针康法促进脑卒中后下肢运动功能重建的功能性近红外光谱研究

doi:10.3969/j.issn.1006-9771.2022.01.005

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (1): 32-37.doi: 10.3969/j.issn.1006-9771.2022.01.005

针康法促进脑卒中后下肢运动功能重建的功能性近红外光谱研究

唐强¹,王雪²,穆姿辰²,张世强²,朱路文³()

1.黑龙江中医药大学附属第二医院,黑龙江哈尔滨市 150001
2.黑龙江中医药大学,黑龙江哈尔滨市 150040
3.黑龙江中医药大学附属第四医院,黑龙江哈尔滨市 150018

收稿日期:2021-09-16 修回日期:2021-12-02 出版日期:2022-01-25 发布日期:2022-02-11
通讯作者: 朱路文 E-mail:zhuluwen1983@126.com
作者简介:唐强(1963-),男,汉族,四川大竹县人,教授,博士生导师,主要研究方向：慢性病常见功能障碍的中医康复。
基金资助:
1. 国家重点研发计划项目(2019YFC1710304);2. 黑龙江省应用技术研究与开发计划项目(GA19C110)

Effects of acupuncture and rehabilitation therapy on lower limb motor function after stroke: an fNIRS study

TANG Qiang¹,WANG Xue²,MU Zichen²,ZHANG Shiqiang²,ZHU Luwen³()

1. Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150001, China
2. Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, China
3. Forth Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150018, China

Received:2021-09-16 Revised:2021-12-02 Published:2022-01-25 Online:2022-02-11
Contact: ZHU Luwen E-mail:zhuluwen1983@126.com
Supported by:
National Key Research and Development Program of China(2019YFC1710304);Applied Technology Research and Development Program of Heilongjiang Province(GA19C110)

摘要/Abstract

摘要：

目的采用功能性近红外光谱成像技术(fNIRS)研究针康法促进脑卒中患者下肢运动功能重建的脑皮质激活模式的变化。方法 2020年12月至2021年7月,黑龙江中医药大学附属第二医院24例脑卒中下肢运动功能障碍患者随机分为康复组(n = 12)和针康组(n = 12),分别进行4周的常规康复训练和针康法干预。对照组纳入10例年龄等基线信息与脑卒中患者无显著性差异的健康受试者。干预前、后分别用Fugl-Meyer评定量表下肢部分(FMA-LE)评估患者的下肢运动功能,并对受试者进行fNIRS检查。基于氧合血红蛋白(HbO₂)计算脑皮质辅助运动区(SMA)、运动前皮质(PMC)及初级感觉运动皮质(SMC)的功能强度变化及偏侧化指数(LI)。结果干预前,康复组和针康组FMA-LE评分无显著性差异(P > 0.05);干预4周后,两组FMA-LE评分均显著提高(t > 3.770, P < 0.001),针康组高于康复组(t = 2.252, P < 0.05)。干预前,对照组平均功能连接强度高于康复组和针康组(P < 0.05),后两组皮质运动相关区域功能连接强度无显著性差异(t = 0.458, P > 0.05);干预后,康复组和针康组平均功能连接强度均提高(t > 2.178, P < 0.05),其中针康组患侧PMC功能连接强度增强(P < 0.05),针康组SMC区LI提高(P < 0.05);针康组FMA-LE评分变化量与患侧PMC功能连接强度的变化量呈正相关(r = 0.579, P < 0.05)。结论针康法可明显改善脑卒中患者下肢运动功能与SMC的非对称性激活。下肢运动功能恢复可能与患侧PMC的激活增强有关。

关键词: 脑卒中, 针康法, 功能性近红外光谱成像, 脑重塑

Abstract:

Objective To investigate the efficacy of acupuncture and rehabilitation therapy on lower limb motor function, and to explore a cortical mechanism using functional near infrared spectroscopy (fNIRS). Methods From December, 2020 to July, 2021, 24 stroke patients with lower limb motor dysfunction in our hospital were randomly divided into rehabilitation group (n = 12) and acupuncture-rehabilitation group (n = 12), and received routine rehabilitation training and acupuncture-rehabilitation intervention for four weeks, respectively. The control group included ten healthy subjects matched the patients. Before and after intervention, the lower limb motor function of the patients was assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), and all the subjects accepted fNIRS examination. The functional intensity and lateralization index (LI) of supplementary motor area (SMA), premotor cortex (PMC) and sensory motor cortex (SMC) were calculated based on oxygenated hemoglobin (HbO₂). Results There was no significant difference in FMA-LE score between the rehabilitation group and the acupuncture-rehabilitation group before the intervention (P > 0.05). After four weeks of intervention, FMA-LE scores improved in both groups (t > 3.770, P < 0.001), and improved more in the acupuncture-rehabilitation group than in the rehabilitation group (t = 2.252, P < 0.05). Before intervention, the average functional connection was more intensitive in the control group than in the two patients groups (P < 0.05), and there was no significant difference between the later two groups (t = 0.458, P > 0.05). After intervention, the average functional connection increased in both groups (t > 2.178, P < 0.05), and the functional connection of the affected PMC of acupuncture-rehabilitation group increased (P < 0.05). The LI in SMC increased in the acupuncture-rehabilitation group (P < 0.05). There was a significant positive correlation between the change of functional connection of the affected PMC and the change of FMA-LE scores in the acupuncture-rehabilitation group (r = 0.579, P < 0.05). Conclusion Acupuncture with rehabilitation therapy can significantly improve the lower limb motor function and asymmetrical activation of SMC in stroke patients. The recovery of lower limb motor function may be related to the enhanced activation of affected PMC.

Key words: stroke, acupuncture and rehabilitation therapy, functional near infrared spectroscopy, cortical reorganization

中图分类号:

R743.3

唐强,王雪,穆姿辰,张世强,朱路文. 针康法促进脑卒中后下肢运动功能重建的功能性近红外光谱研究[J]. 《中国康复理论与实践》, 2022, 28(1): 32-37.

TANG Qiang,WANG Xue,MU Zichen,ZHANG Shiqiang,ZHU Luwen. Effects of acupuncture and rehabilitation therapy on lower limb motor function after stroke: an fNIRS study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 32-37.

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组别	n	性别 (男/女)/n	年龄/岁	病程/d	病变性质 (缺血/出血)/n	瘫痪侧别 (左/右)/n	MMSE
对照组	10	9/1	46.10±11.00	—	—	—	30.10±1.20
康复组	12	11/1	51.91±4.63	40.08±9.20	9/3	6/6	29.18±0.97
针康组	12	11/1	53.50±6.00	35.60±12.87	8/4	5/7	28.75±0.83
χ²/F值		0.444	2.628	0.293	0.202	0.168	0.276
P值		0.801	0.088	0.594	0.653	0.682	0.705

组别	n	干预前	干预后	t值	P值
康复组	12	17.91±4.83	24.32±3.37	3.770	< 0.001
针康组	12	18.50±3.72	27.78±4.12	5.791	< 0.001
t值		0.335	2.252
P值		0.741	0.035

组别	n	干预前	干预后	t值	P值
针康组	12	0.36±0.17	0.49±0.11	2.224	0.037
康复组	12	0.33±0.15	0.44±0.09	2.178	0.040
t值		0.458	1.219
P值		0.651	0.236

针康法促进脑卒中后下肢运动功能重建的功能性近红外光谱研究

Effects of acupuncture and rehabilitation therapy on lower limb motor function after stroke: an fNIRS study

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