针刺外关穴对脑梗死患者脑内葡萄糖代谢的影响

Effect of Needling at Waiguan (SJ5) on Brain Glucose Metabolism in Patients with Cerebral Infarction

目的应用18F氟脱氧葡萄糖(18F-FDG)正电子发射计算机断层成像(PET/CT)脑功能成像技术,观察针刺脑梗死患者外关穴脑内葡萄糖代谢变化,探讨针刺穴位对脑梗死患者脑内葡萄糖代谢的影响及针刺效应的机制。方法 21例脑梗死患者,病灶位于左侧基底节区。全部患者随机分为穴位针刺组(A组)、非经穴针刺组(B组)及空白对照组(C组),每组7例。A组予针刺右侧外关穴,B组予针刺非经非穴位点(右侧外关穴旁10 mm点),C组为空白对照组。所有研究对象均行PET/CT头部显像。所得数据采用SPSS13.0软件及SPM8软件分析。结果与C组比较,A组脑内葡萄糖代谢增加的区域:双侧颞叶颞上回(BA38),右侧额叶额上回(BA9),左侧扣带回(BA24),左侧小脑前叶山顶,左侧小脑后叶蚓锥,右侧小脑后叶扁桃体;B组脑内葡萄糖代谢增加的区域:双侧额叶额上回(BA6、BA9、BA10)、额中回(BA6、BA10),左侧额叶中央前回(BA4),双侧海马钩回(BA36、BA38),左侧扣带回(BA24、BA31),左侧后扣带回(BA30),左侧楔前叶(BA7),左侧顶下小叶(BA40),左侧枕叶舌回(BA18)。与B组比较,A组脑内葡萄糖代谢增加的区域:双侧颞叶颞上回(BA22、BA38),右侧额叶额下回(BA47),左侧小脑前叶山顶,左侧小脑后叶扁桃体。针刺外关穴双侧半球激活的脑区集中在健侧,双侧颞叶颞上回及右侧额叶额下回;小脑激活的区域集中在左侧小脑半球,左侧小脑前叶山顶及双侧小脑后叶扁桃体。结论针刺脑梗死患者外关穴导致脑内局部区域葡萄糖代谢增加,PET/CT脑功能成像能够直观显示针刺穴位脑内葡萄糖代谢的变化。

Objective To observe changes of brain glucose metabolism by needling at Waiguan （S J5） in cerebral infraction （CI） patients usingTM F-fluorodeoxyglucose （FDG） positron-emission computer tomography （PET/CT）, thus exploring its effect and mechanisms. Methods A total of 21 patients with CI were recruited in this study. The location of lesion was limited to the left basal ganglia by CT or MRI scan. All patients were randomly assigned to three groups, i.e., the acupoint group （Group A）, the non-acupoint group （Group B）, the blank control group （Group C）, 7 in each group. Patients in Group A were needled at right Waiguan （S J5）. Those in Group B were needled at non-acupoint 1-10 mm beside Waiguan （SJ5）l, whereas those in Group C did not receive any treatment. All patients underwent PET/CT head scan. All data were statistically analyzed using SPSS 13.0 Software and SPM8 Software. Results Compared with Group C, glucose metabolism increased in bilateral superior temporal gyrus （BA38）, right superior frontal gyrus （BA9）, left cingulate gyrus （BA24）, left culmen and pyramis of cerebellum, and right cerebellar tonsil of cerebellum in Group A. Compared with Group C, glucose metabolism increased in bilateral superior frontal gyrus （BA6, BA9, BA10）, bilateral middle frontal gyrus （BA6, BA10）, left middle frontal gyrus （BA4）, bi- lateral uncus of limbic lobe （BA36, BA38）, left cingulate gyrus （BA24, BA31 ）, left posterior cingulate gy- rus （BA30）, left precuneus （BA7）, left inferior parietal Iobule （BA4）, and left lingual gyrus of occipital lobe （BA18） in Group B. Compared with Group B, glucose metabolism increased in bilateral superior tem- poral gyrus （BA22, BA38）, right inferior frontal gyrus （BA47）, left culmen and cerebellar tonsil of cerebel- lum in Group A. Activated encephalic regions of needling at Waiguan （S J5） were mainly dominated in the healthy side, bilateral superior temporat gyrus, and right inferior frontal gyrus. Activated encephalic regions of cerebellum were located at the left cerebellar hemisphere, left culmen of anterior cerebella lobe, and bi- lateral cerebeUar tonsil of posterior cerebella lobe. Conclusions Needling at Waiguan （S J5） of CI patients induced increased glucose metabolism in local cerebral regions. Functional neuroimaging using PET/CT could directly reflect changes of brain glucose metabolism by acupuncture.