应用mTI-ASL成像评估针刺联合高压氧对CO中毒迟发脑病的疗效

Evaluation of the efficacy of acupuncture combined with hyperbaric oxygen on delayed neuropathological sequelae after carbon monoxide poisoning by using mTI-ASL imaging

目的:基于磁共振多反转时间动脉自旋标记成像(mTI-ASL)技术定量评估针刺联合高压氧(HBO)治疗一氧化碳(CO)中毒迟发脑病(DNS)患者半卵圆中心脑白质血流量变化,从而间接评价其疗效。方法:将临床确诊DNS患者26例随机分为观察组(13例)和对照组(13例)。对照组采用常规治疗联合HBO治疗,观察组在对照组基础上加用"醒脑开窍"法治疗,主穴取水沟、内关、百会、上星、印堂、患侧三阴交、四神聪、丰隆,语言不利加廉泉、金津,上肢不遂配肩髃、外关、手三里,下肢不遂配环跳、阳陵泉、阴陵泉。每日治疗1次,连续5 d为一疗程,疗程间隔2 d,两组均治疗6个疗程。所有患者在治疗前、治疗后1周行常规头颅MR平扫、mTI-ASL和弥散张量成像(DTI)扫描,影像原始数据经Matlab(R2014b)、Mricron及Syngo. via软件处理,测量半卵圆中心脑血流量(CBF)、各向异性(FA)值,采用Pearson法评价参数值间相关性。使用简易智能精神状态检查量表(MMSE)评价认知功能。结果:治疗后两组CBF、MMSE评分及观察组FA值均较治疗前升高(P<0.05);治疗后观察组CBF、FA值及MMSE评分升高较对照组明显(P<0.05);CBF、FA值与MMSE评分两两之间均呈正相关(P<0.05),其中CBF值与MMSE值相关性最佳(r=0.822)。结论:针刺联合高压氧治疗明显改善DNS患者早期脑白质低灌注、提高认知功能评分,其疗效优于单纯高压氧治疗,mTI-ASL成像可以对其疗效作出定量评价。

Objective Quantitative assessment of white blood flow in semi-oval center of patients with delayed neuropathological sequelae(DNS) after carbon monoxide poisoning treated with acupuncture combined with hyperbaric oxygen(HBO) based on magnetic resonance multi-inversion time arterial spin labeling imaging(mTI-ASL), and to evaluate its efficacy indirectly. Methods Twenty-six patients with clinically diagnosed DNS were randomly divided into an observation group(13 cases) and a control group(13 cases). The conventional therapy combined with HBO were given in the control group. In the observation group,on the base of the treatment, Xingnao Kaiqiao acupuncture was applied, the main acupoints were Shuigou(GV 26), Neiguan(PC 6), Baihui(GV 20), Shangxing(GV 23), Yintang(GV 29), Sanyinjiao(SP 6) on the affected side, Sishencong(EX-HN 1), Fenglong(ST 40), Lianquan(CV 23) and Jinjin(EX-HN12) for slurred speech, Jianyu(LI 15), Waiguan(TE 5) and Shousanli(LI 10) for upper limb pain, Huantiao(GB 30), Yanglingquan(GB34), Yinlingquan(SP 9) for lower limb pain, the treatment was given once every day, 5 days as one course, with an interval of 2 days between the course. The treatment for 6 courses was required. The conventional head MR scan, mTI-ASL and diffusion tensor imaging(DTI) scans before and 1 week after treatment were adopted, Matlab(R2014 b), Mricron and Syngo.via software were adopted to measure the cerebral blood flow(CBF) and anisotropy(FA) values of the semi-oval center. The correlation between the parameters was evaluated by Pearson method. And the simple intelligent mental state examination scale(MMSE) was uesd to assess cognitive function. Results After treatment, the CBF, MMSE scores in both groups and FA values in the observation group were higher than those before treatment(P<0.05). After treatment, the CBF, FA and MMSE scores in the observation group were significantly higher than those in the control group(P<0.05). There was a positive correlation between CBF, FA and MMSE scores(P<0.05), and the correlation between CBF and MMSE was the best(r =0.822). Conclusion Acupuncture combined with hyperbaric oxygen can significantly improved early white matter hypoperfusion and improved cognitive function score in patients with DNS. The curative effect is better than that of hyperbaric oxygen therapy alone. The mTI-ASL imaging can quantitatively evaluate its curative effect.