针刺治疗脑卒中后脑白质缺血损害磁共振扩散张量成像研究

A Diffusion Tensor Imaging Research of Acupuncture Alleviating White Matter Ischemic Injury after Stroke

目的使用扩散张量成像(DTI)方法评估针刺改善脑卒中后脑白质缺血损伤的有效性。方法 60例经磁共振扩散加权(DWI)序列扫描证实有单侧脑白质梗死7d内的病人行DTI检查后,随机分成针刺组和无针刺组,每组30例,分别于干预后1个月、2个月及3个月末行常规磁共振成像(MRI)和DTI检查。针刺组病人自首诊第2周内每周3次针刺治疗至3个月末。后处理DTI原始图像得到部分各向异性指数(FA)和表观弥散系数(ADC)。根据T2WI及DWI图像,分别于缺血白质区域和对侧同名纤维束镜像区取感兴趣区,测量FA值和ADC值后计算比值(rFA和rADC),观察其与美国国立卫生研究院脑卒中量表(NIHSS)评分的相关性。结果针刺组与无针刺组缺血性中风病人2个月末和3个月末损伤脑白质的rADC比值差异有统计学意义(F=5.237,P<0.05;F=9.368,P<0.01)。首诊及1个月末rFA值与NIHSS评分呈负相关(r=-0.529,P<0.05;r=-0.516,P<0.05),1个月末及2个月末rADC值与NIHSS评分值呈正相关(r=0.689,P<0.05;r=0.611,P<0.05)。结论通过DTI技术显示针刺能够改善脑卒中病人脑白质缺血损伤,ADC值为主要参考指标。

Objective To assess the effect of acupuncture alleviating the ischemic white matter injury in the stroke patients by diffusiontensor imaging （ DTI） . Methods Sixty unilateral cerebral ischemic patients underwent MRI and DTI study within 7 days after the on -set of illness. Then they were randomly divided into acupuncture group and without acupuncture group with each containing 30. Theacupuncture group patients were treated through acupuncture 3 times a week for 3 months. MRI and DTI scans were done 1 month,2 months and 3 months after treatment. Fractional anisotropy （ FA）maps and apparent diffusion coefficient （ ADC）maps imageswere obtained. With the reference of the T2W and DW images, regions of interest （ ROIs）were selected on the ischemic white mat -ter, and the control ROIs were selected on the contra lateral homonymic white matters.The ratios of FA and ADC （ rFA and rADC）within these ROIs were calculated and compared. The relationship between DTI parameters and national institute of health strokescale （ NIHSS）scores were assessed.Results Results The rADC values were significantly different between acupuncture and nonacupuncture group in the post treatment 2 and 3 month（ F =5.237, P 〈0.05; F =9.368, P 〈0.01） . Spearman’ s correlation analy -sis showed significantly negative correlation between rFA and NIHSS scores of onset and 1 month（ r =-0.529, P 〈0.05; r =-0.516,P 〈0.05） and positive correlation between rADC and NIHSS of the post treatment 2 and 3 month（ r = 0.689, P 〈0.05; r = 0.611,P 〈0.05） . Conclusion Acupuncture therapy is effective for alleviating ischemic white matter injury. The ADC values may be the effective observation index.