针刺对脑梗死后运动功能与各部位皮质脊髓束的影响

Effects of acupuncture on motor function and corticospinal tract after cerebral infarction

目的:基于磁共振扩散张量成像(DTI)探讨调任通督针刺治疗对脑梗死后运动功能与各部位皮质脊髓束(CST)的影响。方法:收集2017年9月—2020年9月就诊于深圳市中医院针灸科及神经科病区与门诊的46例脑梗死患者,随机分为对照组和针刺组,每组23例,对照组仅常规药物基础治疗,针刺组在常规药物治疗基础上进行调任通督针法治疗,共治疗28d。DTI下测量所有患者治疗前后健患侧大脑脚、内囊后肢、脑桥区、梗死灶区各向异性分数(FA)值,计算相对FA值(rFA);同时进行Fugl-Meyer运动功能评分(FMA)。对数据进行组间比较及相关性分析。结果:与本组治疗前比较,两组治疗后FMA增加(P<0.05,P<0.01),治疗后针刺组FMA差值高于对照组(P<0.05);治疗后,所有患者患侧各部位FA和rFA值均增加(P<0.05),且各部位FA和rFA差值均与FMA差值正相关(P<0.01,P<0.05);同时两组均以梗死灶区和患侧内囊后肢差值更高(P<0.01)、与FMA差值相关性也更强(P<0.01)。结论:调任通督针法联合药物治疗对脑梗死后运动功能,以及梗死灶区和患侧内囊后肢区CST的FA、rFA改善显著优于常规单纯药物。

Objective: To explore the motor function and corticospinal tract(CST) in different parts with diffusion tensor imaging(DTI) before and after cerebral infarction treated by ‘Tiaoren Tongdu’ acupuncture method. Methods: A total of 46 patients in Shenzhen Traditional Chinese Medicine Hospital from September, 2017 to September, 2019 were divided into control group(23 patients, only routine drug) and acupuncture group(23 patients, ‘Tiaoren Tongdu’ acupuncture method and routine drug), treated for 28 d. Measured the fractional anisotropy(FA) in the cerebral foot, posterior limb of the internal capsule(PLIC), pons area, infarcted area and corresponding contralateral area, and FA ratio(rFA) was calculated, simplified Fugl-Meyer assessment(FMA) was used to assess motor function. The data were compared between groups and conducted for correlation analysis. Results: After treatment, the FMA score improved in two groups(P<0.05, P<0.01), and which was higher in acupuncture group(P<0.05). After treatment, FA and rFA increased in all of the areas(P<0.05), and the difference before and after treatment of FA and rFA in all of the areas positively correlated with that of FMA scores(P<0.01, P<0.05), all of which was more in the infarct area and the PLIC(P<0.01). Conclusion: ‘Tiaoren Tongdu’ acupuncture combined with routine drug has more obvious improvement on motor function after cerebral infarction, and the parameter values of FA and rFA of CST in infarcted area and PLIC of the affected side than routine drug therapy.