阿尔茨海默病患者穴位埋线后认知功能变化与脑功能成像改变的相关性研究

Correlation Analysis on Changes between Cognitive Ability and Brain fMRI after Acupoint Thread Embedding in Alzheimer's Disease Patients

目的运用脑功能成像(functional magnetic resonance imaging,fMRI)技术探讨穴位埋线治疗阿尔茨海默病(Alzheimer′s disease,AD)的作用机制。方法26例轻、中度AD患者按配对方法分为穴位埋线组和空白对照组,穴位埋线组分别在神门、丰隆、太溪和足三里穴进行埋线,空白对照组用相同操作方法刺激穴位,但埋线针不穿入羊肠线,两组患者均每个月治疗1次,共治疗6次。分别于首次治疗前1周内和6个月治疗结束后1周内运用简易精神状态量表(mini mental state examination,MMSE)和阿尔茨海默病认知评价量表(Alzheimer′s disease assessment scale-cognitive,ADAS-Cog)对两组进行评分。并于治疗前和治疗6个月后,行脑功能成像检查,获得脑内血氧变化的数据,利用SPM软件对两组治疗后量表评分的变化与脑内血氧变化的数据进行相关性分析。结果穴位埋线组治疗后MMSE评分较治疗前显著升高(P<0.01);ADAS-Cog评分显著降低(P<0.01)。空白对照组治疗后MMSE评分较治疗前显著降低(P<0.01);ADAS-Cog评分显著升高(P<0.05),两组治疗后MMSE评分及ADAS-Cog评分比较,差异均有统计学意义(P<0.01,P<0.05)。与MMSE评分变化相关的穴位埋线效应激活的主要脑区,左侧:额下回、额中回、额上回、颞横回;右侧:额上回、额中回、中央前回、海马回、扣带回、中央后回、旁中央小叶;与ADAS-Cog量表评分变化相关的穴位埋线效应激活的主要脑区,左侧:额上回、额中回、梭状回、颞下回、海马回;右侧:额上回、额中回、中央前回、梭状回、颞横回、枕中回、中央后回。结论穴位埋线通过激活额叶、颞叶、边缘系统和小脑等与认知功能相关的脑区,改善AD患者认知功能障碍。

Objective To explore the mechanism of acupoint thread embedding （ATE） in treating Alzheimer＇s disease （AD） by means of brain functional magnetic resonance imaging （fMRI）. Methods Twenty-six pa- tients with mild to moderate AD were assigned to the tested group and the control group in pairing, 13 in each group. ATE was performed in patients of the tested group at Shenmen （HT-/） , Fenglong （ST40） , Taixi （KI3） and Zusanli （ST36） acupoints, once every month for 6 times in total; but for patients of the control group only sham operation was done at the same acupoints. The correlation between cognitive ability and fMRI were assessed by comparing the scores of Mini-Mental State Examination （MMSE） and Alzhemer＇s Disease Assessment Scale- Cognitive section （ADAS-Cog） , monitored at two time points, namely, in one week before starting treatment and 1 week after terminating 6-month treatment. Furthermore, fMRI was detected to obtain the data of the cerebral blood oxygen content before treatment and 6 months after completing the 6-month therapeutic course. Correlation analysis was conducted on the obtained data using software SPM. Results After treatment, changes of MMSE score significently increased in the test group （P 〈0. O1 ） and decreased in the control group （P 〈0. O1 ） , and ADAS-Cog de- creased in the test group （P 〈 O. O1 ） and increased in the control group （ P 〈 O. 05 ）, showing statistical significanoe between the two groups （P 〈 0. 01, P 〈 0. 05）. The activated regions related with the change of MMSE were mainly inferior frontal gyrus, middle frontal gyrus, superior frontal gyrus, transverse temporal gyrus, on the left cerebrum and superior frontal gyrus, middle frontal gyrus, precentral gyrus, hippocampal gyrus, cingulate gyrus,postcentral gyrus, paracentral lobule on the fight cerebrum; those related with change of ADAS-Cog were superior frontal gyrus, middle frontal gyrus, fusiform gyrus, inferior temporal gyrus, hippoeampal gyrus on the left cere- brum, and superior frontal gyrus, middle frontal gyrus, precentral gyrus, fusiform gyrus, transverse temporal gy- rus, postcentral gyrus, middle occipital gyrus on the right cerebrum. Conclusion ATE could improve the cogni- tive ability of AD patients, its possible mechanism may be through the activation on the cognition related regions of frontal, temporal lobe and marginal system, as well as those of cerebellum.