“手足十二针”对缺血性脑卒中偏瘫患者运动皮质连接组功能连接的影响

目的 运用静息态功能磁共振技术探究“手足十二针”对缺血性脑卒中偏瘫患者运动皮质连接组功能连接（functional connectivity, FC）的影响。方法 纳入37例缺血性脑卒中偏瘫患者,分为真穴组25例、假穴组12例。真穴组患者给予“手足十二针”组穴（双侧合谷、内关、曲池、足三里、阳陵泉、三阴交）针刺干预;假穴组患者给予“手足十二针”经穴旁开1寸针刺干预。采用Fugl-Meyer量表(Fugl-Meyer assessment scale, FMA) 评价患者的肢体运动功能,采用美国国立卫生研究院卒中量表 (National Institute of Health stroke scale, NIHSS) 评价患者的神经系统缺损程度,并进行静息态功能磁共振成像。选取双侧初级运动区（primary motor area, M1）、辅助运动区（supplementary motor area, SMA）、运动前区（premotor cortex, PMC）为种子点,分析计算各脑区间FC值。比较两组患者治疗前后FMA量表、NIHSS评分及FC值。结果 与治疗前比较,真穴组患者治疗后FMA上肢运动功能评分、下肢运动功能评分、总分均显著升高（P<0.05）,NIHSS评分显著降低（P<0.05）;双侧M1 FC值显著升高（P<0.05）,患侧SMA与健侧PMC的FC值显著降低（P<0.05）。与治疗前比较,假穴组患者治疗后下肢运动功能评分、FMA总分均显著升高（P<0.05）,NIHSS评分显著降低（P<0.05）。结论 “手足十二针”可能通过增强双侧初级运动区的FC以改善缺血性脑卒中偏瘫患者的运动功能及神经功能缺损程度,且具有穴位特异性,而辅助运动区与运动前区FC的改变也是另一可能的机制。

Effect of "Hand and Foot Acupuncture with Twelve Needles" on Functional Connectivity of Motor Cortex Connectome in Ischemic Stroke Patients with Hemiplegia

Objective To investigate the effect of "hand and foot acupuncture with twelve needles" on the functional connectivity of motor cortex connectome in ischemic stroke patients with hemiplegia using resting-state functional magnetic resonance imaging (fMRI). Methods A total of 37 patients with hemiplegia after ischemic stroke were divided into true acupoint group with 25 patients and sham acupoint group with 12 patients. The patients in the true acupoint group were given hand and foot acupuncture with twelve needles at paired acupoints (Hegu, Neiguan, Quchi, Zusanli, Yanglingquan, and Sanyinjiao at both sides), and those in the sham acupoint group were given acupuncture at 1 Cun lateral from the acupoints for hand and foot acupuncture with twelve needles. Fugl-Meyer assessment(FMA) was used to evaluate limb motor function, National Institutes of Health stroke scale (NIHSS) score was used to evaluate the degree of neurological deficit, and resting-state fMRI was also performed. Primary motor area (M1), supplementary motor area(SMA), and premotor area(PMA) were selected as seed points to analyze and calculate the functional connectivity between brain areas. The two groups were compared in terms of FMA score, NIHSS score, and functional connectivity before and after treatment. Results After treatment, the true acupoint group had significant increases in FMA upper limb motor function score,FMA lower limb motor function score,and total FMA score (P<0.05) and a significant reduction in NIHSS score (P<0.05),as well as a significant increase in the functional connectivity between bilateral M1 areas (P<0.05) and a significant reduction in the functional connectivity between bipsilateral SMA and contralateral PMC (P<0.05). After treatment, the sham acupoint group had significant increases in FMA lower limb motor function score and total FMA score (P<0.05) and a significant reduction in NIHSS score (P<0.05). Conclusion Hand and foot acupuncture with twelve needles may improve motor function and the degree of neurological deficit in ischemic stroke patients with hemiplegia by enhancing the functional connectivity between bilateral M1 areas and has acupoint specificity, and the change in the functional connectivity between SMA and PMC might be an other possible mechanism.