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1. 北京大学人民医院中医科
2. 北京市鼓楼中医医院中医科
3. 北京中医药大学东直门医院神经内科
Published:2020
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LANG Yi, LI Kuang-shi, YANG Jia-yi, et al. Effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction[J]. Acupuncture research, 2020, 45(2): 141-147.
LANG Yi, LI Kuang-shi, YANG Jia-yi, et al. Effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction[J]. Acupuncture research, 2020, 45(2): 141-147. DOI: 10.13702/j.1000-0607.190757.
目的:基于体素形态学法
观察针刺顶颞前斜线对脑梗死偏瘫患者脑灰质重塑的干预效应
揭示头针治疗脑梗死偏瘫的优势和中枢效应位点。方法:选取右侧基底节区脑梗死偏瘫患者及健康受试者各18例。将患者随机分为头针组和对照组各9例
两组均给予拜阿司匹林肠溶片、立普妥等基础药物治疗
头针组在此基础上针刺右侧顶颞前斜线。健康受试者仅在入组时采集T1结构像数据。两组患者分别于治疗前、治疗2周后采集T1结构像数据。比较两组患者治疗前后神经功能缺损程度(NIHSS评分)
脑灰质变化及其与健康人脑灰质的差异。结果:与治疗前比较
治疗后头针组NIHSS评分明显降低(P<0.05)
而对照组治疗前后NIHSS评分差异无统计学意义(P>0.05)。治疗后头针组NIHSS评分较对照组明显降低(P<0.05)。与健康人比较
脑梗死偏瘫患者双侧小脑灰质体素增加。治疗2周后
与健康人比较
头针组在小脑、前扣带回、基底节区(豆状核、屏状核为主)、额内侧回等运动相关皮层及部分感觉皮层出现灰质体素增加
对照组在非运动相关的极少脑区出现小幅度体素增长。与治疗前比较
头针组治疗后在基底节区(豆状核、屏状核为主)的脑区出现体素增长;治疗后
与对照组比较
头针组脑灰质增多较为显著的脑区主要集中在双侧小脑。结论:针刺顶颞前斜线对脑梗死偏瘫患者脑神经功能恢复有促进作用
其机制可能与促进双侧小脑、健侧基底节为主的锥体外系运动调节中枢及部分感觉皮层灰质结构重塑
诱发相应脑区功能代偿有关。
Objective To observe the intervention effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction based on voxel-based morphology(VBM)
and to reveal the advantages and central effect sites of scalp acupuncture for hemiplegia of cerebral infarction. Methods A total of 18 patients with hemiplegia of cerebral infarction in the right basal ganglia and 18 healthy subjects were enrolled and T1 structural scan was performed. The patients were randomly divided into scalp acupuncture group and non-scalp acupuncture group
with 9 patients in each group. SPSS20.0 was used to analyze the degree of neurological deficit(NIHSS) before and after treatment
and SPM8 software package was used to compare the change in gray matter after treatment between the two groups
the difference in gray matter between patients and healthy subjects. Results After treatment
the scalp acupuncture group had a significant reduction in NIHSS(P<0.05)
while the non-scalp acupuncture group had no significant change in NIHSS(P>0.05); the scalp acupuncture group had a significantly lower NIHSS than the non-scalp acupuncture group after treatment(P<0.05). Compared with the healthy subjects
the patients with cerebral infarction had a voxel increase of gray matter in the bilateral cerebellum; after 2 weeks of treatment
the scalp acupuncture group had a voxel increase of gray matter in the motor-related cortex(such as the cerebellum
the anterior cingulate
the basal nucleus
and the medial frontal gyrus) and some parts of the sensory cortex
while the non-scalp acupuncture group had a slight voxel increase of gray matter in few brain regions which were not associated with motor. After treatment
the scalp acupuncture group had a voxel increase in the brain regions of the basal ganglia
mainly the lenticular nucleus and the claustrum. Compared with the non-scalp acupuncture group after treatment
the scalp acupuncture group had a greater gray matter increase in the brain regions mainly in the bilateral cerebellar cortex. Conclusion Acupuncture at the anterior oblique parietotemporal line can promote neurological function recovery in patients with hemiplegia
possibly by promoting gray matter remodeling in the motor centers of the extrapyramidal system(mainly the bilateral cerebellum and the contralateral basal ganglia) and some parts of the sensory cortex and inducing functional compensation in corresponding brain regions.
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