针刺引起孤独症语言障碍儿童事件相关电位P3潜伏期和波幅的变化

Acupuncture induced changes of the event related potential P3 latency and wave amplitude in autistic children with language disorder

目的:观察针刺对孤独症语言障碍儿童事件相关电位P3潜伏期和波幅的影响。方法:选择2000-09/2002-09在宁波市海曙区中医医院儿童脑病科治疗的儿童孤独症30例,按就诊顺序分为针刺组20例和对照组10例。针刺组取四神针、颞三针、脑三针、头智针、舌三针、手三针、手智针、足三针、足智针、风池、哑门,针刺1次/d,30min/次,10min行针1次,每周休息2d,4周为1个疗程,共治疗4个疗程。对照组口服智康口服液(由何首乌、远志、龙眼肉、女贞子、龙骨、茯苓等组成,含生药3g/mL)、吡拉西坦口服液,3次/d,每次各10mL,连续治疗4个月。治疗前后使用日本MEB-4200诱发电位仪检测2组事件相关电位P3波幅和潜伏期的变化,事件相关电位P3的潜伏期可反映大脑对刺激进行编码、分类和识别的速度,P3的波幅与大脑皮质突触数目及注意状态有关,评估其由心理活动产生的脑电变化。结果:按意向处理分析,30例患儿均进入结果分析。①P3潜伏期:针刺组治疗后较治疗前明显缩短犤(492.19±31.04),(525.64±39.26)ms,t=8.48,P<0.01犦,对照组与治疗前比较无差异犤(510.38±23.29),(518.23±26.35)ms,t=1.97,P>0.05犦,治疗前后差值针刺组显著高于对照组犤(33.45±8.22),(7.85±3.06)ms,P<0.01犦。②P3波幅:针刺组治疗后较治疗前明显升高犤(5.98±1.63),(4.66±1.24)μV,t=2.21,P<0.05犦,对照组与治疗前比较无差异犤(4.85±1.09),(4.72±1.05)μV,t=1.48,P>0.05犦,治疗前后差值针刺组显著高于对照组犤(1.32±0.39),(0.13±0.04)μV,P<0.01犦。结论:针刺能有效缩短孤独症儿童事件相关电位P3潜伏期,提示针刺治疗使神经冲动传导加快,大脑对外界信息的认知加工时间缩短。孤独症儿童针刺治疗后P3波幅升高,提示针刺可以促进发育受阻的患儿的神经纤维的生长发育,增加大脑皮质突触的数目与质量,同时,尽可能提高了孤独症患儿的注意水平,增加了能激活起来的神经元数量。

AIM： To observe the influence of acupuncture on event evoked potential P3 latency and wave amplitude in autistic children with language disorders.METHODS： Thirty autistic children, who were treated in the Department of Pediatric Encephalopathy, Haishu District Hospital of Traditional Chinese Medicine of Ningbo City between September 2000 and September 2002, were divided into acupuncture group （n=20） and control group （n=10）aecording to their order of admission. The patients in the acupuncture group were treated with acupuncture at sishenzhen, niesanzhen,naosanzhen, touzhizhen, shesanzhen, shousanzhen, shouzhizhen, zusomhen,zuzhizhen, fengchi and yamen acpoints, once a day, 30 minutes for each time, 10 minutes for each acupuncture; There was a 2-day rest every week,and 4 weeks as a course for 4 courses; The patients in the control group were treated with Zhikang oral solution （tuber fleeceflower root, polygala root, longan aril, glossy privet fruit, dragon＇s bone and tuckahoe, containing crude drug of 3 g/mL） and piracetam oral solution, 3 times a day, 10 mL for each time, they were treated for 4 continuous weeks. The changes of two kinds of event related potential P3 wave amplitude an latency were detected with Japanese MEB-4 200 evoke potential meter before and after treatment respectively; The event related potential P3 latency could reflect the coding, sorting and identifying velocity of cerebrum to stimulation, and P3 wave amplitude was associated with the number of cerebral cortical synapse and attentive status to evaluated the electrocerebral changes caused by psychological activities.RESULTS： According to intention-to-treat analysis, all the 30 patients were involved in the analysis of results. ① P3 latency： It was obviously shortened after treatment in the acupuncture group as compared with that before treatment [（492.19±31.04）, （525.64±39.26） ms, t=8.48, P 〈 0.01],but there was no significant difference in the control group before and after treatment [（510.38±23.29）, （518.23±26.35） ms, t=1.97, P 〉 0.05]; The difference before and after treatment in the acupuncture group was signifieantly greater than that in the control group [（33.45±8.22）,（7.85±3.06） ms, P 〈 0.01]. ② P3 wave amplitude： It was obviously increased after treatment in the acupuncture group as compared with that before treatment [（5.98±1.63）, （4.66±1.24） μV, t=2.21, P 〈 0.05], but there was no significant difference in the control group before and after treatment[（4.85±1.09）, （4.72±1.05）μV, t=1.48, P 〉 0.05]; The difference before and after treatment in the acupuncture group was significantly greater than that in the control group [（1.32±0.39）, （0.13±0.04）μV, P 〈 0.01].CONCLUSION： Acupuncture can effectively shorten the event related potential P3 latency in autistic children, indicating that acupuncture treatment accelerates nervous impulse conduction, the recognizing and processing time of cerebrum to environmental information. After acupuncture treatment, the P3 wave amplitude of autistic children is increased, it is indicated that acupuncture can promote the growth and development of nerve fiber in children with developing disorder, increase the number and quality of cerebral cortical synapse; It also improves thelevel of attention in autistic children as much as possible, and increases the number of neurons that can be activated.