CAJ | 학술논문

目的：探讨针刺百会穴改善脑卒中患者记忆力的中枢机制。方法将32例脑卒中患者随机分成观察组和对照组，两组均给予神经内科常规治疗以及物理、作业康复治疗。观察组在此基础上针刺百会穴8周，对照组针刺阳陵泉穴8周。治疗前后两组行静息态fMRI扫描，观察左、右海马功能连接的变化；采用韦氏记忆量表对患者进行评定。对韦氏记忆量表评定结果与脑功能连接进行相关性分析。结果治疗前，两组韦氏记忆量表的各项得分和记忆商无显著性差异。观察组治疗后，记忆量表总分、记忆商改善(P<0.05)；左侧海马与右侧额下回、右侧额中回，以及右侧海马与左侧额叶、左侧顶叶连接增加。记忆商与左侧海马和右侧额中回的功能连接(r=0.56)、右侧海马和左侧额上回的功能连接(r=0.75)、右侧海马和左侧顶叶的功能连接(r=0.88)呈正相关。对照组治疗前后，记忆量表总分、记忆商无显著性差异(P>0.05)，左侧海马与右侧枕中回、右侧海马与右侧小脑后叶、左侧颞上回之间的连接减少，量表分与海马脑区功能连接无明显相关性。结论针刺百会改善脑卒中患者记忆力的中枢效应机制，可能与增加海马与额叶、顶叶之间脑网络的功能连接有关。
목적：탐토침자백회혈개선뇌졸중환자기억력적중추궤제。방법장32례뇌졸중환자수궤분성관찰조화대조조，량조균급여신경내과상규치료이급물리、작업강복치료。관찰조재차기출상침자백회혈8주，대조조침자양릉천혈8주。치료전후량조행정식태fMRI소묘，관찰좌、우해마공능련접적변화；채용위씨기억량표대환자진행평정。대위씨기억량표평정결과여뇌공능련접진행상관성분석。결과치료전，량조위씨기억량표적각항득분화기억상무현저성차이。관찰조치료후，기억량표총분、기억상개선(P<0.05)；좌측해마여우측액하회、우측액중회，이급우측해마여좌측액협、좌측정협련접증가。기억상여좌측해마화우측액중회적공능련접(r=0.56)、우측해마화좌측액상회적공능련접(r=0.75)、우측해마화좌측정협적공능련접(r=0.88)정정상관。대조조치료전후，기억량표총분、기억상무현저성차이(P>0.05)，좌측해마여우측침중회、우측해마여우측소뇌후협、좌측섭상회지간적련접감소，량표분여해마뇌구공능련접무명현상관성。결론침자백회개선뇌졸중환자기억력적중추효응궤제，가능여증가해마여액협、정협지간뇌망락적공능련접유관。
Objective To explore the central mechanism of acupuncture at Baihui (GV20) for memory impairment after stroke. Meth-ods 32 stroke patients were randomized to receive acupuncture at Baihui (GV20) (as observation group) and acupuncture at Yanglingquan (GB34) (as control group) for 8 weeks. At the meantime, all participants received routine treatment including physical and occupational ther-apies. They were scanned with resting-state functional magnetic resonance imaging (fMRI) to find functional connectivity and assessed with Wechsler Memory Scale (WMS) before and after treatment. The results of WMS and functional connectivity were analyzed with Pearson's correlation. Results The memory scores and memory quotient improved significantly after treatment in the observation group (P<0.05). The functional connectivity significantly increased occurred in the left hippocampus to right inferior frontal gyrus, right middle frontal gyrus and left inferior frontal gyrus;and right hippocampus to left middle frontal gyrus, left superior frontal gyrus and left parietal lobe. Significant cor-relations were found between memory quotient and functional connectivity of hippocampus to frontal lobe and left parietal lobe in the obser-vation group. There was no statistical significance in memory scores and memory quotient in the control group. The functional connectivity significantly decreased in left hippocampus to right middle occipital gyrus, and right hippocampus to right superior temporal gyrus and right posterior lobe of cerebellum. There was no statistical correlation between functional connectivity and results of WMS. Conclusion The acu-puncture at Baihui can improves memory ability of stroke patients, which may associate with the increase of functional connectivity of hip-pocampus with frontal lobes and parietal lobes.