针灸治疗对脑梗死后运动功能和皮质脊髓束损伤效果的神经影像学观察

doi:10.3969/j.issn.1006-9771.2021.11.011

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (11): 1312-1317.doi: 10.3969/j.issn.1006-9771.2021.11.011

针灸治疗对脑梗死后运动功能和皮质脊髓束损伤效果的神经影像学观察

杨福霞¹,侯冬梅²,高进云¹(),古媚³,赵波沣¹(),曾旭梅¹,詹敏敏¹,谢敏娇¹,谢耀钦⁴

1.深圳市中医院,广东深圳市 518033
2.济南市人民医院,山东济南市 271100
3.深圳市人民医院,广东深圳市518001
4.中国科学院深圳先进技术研究院,广东深圳市 518001

收稿日期:2021-02-06 修回日期:2021-09-13 出版日期:2021-11-25 发布日期:2021-12-03
通讯作者: 高进云,赵波沣 E-mail:274117273@qq.com;zhaobf@126.com
作者简介:杨福霞(1976-),女,汉族,山东济南市人,博士,副主任医师,主要研究方向：针灸治病的临床与机制研究。
基金资助:
1. 国家中医药管理局全国老中医药专家学术经验继承工作项目(No. 国中医药人教发[2017]29号);2. 广东省自然科学基金项目(2018A030313975);3. 深圳市"医疗卫生三名工程"项目(SZSM201612001)

Effects of Acupuncture on Motor and Corticospinal Tract Impairment after Cerebral Infarction: Using Diffusion Tensor Imaging and Tractography

YANG Fu-xia¹,HOU Dong-mei²,GAO Jin-yun¹(),GU Mei³,ZHAO Bo-feng¹(),ZENG Xu-mei¹,ZHAN Min-min¹,XIE Min-jiao¹,XIE Yao-qin⁴

1. Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong 518033, China
2. Ji'nan People's Hospital, Ji'nan, Shandong 271100, China
3. Shenzhen People's Hospital, Shenzhen, Guangdong 518001, China
4. Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, Guangdong 518001, China

Received:2021-02-06 Revised:2021-09-13 Published:2021-11-25 Online:2021-12-03
Contact: GAO Jin-yun,ZHAO Bo-feng E-mail:274117273@qq.com;zhaobf@126.com
Supported by:
National Administration of Traditional Chinese Medicine Senior Chinese Medicine Experts Academic Experience Inheritance (No. [2017]29);Natural Science Foundation of Guangdong(2018A030313975);Shenzhen 3-Famous Project for Medical and Health Services(SZSM201612001)

摘要/Abstract

摘要：

目的观察调任通督针法对脑梗死皮质脊髓束(CST)损伤及肢体功能的影响。方法 2017年2月至2020年12月,深圳市中医院就诊脑梗死患者54例分层随机分为对照组(n = 27)和针刺组(n = 27),每组再根据CST受损分级分为1、2、3级亚组,每亚组各9例。两组均行常规药物治疗,针刺组加调任通督针法。治疗前和治疗4周后,采用Fugl-Meyer评定量表(FMA)和改良Barthel指数(MBI)进行评定,采用磁共振弥散张量成像及其纤维束成像获取梗死灶区CST损伤分级、DTI获取各向异性分数(FA)和健患侧FA比(rFA)。结果治疗后,两组各亚组FMA和MBI评分,FA和rFA均增加(t > 2.841, P < 0.05);针刺组各亚组FMA和MBI评分差值,FA和rFA差值均高于对照组对应亚组(t > 2.140, P < 0.05)。结论调任通督针法可促进脑梗死患者CST损伤恢复,从而促进运功功能恢复。

关键词: 脑梗死, 针刺, 弥散张量成像, 弥散张量纤维束成像, 运动, 皮质脊髓束

Abstract:

Objective To explore the effects of Tiaoren Tongdu Acupuncture on motor function and corticospinal tract (CST) remodeling after cerebral infarction.Methods From February, 2017 to December, 2020, 54 patients with cerebral infarction were randomly divided into control group (n = 27) and acupuncture group (n = 27), each group was divided into subgroups 1, 2 and 3 according to the impairment of corticospinal tract, with nine cases for each subgroup. All the patients received routine medicine, while the acupuncture group received Tiaoren Tongdu Acupuncture, for four weeks. They were assessed with Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) before and after treatment, and scanned with diffusion tensor imaging and diffusion tensor tractography, to obtain the fractional anisotropy (FA) and the bilateral FA ratio (rFA).Results The scores of FMA and MBI, and FA and rFA increased in both groups (t > 2.841, P < 0.05) after treatment, and increased more in the acupuncture group than in the control group (t > 2.140, P < 0.05).Conclusion Tiaoren Tongdu Acupuncture can promote the recovery of CST to improve motor function for patients with cerebral infarction.

Key words: cerebral infarction, acupuncture, diffusion tensor imaging, diffusion tensor tractography, motor, corticospinal tract

杨福霞,侯冬梅,高进云,古媚,赵波沣,曾旭梅,詹敏敏,谢敏娇,谢耀钦. 针灸治疗对脑梗死后运动功能和皮质脊髓束损伤效果的神经影像学观察[J]. 《中国康复理论与实践》, 2021, 27(11): 1312-1317.

YANG Fu-xia,HOU Dong-mei,GAO Jin-yun,GU Mei,ZHAO Bo-feng,ZENG Xu-mei,ZHAN Min-min,XIE Min-jiao,XIE Yao-qin. Effects of Acupuncture on Motor and Corticospinal Tract Impairment after Cerebral Infarction: Using Diffusion Tensor Imaging and Tractography[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(11): 1312-1317.

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组别	n	性别(男/女, n)	年龄(岁)	病程(d)	偏瘫侧(左/右, n)	利手(右/左, n)
对照组	27	15/12	61.24±16.51	55.64±23.01	16/11	24/3
针刺组	27	14/13	63.36±19.07	65.23±25.04	14/13	25/2
χ²/t值		0.074	0.435	0.701	0.300	0.220
P值		0.785	0.664	0.486	0.584	0.639

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	75.9±12.7	93.3±5.4	15.5±3.5	17.330	< 0.001
针刺组	9	77.8±8.4	94.9±5.4	19.0±3.5	19.331	< 0.001
t值		0.377		2.140
P值		0.711		0.048

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	64.1±18.9	74.4±21.7	11.6±2.2	4.793	0.004
针刺组	9	62.8±19.3	84.6±23.3	14.1±2.6	12.810	< 0.001
t值		0.154		2.163
P值		0.879		0.046

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	35.06±7.91	44.53±15.83	5.27±2.42	3.085	0.015
针刺组	9	39.26±9.15	45.53±13.56	10.47±3.57	6.788	< 0.001
t值		1.042		3.617
P值		0.313		0.002

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	74.0±12.5	90.0±8.5	13.1±5.1	16.560	< 0.001
针刺组	9	76.9±11.2	92.2±8.8	18.2±5.0	18.840	< 0.001
t值		0.159		2.155
P值		0.731		0.047

针灸治疗对脑梗死后运动功能和皮质脊髓束损伤效果的神经影像学观察

Effects of Acupuncture on Motor and Corticospinal Tract Impairment after Cerebral Infarction: Using Diffusion Tensor Imaging and Tractography

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组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	61.5±11.9	73.3±14.8	12.7±3.8	13.001	< 0.001
针刺组	9	60.6±10.4	78.3±14.3	16.8±4.3	14.880	< 0.001
t值		0.160		2.154
P值		0.875		0.046

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	36.54±9.53	45.33±15.92	7.58±2.45	6.831	< 0.001
针刺组	9	37.75±12.57	47.59±10.59	11.05±4.03	11.380	< 0.001
t值		0.230		2.207
P值		0.820		0.042

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	0.63±0.24	0.71±0.22	0.08±0.02	6.240	< 0.001
针刺组	9	0.63±0.25	0.74±0.23	0.11±0.03	7.709	< 0.001
t值		0.017		2.250
P值		0.986		0.039

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	0.50±0.28	0.56±0.32	0.05±0.02	4.453	0.006
针刺组	9	0.51±0.31	0.58±0.30	0.08±0.03	6.650	< 0.001
t值		0.022		2.153
P值		0.982		0.047

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	0.30±0.17	0.33±0.18	0.03±0.01	2.841	0.022
针刺组	9	0.31±0.16	0.34±0.18	0.04±0.02	4.882	0.001
t值		0.026		2.229
P值		0.979		0.041

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	0.70±0.20	0.84±0.28	0.13±0.02	12.250	< 0.001
针刺组	9	0.71±0.25	0.87±0.19	0.17±0.03	21.530	< 0.001
t值		0.056		2.325
P值		0.955		0.034

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	0.559±0.201	0.635±0.259	0.077±0.022	5.678	< 0.001
针刺组	9	0.558±0.274	0.661±0.174	0.102±0.026	8.267	< 0.001
t值		0.009		2.202
P值		0.993		0.043

组别	n	治疗前	治疗后	治疗前后差	t值^a	P值^a
对照组	9	0.347±0.162	0.376±0.176	0.035±0.012	3.944	0.004
针刺组	9	0.341±0.139	0.397±0.169	0.050±0.017	8.397	< 0.001
t值		0.084		2.163
P值		0.933		0.046

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