针刺对脑梗死后痉挛期患者脑功能重塑作用的功能磁共振成像研究

目的:观察健康人及脑梗死后左侧偏瘫患者执行左侧上肢运动及针刺左侧阳陵泉穴后的激活区分布特点,初步探讨脑梗死后痉挛期脑功能重塑的特点及针刺阳陵泉对其影响的机制。方法:观察8例健康人及5例脑梗死后左侧偏瘫患者。试验1:分别对正常组及偏瘫组进行左侧上肢运动。试验2:分别对正常组及偏瘫组针刺左侧阳陵泉穴。两个试验均采用组块设计模式,运用BOLD-f MRI技术及Brain Voyager软件分析方法显示激活情况。结果:正常组执行运动任务出现右侧初级感觉运动皮质及双侧小脑的明显激活;正常组针刺左侧阳陵泉穴出现左侧小脑、两侧中央后回和顶下小叶的激活;偏瘫组执行运动任务,双侧大脑皮质均有明显激活,包括双侧初级感觉运动皮质(SM1)、运动前区(PMC)和次级运动区(PPC)、双侧丘脑、小脑蚓部、双侧小脑、右侧岛叶、壳核,以及健侧苍白球;偏瘫组针刺左侧阳陵泉穴出现中脑、左侧大脑皮质的运动前区和次级运动区的激活。结论:脑梗死后痉挛期脑功能重塑的机制在于通过功能区的转移和次级功能区的功能代偿,而针刺阳陵泉穴主要作用于锥体外系,通过调节中枢神经递质的释放,缓解痉挛状态。

A research of functional magnetic resonance imaging on the effects of acupuncture on brain reorganization in cerebral infarction patients with hemiplegia at spasm stage

Abstract Objective: To observe the effects of extremity movement and acupuncture at left GB34 on the distribution of brain active regions in cerebral infarction patients at spasm stage by functional magnetic resonance imaging(fMRI), and to explore the characteristics and mechanism of brain reorganization in stroke patients. Method: Examination 1: Left upper extremity movement task were executed in 8 normal people and 5 cerebral infarction patients with left hemiplegia. Examination 2: Acupuncture were applied at left GB34 in normal group and hemiplegia group. In both examination 1 and 2, block design were adopted, BOLD-fMRI and BrainVoyager software were used to analyze the active regions. Result: In normal group, left upper extremity movement obviously activated right primary sensorimotor cortex and bilateral cerebellum; acupuncture at left GB34 activated left cerebellum, bilateral posterior central gyri and inferior parietal lobule.In hemiplegia group, left upper extremity movement activated the both cerebrum, including primary sensorimotor cortex(SM1),premotor cortex(PMC),posterior parietal cortex(PPC),bilateral thalami,vermis cerebelli,bilateral cerebellum,right insula,right putamen and globus pallidus of unaffected side;acupuncture at left GB34 activated midbrain, left premotor cortex and PPC. Conclusion: Left upper extremity movement in hemiplegia group activates more regions of extrapyramidal system and PPC than that in normal group, the mechanism of brain reorganization after cerebral infarction is transposition of domains and functional compensation of secondary domains. Acupuncture at GB34 affect extrapyramidal, and regulate neurotransmitter to alleviate spasticity.