电针治疗脑梗死后记忆障碍的磁共振波谱成像研究

Magnetic resonance spectroscopic study of memory impairment after cerebral infarction treated with electroacupuncture

目的:通过观察脑梗死患者脑组织内代谢物氢质子磁共振波谱成像(1 H-MRS),研究电针治疗对脑梗死后记忆障碍的影响。方法:将60例脑梗死后出现记忆障碍患者随机分为观察组及对照组,每组30例。对照组给予康复科常规康复训练及常规药物治疗;观察组在对照组治疗基础上加用电针干预,取中额中线(MS 1)、顶中线(MS 5)、顶颞后斜线(MS 7)、合谷、太冲、足三里、太溪、悬钟、风池,均双侧取穴。每日治疗1次,每周治疗5次,治疗时间为8周。全部患者均于治疗前及治疗后进行临床记忆量表评分,并进行头部常规磁共振(MRI)及1 H-MRS扫描,测定脑梗死病灶区N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱(Cho)/Cr的比值。结果:治疗8周后,两组患者临床记忆量表评分较治疗前均升高(P<0.01),NAA/Cr均较治疗前升高(P<0.05),Cho/Cr均较治疗前下降(P<0.05),且与对照组相比,观察组变化更为明显(均P<0.05)。结论:在常规药物治疗和康复训练基础上,电针能够改善脑组织的代谢,提高患者的记忆功能,疗效优于单纯药物与康复训练治疗。

Objective To study the impacts of electroacupuncture （EA） on memory impairment after cerebral infarction through the observation of hydrogen proton magnetic resonance spectroscopy （1H-MRS） of brain tissue metabolites in the patients of cerebral infarction. Methods Sixty cases of memory impairment after cerebral infarc- tion were randomized into an observation group and a control group, 30 cases in each one. The conventional rehabilitation training and medication were applied to all the patients. In the observation group, beside the basic treatment, EA was applied to bilateral Ezhongxian （MS 1）, Dingzhongxian （MS 5）, Dingniehouxiexian （MS 7）, Hegu （LI 4）, Taichong （LR 3）, Zusanli （ST 36）, Taixi （KI 3）, Xuanzhong （GB 39） and Fengchi （GB 20）. The treatment was given once a day, 5 times a week, for 8 weeks. The clinical memory scale was used for the score evaluation before and after treatment in all the patients. The magnetic resonance image （MRI） and ^1H-MRS scanning were applied to the head. The ratio of N-acetyl aspartate （NAA） and ereatine （Cr） and the ratio of choline （Cho） and Cr were determined in the loci of cerebral infarction. Results Eight weeks later, the scores of clinical memory scale were all increased after treatment as compared with those before treatment in the two group （all P〈0.01）. The ratio of NAA and Cr was increased as compared with that before treatment （P〈0.05）; the ratio of Cho and Cr was reduced as compared with that before treatment （P〈0.05）. The changes in the observation group were more obvious than those in the control group （all P〈0.05）. Conclusion On the basis of the conventional medication and rehabilitation training, EA improves the metabolism of brain tissue and memory function of the patients. The efficacy of this therapy is better than that of medication combined with rehahilitation training.