62(2):133-140.
[52]Schulz JB, Skalej M, Wedekind D, et al. Magnetic resonance imaging based volumetry differentiates idiopathic Parkinson's syndrome from multiple system atrophy and progressive supranuelear palsy[J]. Ann Neurol,1999; 45:65-74.
[53]Ghaemi M, Hilker R, Rudolf J, et al. Differentiating multiple system atropy from Parkinson' s disease:contribution of strial and midbrain MRI volumtery and multi—tracer PET imaging[J]. J Neurol Neurosurg Psychiatry,2002; 73: 511-523.
[54]Choe BY, Park JW, Lee KS, et al. Neuronal laterality in Parkinson s disease with unilateral symptom by in vivo 1H magnetic resonance spectroscopy. Invest Radiol,1998; 33(8):450-455.
[55]Gujar SK, Maheshwari S, BjOrkman-Burtscher Ⅰ, et al. Magnetic resonance spectroscopy[J]. J Neuroophthalmol,2005,25(3):217-226.
[56]Hattingen E, Magerkurth J, Pilatus U, et al. Phosphorus and proton magnetic resonance spectroscopy demonstrates mitoehondrial dys—function in early and advanced Parkinson's disease[J]. Brain,2009,132(12):3285-3297.
[57]Lucetti C, Del Dotto P, Gambaccini G, et al. Influences of dopaminergic treatment on motor cortex in Parkinson disease:a MRI/MRS study. Mov Disorder, 2007; 22 (15):2170-2175.
[58]Bluml S, Kopyov O, Jacques S, et al. Activation of neurotransplants in humans. ExpNeural,1999; 158(1):121.
[59]Yoshikawa K, Nakata Y, Yamada K, et al. Early pathological changes in the parkinsonian brain demonstrated by diffusion tensor MRI. J Neurol Neurosurg Psychiatry,2004,75:481.
[60]Chan LL, Rumpel H, Yap K, et al. Case control study of diffusion tensor imaging in Parkinson disease. J. Neurol Neurosurg Psychiatry,2007,78: 1383.
[61]刘其春.磁共振成像技术在帕金森病诊断中的作用[J],医学临床研究.2009,26(12)：2375-2378.
[62]Rieger JW,Kim A,Argyelan M,el al.Cortical functional anatomy of voluntary saccades in Parkinson disease[J]. Clin EEG Neurosci,2008,39(4):169-174.
[63]Wu T, Hallett M. A functional MRI study of automatic movements in patients with Parkinson s disease [J]. Brain,2005,128 (Pt 10):2250-2259.
[64]Ukmar M. Functional MRI in the assessment of cortical activation in subjects with Parkinson's disease[J]. Radiol Med(Torino),2006,111(1): 104-115.
[65]Moretti R, Torre P, Antonello RM, et al. Role of the cerebellum in the control of distal motor activities in patients with akinetic-rigid Parkinson disease[J]. Recenti Prog Med,2005,96(12):599-603.
[66]Eckert T, Peschel T, Heinze HJ, el al. Increased pre-SMA activation in early PD patients during simple self initiated hand movements[J]. J Neurol, 2006,253(2):199-207.
[67]Owen AM. Cognitive dysfunction in Parkinson's disease:the role of frontostriatal circuitry[J]. Neuroscientist,2004,10(6):525-537.
[68]Holden A,Wilman A,Wieler M,et al. Basal ganglia activation in Parkinson's disease[J]. Parkinsonism Relat Disord,2006,12(2):73-77.
[69]Haslinger B, Erhard P, Kampfe N, et al. Events-related functional magnetic imaging in Parkinson's disease before and after levodopa. Brain,2001; 123 (3):558-570.