针灸治疗对脑卒中患者糖代谢影响的观察

Effects of acupuncture on glucose metabolism of stroke patients

目的:观察运动状态下针刺治疗对脑卒中患者脑运动功能区糖代谢的影响,探讨针灸治疗脑卒中,改善脑卒中患者运动功能的机制。方法:①实验于2002-01/2003-01在解放军总医院核检测中心完成。选择同期本院神经内科住院脑卒中患者6例,男3例,女3例,均对检测项目知情同意。②首次实验中受试者平卧于检查床进行患侧手(右手)的自主节律(0.5Hz)握拳运动20min,不给予针灸治疗。第2次实验隔日进行,先给予针灸刺激,平刺百会和右侧曲鬓穴,得气后进行电针治疗。起针后行正电子发射断层扫描(PET)扫描。将两次扫描结果用SPM软件进行比较分析,并用Talairach大脑立体定位坐标进行定位。③对每例患者的PET扫描图像进行标准化和平滑处理,然后对图像的每一像素点的数据做单边t检验:假设电针后可能使运动状态下大脑葡萄糖代谢率增加,计算出相应的t值,绘制由t值构成的统计参数图,得到相应的糖代谢增高/减低的变化区域。结果:脑卒中患者6例均进入结果分析。①电针治疗后葡萄糖代谢增高的区域主要集中于健侧(左侧),其中第一躯体运动皮质区即中央前回(4区)、补充运动区即额内侧回(6区)、运动前区即额中回(6区)及顶上小叶(7区)有明显变化(t=2.79～3.20,P<0.05～0.01)。②葡萄糖代谢减低主要集中于病灶侧(右侧)中央前回(4区)、额中回(6区)和顶上小叶(t=2.23～3.89,P<0.05～0.01)。结论:针灸可以改善双侧大脑运动功能区的糖代谢,可能具有诱导兴奋或抑制潜在的与运动相关的神经组织,补偿或协助受损的大脑功能区,促进运动功能重建。

AIM： To observe the effects of acupuncture on the glucose metabolism of cerebral motor area of stroke patients under movement, and investigate the mechanism of acupuncture in treating stroke and ameliorating the motor function of stroke patients. METHODS： （1） The experiment was conducted in the nuclear calibration center of the General Hospital of Chinese PLA from January 2002 to January 2003. Six stroke inpatients （3 males and 3 fe,nales） were selected from the Department of Neurology in this hospital, and they all voluntarily participated in the study. （2） In the first test, the patients lay on the back in examinating couch to examine the clenching fist movement of automatic rhythm （0.5 Hz） of the ipsilateral （right） hand for 20 minutes, acupuncture was given. The second test was performed every other day, the patients were firstly treated with acupuncture, the acupaints of Baihui and right Qubin were needled horizontally, and then electroacupuncture stimulation was given after needling sensation. Positronemission tomography （PET） was performed after needle removal. The results of twice PET were comparatively analyZed with SPM software, and localized with Talairacil coordinates-transformed imaging data. （3） The PET imaging of each patient was standardized and smoothed, and then the one-tailed t test was applied to analyzed the data of each picture element point. The corresponding t value was calculated providing that the cerebral glucose metabolic rate under movement after electreacupuncture, and then the statistical parameter picture composed by t value was drawn, and the changing area of corresponding increased/decreased glucose metabolic rate was obtained. RESULTS： All the 6 stroke patients were involved in the analysis of results.（1）After electroacupuncture, the regions of increased glucose metabolism mainly concentrated in the unaffected （left） side, and there were obvious changes in precentral gyrus （the first body movement cortex, 4 regions）, medial frontal gyros （movement complement area, 6 regions）, middle frontal gyrus （movement frontal area, 6 regions） and superior parietal lobule （7 regions） （t=.2.79-3.20, P 〈 0.05-0.01）. （2） The impaired glucose metabolism mainly concentrated in the precentral gyrus （4 regions）, middle frontal gyrus （6 regions） and superior parietal lobule of the focal （right） side （t=2.23-3.89, P 〈 0.05-0.01）. CONCLUSION： Acupuncture can improve the bilateral glucose metabolism of cerebral motor area. It is suggested that acupuncture may induce to active or restrain potential nerve tissue about motor and make up or help injured cerebral motor area to accelerate the cerebral motor plasticity.