阿尔茨海默病针刺四关穴动脉自旋脑灌注初步研究

A preliminary study of arterial spin labeling brain perfusion acupuncture at the four acupoint in Alzheimer's disease

目的:应用三维动脉自旋标记技术探索阿尔茨海默病针刺四关穴脑血流灌注变化,初步评价针刺四关穴的治疗效果。材料与方法:搜集10例经首都医科大学宣武医院神经内科记忆障碍门诊诊断的AD患者(AD组)和10例年龄、性别和受教育程度与之相匹配的正常老年人作为对照(NC组),其中AD组患者行针刺四关穴治疗6个月。采用三维动脉自旋标记(three-dimensional arterial spin labeling,3D-ASL)技术测量被试者脑多部位灌注信号强度,运用神经心理学量表辅助评估AD组及NC组的认知状态。AD组和NC组在入组时和6个月后完成MRI扫描和神经心理学量表测评,分析两组被试的异同。结果:(1)AD组和NC组被试年龄、性别、受教育年限匹配,组间差异无统计学意义(P>0.05); AD组简明精神状态检查量表(mini-mental state examination, MMSE)和蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分值显著低于NC组。(2)AD组和NC组被试基线数据左右侧脑灌注信号强度差异无统计学意义;AD组在双侧海马、双侧后扣带回、双侧额颞叶皮层、右侧枕叶皮层部位ASL信号强度降低,以右侧后扣带回为著。(3)AD组基线与6个月后复查ASL图像比较,左颞叶皮层、右侧尾状核信号强度减低,差异有统计学意义;NC组基线与6个月复查比较信号强度无显著性差异;AD和NC组二次检查脑灌注ASL的信号差异无统计学意义。结论:(1)应用3D-ASL技术可以显示AD脑灌注异常区,有可能作为AD早期诊断的指标之一。(2)针刺四关穴或可减缓AD脑灌注减低进程。

Objective To explore the changes of cerebral blood flow by acupuncture at Four acupoint,and to evaluate the therapeutic effect of acupuncture at Four acupoint in Alzheimer’s disease(AD). Materials and methods Ten AD patients(AD group) diagnosed by the neurological memory disorders clinic of Xuanwu Hospital, Capital Medical University and 10 normal aged people with age, gender and level of education matched with AD patients as control group(NC group)were recruited in the study, and the AD patients accepted acupuncture treatment at four acupoint for six months. Three dimensional arterial spin labeling(3 D-ASL) was used to measure the intensity of cerebral perfusion signal of the subjects, and the cognitive status of AD group and NC group was evaluated by using the neuropsychological scale. Both AD group and NC group collected images and scale data after 6 months, and analyzed the differences and changes of cerebral perfusion characteristics between the two groups. Results(1)There was nostatistical difference in age, gender and level of education between the two groups(P > 0.05).The scores of MMSE and MoCa in AD group was significantly lower than that of NC group.(2)The signal intensity of the bilateral brain was no statistical difference in the baseline data of the two groups.The signal intensity of bilateral hippocampus, double posterior cingulate, bilateral fronto-temporal cortex, right occipital cortex was reduced in AD group, and the most significant decline was observed in posterior cingulate.(3) Comparing the baseline of ASL in AD group with the data after 6 month, the signal intensity of the left temporal cortex and right caudate nucleus was reduced, and the difference was statistically significant. There was no statistical difference between the baseline and the review data of NC group. There was no statistical difference in the signal difference between AD and NC group in two examination. Conclusion(1) The application of 3 D-ASL technology can reveal the abnormal cerebral perfusion area of AD patients,which may be one of the indicators for early diagnosis of AD.(2) Acupuncturing four acupoint may slow down the reduced process of AD cerebral perfusion.