MRI分析针刺缺血性血管性痴呆患者太溪-飞扬穴的脑响应

  目的  通过任务态功能磁共振成像观察即时针刺缺血性血管性痴呆（IVD）患者原络配穴（太溪-飞扬）脑功能活动状态的变化，探讨针刺治疗IVD患者的脑效应机制。  方法  采用Achieva 3.0T磁共振扫描仪对12例IVD患者行任务态功能成像扫描，先采集4 min的3D结构像，随后采集6 min的针刺原络穴配伍（太溪-飞扬穴）的针刺态数据，间隔2周对该组患者再采集一次6 min的针刺络穴飞扬穴的针刺态数据，获得的图像数据经过后处理后予以一般线性模型分析，统计值体素水平P=0.001（未校正），簇水平P<0.05（FWE校正）。获得针刺任务态IVD患者脑内神经元活动变化的脑激活区域。  结果  配伍针刺IVD患者太溪-飞扬穴正激活脑区有:右侧海马旁回，右侧角回，左侧丘脑，右侧丘脑，右侧脑岛，左侧前扣带和中央旁小叶；负激活脑区有:左侧小脑脚1区，左侧下半月小叶，小脑蚓部8区，左侧小脑后叶，左侧梭状回，左侧颞下回，右侧颞下回，左侧眶部额下回，左侧枕下回，左侧颞上回，左侧枕下回，左侧舌回，左侧顶下小叶，左侧顶上小叶。针刺IVD患者飞扬穴正激活脑区:右侧小脑前叶，右侧小脑后叶，小脑蚓部3区，右侧岛叶，右侧额下回，右侧缘上回，右侧颞上回，右侧丘脑，右侧豆状核；负激活脑区:左侧距状裂周围皮层，左侧后扣带回，左侧楔前叶。针刺IVD患者太溪-飞扬组穴与飞扬穴比较，激活增高的脑区:左内侧额上回，左侧距状裂周围皮层，左侧岛盖部额下回；激活减低的脑区:右侧缘上回，左侧缘上回，右侧额中回，右侧脑岛，左内侧和旁扣带脑回，左、右侧小脑6区，右侧豆状壳核，右侧丘脑，左侧额中回，左侧眶部额下回，左侧梭状回，左侧颞中回，右侧颞中回，右侧中央后回。  结论  针刺IVD患者主客原络配穴（太溪-飞扬穴）的即刻效应可直接影响并调节与认知功能相关脑区的神经元活动，推测这是针刺太溪-飞扬穴治疗血管性痴呆的潜在中枢机制；针刺IVD患者主客原络配穴相比单穴脑激活区更广泛，更具独特优势。 

A functional magnetic resonance imaging study of the brain effect mechanism by needling source connecting points "Taixi-Feiyang acupoints" in patients with ischemic vascular dementia

  Objective  To observe the changes of brain functional activities of the source and connecting needling (Taixi-Feiyang acupoint) of patients with ischemic vascular dementia by event-related cerebral functional magnetic resonance imaging.  Methods  A 6-minute task state experiment was performed on 12 patients with ischemic vascular dementia using a 3.0T magnetic resonance scanner. The 3D structural image scan for 4 minutes was collected first, and then the needle-prick data of the source connecting points (Taixi-Feiyang acupoint) was collected for 6 minutes. The needle-prick data of the single points of the Feiyang acupoint was collected again for 6 minutes at an interval of 2 weeks. The obtained image data was processed and analyzed by a general linear model.The brain function partitions with altered neuronal activities in patients with needle-prick ischemic vascular dementia were obtained.  Results  Brain activation areas of needling the source connecting points " Taixi and Feiyang" in patients with ischemic vascular dementia were right hippocampal gyrus, right horn gyrus, left thalamus, right thalamus, right insula, left anterior cingulate and central paraloids. The negatively activated brain areas were left cerebellar foot area 1, left lower half moon lobule, cerebellar worm eighth area, left cerebellar posterior lobe, left fusiform gyrus, left inferior temporal gyrus, right inferior temporal gyrus, left orbital subfrontal gyrus, left occipital regress, left temporal recirculation, left occipital recurrent, left glossal gyrus, left sub-parietal lobules, and left parietal lobes.  Conclusion  The immediate effect of needling the source connecting points "Taixi-Feiyang acupoints" in patients with ischemic acupuncture vascular dementia can directly affect and regulate the neuronal activities of the brain function partitions related to cognitive activities. The treatment of source and connecting needling has a wider range of brain activation areas.