应用PET研究针刺信号对人脑能量代谢的影响

Study on Influence of Acupunctural Signal on Energy Metabolism of Human Brain by Positron Emission To-mography

目的:应用正电子发射型计算机断层（PET）和18F-2-脱氧葡萄糖（FDG）研究针刺时人脑内能量代谢的生化过程,进一步阐述针刺信号和神经系统的关系。方法:选择健康志愿者1名和脑梗塞患者4例。健康志愿者随机选择右侧,患者选择瘫痪侧上下肢体,以韩氏穴位神经刺激仪电针合谷。曲池、足三里和三阴交穴位。使用GE Advance Ⅱ PET系统,同一患者同体位下接受针刺前和电针状态下2次PET显像,并进行定量分析。结果:健康志愿者针刺前双侧大脑皮层、丘脑、基底节和小脑的葡萄糖代谢基本对称,当电针右侧诸穴位时,对侧丘脑、对侧额叶和顶叶的运动和感觉皮质区葡萄糖代谢增高。4例脑梗塞患者针刺前PET所示的病灶区葡萄糖代谢明显低下（和头颅CT或MRI所见相同）,但病变范围更大,电针时左内囊葡萄糖代谢明显增高,病灶区明显缩小。较大动脉梗塞患者电针时病灶区葡萄糖代谢增高,皮质增宽,水肿区明显缩小。定量分析见病灶区局部脑/全脑葡萄糖比值变化明显和葡萄糖代谢变化率增高。结论:（1）针刺健康人肢体穴位时,脑的局部葡萄糖代谢增高。（2）针刺瘫痪侧肢体穴位时,除对侧丘脑、对侧额叶和顶叶皮质区葡萄糖代谢增高外,针刺前所见的葡萄糖代谢低下区也明显增高,病灶缩小或消失。（3）针刺可激发脑神经细胞的功能。

Objective: To study the biologic process of energy metabolism in brain during acupuncture using positron e-mission tomography (PET) with 18F-2-desoxyglucose (18FDG) for further elucidation of the relationship between acupunctural signal and nerve system. Methods: Electroacupuncture (EA) was applied on right lateral of a healthy volunteer and paralytic limbs of 4 patients with cerebral infarction at acupoints L14, LI11, ST36 and SP6 using Hans acupoint-nerve stimulator. PET imaging was conducted on the healthy subject or patients with the same posture before and during EA with GE Advance Ⅱ PET system. Results: PET showed that in the healthy subject, before EA, the glucose metabolism (GM) in bilateral cerebral cortex, bilateral thalamus, basal nuclei and cerebellum was almost symmetrical, but during EA, the GM in contralateral thalamus, contralateral frontal lobe and parietal lobe (motor and sensory area) increased obviously. While in the patients before EA, the GM in the infarcted area was significantly lower than that in the non-infarcted area, as compared with that observed with CT and MRI, it showed a similar figure but with bigger abnormal area. During EA, GM in the infarcted area increased with apparent reduction of size. Increased GM of focal area, widened cerebral cortex and decreased edematous area were shown in patients with larger infarction area. Quantitative analysis revealed evident change in local/total ratio of glucose and increase of GM change rate. Conclusion: (1) EA on limb acupoints of healthy subject could induce obvious increase of regional GM in brain and contralateral thalamus, contralateral frontal lobe and parietal lobe (motor and sensory area). (2) EA on acupoints of paralytic limbs could cause increase of GM in contralateral thalamus, contralateral frontal lobe and parietal lobe. Besides, GM also increased in the area with lowered GM before EA, accompanied with shrinkage or disappearance of lesion. (3) Acupuncture could evoke the function of brain cells and raise the GM in them.