重复经颅磁刺激联合镜像疗法对脑卒中偏瘫患者上肢运动功能及神经电生理的效果

目的探讨1 Hz重复经颅磁刺激(rTMS)联合镜像疗法对脑卒中偏瘫患者上肢运动功能及患侧皮质神经电生理的效果。方法选择2022年10月至2023年3月复旦大学附属金山医院收治的脑卒中患者60例,随机分为对照组(n=15)、磁刺激组(n=15)、镜像疗法组(n=15)和联合组(n=15)。各组均给予内科治疗和常规康复治疗,在此基础上,对照组给予空载磁刺激和假镜像疗法,磁刺激组给予1 Hz低频rTMS和假镜像疗法,镜像疗法组给予空载磁刺激和镜像疗法,联合组给予1 Hz低频rTMS联合镜像疗法,共4周。采用Fugl-Meyer评定量表上肢部分(FMA-UE)和上肢动作研究量表(ARAT)评估患侧上肢运动能力,经颅磁刺激仪测定患侧皮质的运动诱发电位(MEP)振幅及中枢传导时间(CMCT)。结果治疗后,各组FMA-UE评分、ARAT评分、MEP振幅均显著提高(|t|>3.854,P<0.001),CMCT均显著缩短(t>5.967,P<0.001)。与对照组比较,磁刺激组、镜像疗法组和联合组FMA-UE评分、ARAT评分和MEP振幅更高,CMCT更短(P<0.05);与磁刺激组和镜像疗法组比较,治疗后联合组FMA-UE评分、ARAT评分和MEP振幅更高,CMCT更短(P<0.05)。各组FMA-UE评分、ARAT评分与MEP振幅呈显著正相关,与CMCT呈显著负相关(R2>0.804,P<0.001)。结论1 Hz低频rTMS联合镜像疗法有助于脑卒中后脑功能重塑,促进偏瘫患者上肢运动功能恢复。

Effect of electroacupuncture combined with repetitive transcranial magnetic stimulation on limb dysfunction in patients with ischemic stroke

(rTMS) on limb dysfunction in ischemic stroke patients. Methods: A total of 63 stroke patients were divided into an observation group and a control group using the random number table method. Thirty-one patients in the control group were treated with routine Western medicine combined with rTMS;32 patients in the observation group were treated with EA in addition to the intervention in the control group. The duration of treatment was 3 months. The National Institutes of Health stroke scale (NIHSS), the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI), and the motor evoked potential (MEP) latency of transcranial magnetic stimulation were observed before and after treatment in both groups. Results: Two cases withdrew from the observation group and 1 case withdrew from the control group. After treatment, the NIHSS score in both groups was lower than that before treatment, the FMA and MBI scores were higher than those before treatment, and the latency period of MEP was shorter than that before treatment, and the differences were statistically significant (P<0.05). After treatment, the NIHSS, FMA, and MBI scores and MEP latency period of the observation group improved more than those of the control group, and the differences between the groups were statistically significant (P<0.05). Conclusion: EA combined with rTMS can improve the motor function of limbs in ischemic stroke patients and improve their self-care ability. The mechanism may be related to increasing the excitability of the motor cortex and improving the electrophysiological function of the central nervous system.

丰富环境通过激活Wnt/β-catenin信号通路促进脑缺血小鼠海马区的突触重塑

目的探讨丰富环境饲养促进脑缺血小鼠海马区突触重塑的作用机制。方法清洁级成年雄性小鼠(C57BL/6)60只,按随机数字表法选取16只设为假手术组,剩余44只接受永久性左侧大脑中动脉栓塞(pMCAO)手术。将造模成功的32只小鼠随机分为标准饲养组和丰富环境组,每组16只。术后3 d行丰富环境干预,假手术组和标准环境组置于标准环境鼠笼中饲养,丰富环境组置于丰富环境鼠笼中饲养,持续干预28 d;干预28 d后,采用透射电镜技术及蛋白免疫印迹检测技术,分别检测和观察分析3组小鼠海马CA3区的突触数量以及海马区Wnt7a、Dvl1、β-catenin、突触素、PSD-95蛋白表达水平的变化。结果与标准环境组相比,丰富环境组海马区突触素、PSD-95、Wnt7a、Dvl1、β-catenin的蛋白表达水平显著升高,与标准饲养组比较,差异均有统计学意义(P<0.05)。丰富环境组海马CA3区的突触数量亦明显高于标准饲养组(P<0.05)。结论丰富环境可以激活脑缺血小鼠海马区Wnt7a-β-catenin-Dvl1信号通路,从而促进脑缺血小鼠海马区突触重塑。