针刺阳陵泉对中风偏瘫后运动区之间脑功能连接度的影响

Effect of Acupuncture on Yanglingquan(GB 34)on Brain Functional Connectivity between Motor Areas in Hemiplegia Patients after Stroke

目的:基于功能性磁共振成像技术(fMRI)观察不同程度运动功能损伤后背侧运动前区(PMd)、腹侧运动前区(PMv)与初级运动区(M1)之间脑功能连接度(FC)的变化,探究中风偏瘫后针刺脑效应机制和位点,为针刺促进脑功能重塑提供影像学证据。方法:选取2014年9月至2019年9月北京中医药大学东直门医院收治的中风后左侧偏瘫患者26例作为研究对象,根据Fugl-Meyer运动功能评分(FMA)分为轻中度组(50~99分)18例、重度组(0~49分)8例,进行临床量表评价及fMRI扫描。选取双侧PMd、PMv、M1为种子点,比较这15对种子点对间FC的变化及与FMA的相关性。结果:全组在针刺态下健侧PMd-病灶侧M1、双侧PMv、PMd间FC高于静息态(P<0.05)。2组内,针刺态下轻中度组健侧PMd-病灶侧M1、病灶侧PMd-M1、双侧M1间FC高于静息态(P<0.05);针刺态下重度组病灶侧PMv-M1间FC低于静息态(P<0.05)。在静息态,重度组病灶侧PMv-健侧M1、病灶侧PMv-M1间FC高于轻中度组(P<0.05)。在重度组中,静息态时FMA与健侧PMv-病灶侧M1、健侧PMv-病灶侧PMd、双侧PMv间FC正相关(r>0,P<0.05);针刺态时FMA与健侧PMd-病灶侧M1、病灶侧PMd-M1间FC正相关(r>0,P<0.05)。结论:脑梗死不同程度运动功能损伤后在脑功能重塑中存在相应的脑区,针刺阳陵泉通过脑区间特定的效应位点,促进运动功能恢复,影响中风后偏瘫的脑功能恢复与重塑。

Objective:To observe the changes in brain functional connectivity(FC)between the dorsal premotor cortex(PMd),the ventral premotor cortex(PMv),and the primary motor cortex(M1)after different degrees of motor function injury based on functional magnetic resonance imaging(fMRI)technology,explore the effect mechanism and sites of brain acupuncture after stroke-induced hemiplegia,and provide imaging evidence for acupuncture to promote the remodeling of brain function after stroke-induced hemiplegia.Methods:Twenty-six cases of patients with left hemiplegia admitted to the Dongzhimen Hospital,Beijing University of Chinese Medicine from September 2014 to September 2019 were enrolled as research subjects,including 18 mild and moderate cases(50-99 points)and eight severe cases(0-49 points)according to Fugl-Meyer assessment(FMA).The patients underwent clinical scale evaluation and fMRI scanning.The bilateral PMd,PMv,and M1 were selected as seed points,and the changes in functional connectivity between the 15 pairs of seed points and the correlation with FMA were compared.Results:In all the groups,the FC between the contralesional PMd-affected M1,bilateral PMv,and bilateral PMd under acupuncture was significantly higher than that under the resting state(P<0.05).The FC between contralesional PMd-affected M1,affected PMD-M1,and bilateral M1 in the mild and moderate group under acupuncture was higher than that under the resting state(P<0.05),and the FC between affected PMv-M1 in the severe group under acupuncture was lower than that under the resting state(P<0.05).The FC between affected PMv-contralesional M1 and affected PMv-M1 in the severe group under the resting state was higher than that in the mild to moderate group(P<0.05).In the severe group,FMA was positively correlated with FC between contralesional PMv-affected M1,contralesional PMv-affected PMd,and bilateral PMv under the resting state(r>0,P<0.05).FMA was positively correlated with FC between contralesional PMd-affected M1 and affected PMd-M1 under acupuncture(r>0,P<0.05).Conclusion:After different degrees of motor function impairment induced by cerebral infarction,there are corresponding brain areas in brain function remodeling,and acupuncture on Yanglingquan can promote the recovery of motor function and affect the recovery and remodeling of brain function after stroke-induced hemiplegia by selecting specific effect points.