针刺阳陵泉穴对脑梗死患者感觉运动网络功能连接及其动态性影响的功能性磁共振成像研究

Functional magnetic resonance imaging study on functional connectivity and dynamic effect of acupuncture at Yanglingquan on sensory motor network in patients with cerebral infarction

目的借助功能磁共振手段探索脑梗死患者感觉运动网络功能连接及其动态性在针刺左侧阳陵泉穴前后的变化及留针的效应机制。方法研究为前瞻性研究,选取2014年9月至2019年9月在东直门医院住院治疗的右侧皮质下脑梗死患者25例作为试验组,同期健康人对照21名作为健康对照组,在功能性磁共振成像下采集静息态、针刺态的图像,对图像进行预处理,借助独立成分分析技术提取受试者感觉运动脑网络,基于感觉运动网络进行功能连接及其动态性变化在针刺前后的比较分析。结果试验组针刺态感觉运动网络内功能连接与静息态在左侧顶下小叶存在差异,针刺态较静息态增强(P<0.05,GRF校正),峰值点坐标为(-27,-51,48),峰值点T值为5.502,体素数目12。针刺态感觉运动网络内动态功能连接变异性较静息态在左侧中央后回差异有统计学意义,针刺态较静息态降低(P<0.05,GRF校正),峰值点坐标为(-5,-30,39),峰值点T值为-3.153,体素数目9。对照组感觉运动网络内功能连接针刺态、静息态差异无统计学意义,感觉运动网络外则针刺态和静息态感觉运动网络和丘脑的差异均有统计学意义,针刺态较静息态强度下降(P<0.05,GRF校正),峰值点坐标为(-12,3,6),峰值点T值为-4.253,体素数目183。感觉运动网络内动态功能连接变异性针刺前后差异无统计学意义。组间比较两组功能连接在双侧内侧额上回存在针刺态时的差异,试验组较健康对照组增强(P<0.05,GRF校正),峰值点坐标为(0,42,48),峰值点T值为3.988,体素数目53。在丘脑存在静息态时的差异,试验组较健康对照组减弱(P<0.05,GRF校正),峰值点坐标为(-9,-15,9),峰值点T值为-6.596,体素数目101;两组动态功能连接变异性针刺态差异无统计学意义,静息态可见散在差异(P<0.05,GRF校正)。以年龄、性别、病程为控制变量进行偏相关分析,试验组针刺态、静息态感觉运动网络内平均功能连接强度均与下肢Fugl-Meyer评测(Fugl-Meyer assessment,FMA)分数负相关,针刺态感觉运动网络内平均功能连接与下肢FMA分数相关系数为-0.533(P=0.011),静息态感觉运动网络内平均功能连接与下肢FMA分数相关系数-0.485(P=0.022)。结论脑梗死患者针刺态感觉运动网络内脑功能存在和静息态不同的运作模式,并且这种运作模式还具和时间相关的波动性改变。

Objective To explore the changes of sensorimotor network functional connectivity and coefficient of variation of dyanmic functional connection in stroke patients before and after acupuncture on the left Yanglingquan by means of functional magnetic resonance,and explore the effect mechanism of needle retention.Methods Twenty five patients with right subcortical cerebral infarction who were hospitalized in Dongzhimen Hospital from September 2014 to September 2019 were selected as the experimental group.In the same period 21 healthy controls were selected as healthy control group.The resting state and acupuncture state images were collected by functional magnetic resonance imaging,and the images were preprocessed.The sensory motor brain network of subjects was extracted by independent component analysis(ICA).The functional connectivity and dynamic changes were compared before and after acupuncture based on the sensory motor network.Results In the experimental group,there were differences between acupuncture state and resting state in the left inferior parietal lobule.The acupuncture state was stronger than the resting state(P<0.05,GRF correction).The coordinates of the peak point were(-27,-51,48),the T value of the peak point was 5.502,and the number of voxels was 12.The variation of dynamic functional connectivity in the sensory motor network of acupuncture state was significantly lower than that in resting state(P<0.05,GRF correction),the peak point coordinates were(-5,-30,39),the peak T value was-3.152,and the number of voxels is 9.In the control group,there was no significant difference between acupuncture state and resting state in functional connection of sensory motor network,while the difference of sensory motor network and thalamus between acupuncture state and resting state was statistically significant.The intensity of acupuncture state was lower than that of resting state(P<0.05,GRF correction),the coordinates of peak point were(-12,3,6),the T value of peak point was-4.253,and the number of voxels was 183.There was no significant difference in the variation of dynamic functional connectivity in sensory motor network before and after acupuncture.Compared with the healthy control group,the functional connectivity of the experimental group was stronger than that of the healthy control group(P<0.05,GRF correction).The coordinates of the peak point were(0,42,48),the T value of the peak point was 3.988,and the number of voxels was 53.The difference in the resting state of thalamus in the experimental group was weaker than that in the healthy control group(P<0.05,GRF correction),the coordinates of the peak point were(-9,-15,9),the T value of the peak point was-6.596,and the number of voxels was 101;there was no significant difference in the dynamic functional connectivity variability between the two groups,but there were scattered differences in the resting state(P<0.05,GRF correction).With age,gender and course of disease as control variables,partial correlation analysis showed that the average functional connectivity strength in the sensory motor network of the experimental group was significantly higher than that of the Fugl Meyer assessment(FMA)of the lower limbs.There was a negative correlation between the scores of FMA.The correlation coefficient between the average functional connectivity in the sensory motor network of acupuncture state and the FMA score of lower extremity was-0.533(P=0.011),and the correlation coefficient between the average functional connectivity in the sensory motor network of acupuncture state and FMA score of lower extremity was-0.485(P=0.022).Conclusion The brain function in acupuncture state sensorimotor network of patients with cerebral infarction is different from that in resting state,and this operation mode also has time-related fluctuation changes.