针刺阳陵泉对不同病程缺血性脑卒中偏瘫患者脑效应机制研究

目的 基于功能磁共振成像技术探究针刺阳陵泉对不同病程缺血性脑卒中偏瘫患者的脑效应机制。方法 筛选纳入损伤以单侧基底节区和（或）放射冠为主的40例缺血性脑卒中偏瘫患者分为长病程组24例、短病程组16例。对所有受试者进行1次fMRI扫描，扫描期间给予针刺患侧阳陵泉干预，持续1 Hz的频率平补平泻捻针1分钟，留针8分钟出针。选取双侧半球的辅助运动区（SMA）、背侧运动前区（PMd）、腹侧运动前区（PMv）、初级运动区（M1）共计8个种子点，计算并对比静息态及针刺态下每对种子点之间的功能连接强度的变化及与FMA的相关性。结果 静息态时，长病程组PMv-R与SMA-L之间功能连接度强于短病程组（P＜0.05）；针刺态时，长病程组中SMA-L与PMv-L之间功能连接弱于静息态时（P＜0.05），短病程组中SMA-L与SMA-R、PMv-R之间、SMA-R与PMd-R之间、PMv-R与PMv-L之间功能连接强于静息态（P＜0.05）；针刺态时，长病程组和短病程组间各对种子点对在针刺态下和全组各对种子点在静息态与针刺态下之间功能连接强度差异均无统计学意义(P＞0.05)；长病程组中，针刺态时下肢FMA评分与健侧PMd-L—M1-L之间功能连接强度呈负相关（r=-0.411, P＜0.05）；短病程组中，静息态时下肢FMA评分与PMd-L—M1-L、PMv-R—M1-R之间功能连接强度呈负相关（r=-0.588及r=-0.542，P＜0.05）；在全组中，静息态时下肢FMA评分与PMv-R—M1-R之间功能连接强度呈负相关（r=-0.432, P＜0.05）；上下肢FMA总分与PMv-R—M1-R之间功能连接强度呈负相关（r=-0.319, P＜0.05）。结论 不同病程脑卒中偏瘫患者在接受针刺患侧阳陵泉后在脑结构重组及脑功能重塑的过程中有着差异性的表现，激活的脑区也存在差别，病程时间越长的患者，其大脑病灶侧PMv与健侧SMA之间存在更强的功能连接。针刺阳陵泉时，脑区功能连接在双侧SMA、PMd、PMv、M1之间有特定的效应靶点，可能是改善患者运动功能障碍和神经缺损程度的作用机制之一。

The Brain Effect Mechanism of Acupuncture at Yanglingquan in Patients with Different Durations of Hemiplegia Due to Ischemic Stroke

Objective To investigate the brain effect mechanism of acupuncture at Yanglingquan in patients with different durations of hemiplegia due to ischemic stroke based on functional magnetic resonance imaging (fMRI). Methods A total of 40 patients with unilateral hemiplegia due to ischemic stroke were enrolled and divided into long duration group and short duration group, and all subjects were given acupuncture at Yanglingquan at the ipsilateral side during MRI scanning.A total of eight seed points were selected in motor-related brain regions(SMA, PMd, PMv, M1) in both hemispheres; the changes in functional connectivity between each pair of seed points in the resting state and the acupuncture state were calculated and compared, and their correlation with Fugl-Meyer Assessment (FMA) score was analyzed. Results In the resting state,compared with the short duration group, the long duration group had a significantly stronger functional connectivity between ipsilateral PMv and contralateral SMA (P<0.05); for the long duration group, the functional connectivity between contralateral SMA and contralateral PMv in the acupuncture state was significantly weaker than that in the resting state (P<0.05), while the short duration group had a significantly stronger functional connectivity between SMA at both sides, between contralateral SMA and ipsilateral PMv, between ipsilateral SMA and ipsilateral PMd, and between PMv at both sides in the acupuncture state than in the resting state (P<0.05). In the long duration group, FMA score of lower extremities was negatively correlated with the functional connectivity between contralateral PMd and contralateral M1 in the acupuncture state (r =-0.411,P<0.05); in the short duration group, FMA score of lower extremities was negatively correlated with the functional connectivity between contralateral PMd and contralateral M1 and between ipsilateral PMv and ipsilateral M1 in the resting state (r =-0.588 and -0.542,P<0.05); in the whole group, FMA scores of lower extremities and whole body were negatively correlated with the functional connectivity between ipsilateral PMv and ipsilateral M1 in the resting state (r=-0.432 and -0.319,P<0.05). Conclusion Contralateral SMA-PMv can be used as an effective target for acupuncture in patients with a long duration of hemiplegia, while SMA at both sides,contralateral SMA and ipsilateral PMv,ipsilateral SMA and ipsilateral PMd, and PMv at both sides can be used as effective targets for acupuncture in patients with a short duration of hemiplegia. The above indices can also be used as the neurobiological indices to judge the rehabilitation and prognosis of limb motor function in patients with hemiplegia due to stroke.