电针治疗脑梗死手运动功能障碍的临床疗效及BOLD-fMRI定量分析

Effect of Electro-Acupuncture Treating Hand Dyskinesia due to Cerebral Infarction: A study of Clinical Analysis and BOLD-f MRI Quantitative Analysis

目的:应用血氧水平依赖功能磁共振成像(BOLD-f MRI)方法评价电针治疗脑梗死手功能障碍患者的临床疗效。方法:按照随机数字表法将60例脑梗死手运动功能障碍患者分为观察组和对照组,每组30例,另选30例健康志愿者作为健康组进行对照研究;在常规的康复训练基础上,观察组给予电针疗法,对照组给予普通针刺疗法,治疗时间为4周。治疗前后,采用Fugl-Meyer运动量表评价患者手运动障碍改善情况,采用改良Barthel指数评价患者日常生活能力,采用BOLD-f MRI评价电针疗法对手运动功能障碍患者的手运动中枢激活情况,健康组患者进行单次的f MRI检查,并记录手运动中枢激活情况。结果:治疗前,两组各项指标比较差异无统计学意义(P> 0. 05)。治疗后,观察组患侧FM评分和MBI评分较治疗前明显增加,且优于对照组,差异有统计学意义(P <0. 05); 60例脑梗死患者健侧手被动运动激活大脑半球感觉运动皮质的LI值大于患侧手,差异具有统计学意义(P <0. 05)。治疗后,观察组患侧手(右手)运动激活大脑半球感觉运动皮质的LI值明显大于治疗前,差异具有统计学意义(P <0. 05)。结论:电针能够激活患侧的大脑手功能运动皮质,促使脑功能重组和代偿,促进脑梗死患者手运动功能障碍的尽快康复。

Objective ： To evaluate the clinical efficacy of electro - acupuncture in the treatment of hand dysfunction in pa- tients with cerebral infarction by the method of blood oxygen level - dependent functional magnetic resonance imaging（ BOLD - fMRI）. Methods ： 60 cases of cerebral infarction with hand dyskinesia were randomly divided into the observa-tion group（n = 30） and the control group（n= 30） ; another 30 healthy volunteers were taken as the blank control. Onthe basis of the conventional rehabilitation training, the observation group was given electro - acupuncture treatment,whereas the control group was given common acupuncture. The treatment course was four weeks. The improvement ofhand dyskinesia was evaluated by Fugl - Meyer scale, daily living ability was assessed by the improved Barthel index,activation of cheirokinesthetic center was checked by BOLD - fMRI after electro - acupuncture treatment. A single fMRIexamination was performed to examine activation of cheirokinesthetic center. Results： Before the treatment, there wereno significant differences between the two groups in all indexes（P 〉0.05）. After the treatment, the FM value and MBIscore increased significantly in the observation group, which were significantly higher than those in the control group（P 〈 0.05）. The LI value of sensorimotor cortex was higher in the uninjuried side than that in the injuried side in thetwo groups （P 〈 0. 05 ） ; the LI value of the injuried side was significantly increased after the treatment （P 〈 0. 05 ）. Con-clusion： Electro -acupuncture can activate the corresponding motor cortex of the affected hand, promote the reorgani-zation and compensation of brain function, and accelerate the recovery of hand dyskinesia in patients with cerebral in-farction.