头针结合康复训练对脑卒中运动功能障碍患者脑功能连接的影响

关键词：脑卒中  运动功能障碍  头针  功能性磁共振  功能连接

Keywords:Tongji Hospital of Tongji University,Shanghai,200065

摘要：

      摘要 目的：比较头针结合康复治疗与单纯康复治疗对脑卒中运动功能障碍患者脑功能连接（functional connectivity， FC）的影响。 方法：将纳入研究的40例脑卒中运动功能障碍患者随机分为治疗组和对照组，每组20例。两组均接受康复治疗，治疗组在康复治疗基础上接受头针治疗，每组患者在治疗前后接受功能性磁共振（functional magnetic resonance imaging， fMRI）扫描。以病灶侧初级运动皮质（primary motor cortex， M1）为感兴趣区（region of interest， ROI），观察其他脑区与M1的功能连接。 结果：①治疗组患者眶部额下回、眶部额中回、右额中回、双侧内侧额上回与M1的功能连接增强；右颞下回与M1的功能连接减弱（FWE校正，P<0.05，激活体素范围>59）；对照组患者左三角部额下回与M1的功能连接增强；②治疗后两组患者Fugl-Meyer评分均比治疗前升高，且治疗组高于对照组（P<0.01）；③治疗组治疗前后的FC变化与Fugl-Meyer评分变化之间存在显著中度正相关性（P<0.05），治疗组治疗前后双内侧额上回FC变化与上肢Fugl-Meyer评分变化存在显著中度正相关性（P<0.05）。 结论：头针结合康复治疗能够增强脑卒中运动功能障碍患者额叶与病灶侧M1之间的功能连接，双内侧额上回与脑卒中运动功能障碍患者上肢恢复情况相关。

Abstract:

      Abstract Objective： To compare the effects of scalp acupuncture combined with rehabilitation therapy and rehabilitation therapy alone on the brain functional connectivity（FC） in patients with post-stroke motor dysfunction. Method： Forty patients with post-stroke motor dysfunction were randomly divided into a treatment group and a control group， with 20 patients in each group. Both groups received routine rehabilitation therapy， with the treatment group receiving additionally scalp acupuncture therapy. Functional magnetic resonance imaging（fMRI） scans were performed on all patients before and after treatment， with the affected side primary motor cortex （M1） as the region of interest（ROI） to observe the FC between the M1 and other brain regions. Result： In the treatment group， FC was enhanced between the orbital inferior frontal gyrus， orbital middle frontal gyrus， right middle frontal gyrus， bilateral medial superior frontal gyri， and M1； conversely， FC between the right inferior temporal gyrus and M1 was reduced （FWE corrected， P<0.05， cluster size>59）. In the control group， FC between the left triangular part of the inferior frontal gyrus and M1 was enhanced. After treatment， both groups showed a significant increase in Fugl-Meyer scores compared to pre-treatment， with the treatment group scoring higher than the control group（P<0.01）. In the treatment group, changes in FC before and after treatment were moderately and significantly correlated with improvements in Fugl-Meyer scores （P<0.05）. Additionally， changes in FC of the bilateral medial superior frontal gyri before and after treatment were significantly positively correlated with changes in upper limb Fugl-Meyer scores（P<0.05） in the treatment group. Conclusion： Scalp acupuncture combined with rehabilitation therapy can enhance the functional connectivity between the frontal lobe and the affected side M1, and the functional connectivity of the bilateral medial superior frontal gyri is associated with the recovery of upper limb function in patients with post-stroke motor dysfunction.