CAJ | 학술논문

目的应用血氧水平依赖性功能磁共振成像(BLOD-fMRI)及磁共振弥散张量成像(DTI)技术观察脑梗死偏瘫患者神经纤维束的完整性及其脑功能区对针刺的反应,探讨神经纤维束损伤时针刺的神经作用机制.方法选取20例以左上肢偏瘫为主要症状的脑梗死患者,病程3～6周.对患者行DTI及针刺左侧合谷穴、外关穴任务下BOLD-fMRI检查.DTI原始数据经过处理后重建锥体束三维图像,观察右侧锥体束的损伤情况.BOLD-fMRI原始数据应用SPM 8等软件处理之后,观察脑功能激活区的分布情况.结果 20例脑梗死患者右侧锥体束有不同程度的中断受损改变.脑梗死患者针刺左侧合谷穴、外关穴任务下,两侧基底核区核团及丘脑激活最为明显,左额内侧回、额上回、左岛叶有明显激活区域,中脑网状结构、红核、黑质及左小脑山坡、齿状核、右侧额叶皮质见大量激活区域,左颞下回、梭状回、左额中回、左额下回、两侧楔前叶、右小脑山坡、右顶叶皮质有少量激活区.负激活脑区包括左后扣带回、右枕叶及右额上回.结论 DTI技术可直观反映脑梗死偏瘫患者的锥体束损伤情况,损伤时锥体外系在针刺效应中发挥了显著作用,DTI与BLOD-MRI联合应用对研究脑梗死患者的针刺康复机制具有重要价值.
목적 응용혈양수평의뢰성공능자공진성상(BLOD-fMRI)급자공진미산장량성상(DTI)기술관찰뇌경사편탄환자신경섬유속적완정성급기뇌공능구대침자적반응,탐토신경섬유속손상시침자적신경작용궤제.방법 선취20례이좌상지편탄위주요증상적뇌경사환자,병정3～6주.대환자행DTI급침자좌측합곡혈、외관혈임무하BOLD-fMRI검사.DTI원시수거경과처리후중건추체속삼유도상,관찰우측추체속적손상정황.BOLD-fMRI원시수거응용SPM 8등연건처리지후,관찰뇌공능격활구적분포정황.결과 20례뇌경사환자우측추체속유불동정도적중단수손개변.뇌경사환자침자좌측합곡혈、외관혈임무하,량측기저핵구핵단급구뇌격활최위명현,좌액내측회、액상회、좌도협유명현격활구역,중뇌망상결구、홍핵、흑질급좌소뇌산파、치상핵、우측액협피질견대량격활구역,좌섭하회、사상회、좌액중회、좌액하회、량측설전협、우소뇌산파、우정협피질유소량격활구.부격활뇌구포괄좌후구대회、우침협급우액상회.결론 DTI기술가직관반영뇌경사편탄환자적추체속손상정황,손상시추체외계재침자효응중발휘료현저작용,DTI여BLOD-MRI연합응용대연구뇌경사환자적침자강복궤제구유중요개치.
Objective To observe the integrity of white matter fibers and functional regions of the brain in response to acupuncture and to explore acupuncture's mechanism when the pyramidal tract is damaged.Methods Twenty cerebral infarction survivors with left upper limb hemiplegia as their main sequela were examined using diffusion-tensor imaging (DTI) and blood oxygenation level dependent functional magnetic resonance imaging(BOLD-fMRI) while receiving acupuncture at the left HeGu and left WaiGuan acupoints.The experiments were conducted 3-6 weeks after onset of the hemiplegia.The DTI raw data were reconstructed to display 3-dimensional pyramidal tract images and the damage to the right lateral tract was observed.The BOLD-fMRI data were processed using SPM8 software to show the excited brain regions.Results The right lateral pyramidal tracts of the 20 patients were interrupted with different degrees of damage.The regions excited during the acupuncture were the bilateral nuclei of the basal ganglia and the thalamus.The left medial frontal gyrus, the left superior frontal gyrus and the left insula also had obviously excited regions.There were also a large number of excited regions in the reticular formation, the red nucleus and the substantia nigra of the midbrain, in the left cerebellum's hillside and dentate nucleus,and in the right prefrontal cortex.Minor excitement was also observed in the left inferior temporal gyrus, the fusiform gyrus, the left middle frontal gyrus, the left inferior frontal gyrus, the anterior precuneus bilaterally, the right cerebellum hillside and the right parietal cortex.The left posterior cingulate gyrus, the right occipital lobe and the right superior frontal gyrus all showed below-normal excitation.Conclusion The pyramidal tract is damaged in hemiplegic stroke patients, but extrapyramidal systems also play a significant role in determining the effects of acupuncture.DTI used together with BOLD-fMRI allows studying the mechanism through which acupuncture helps rehabilitate cerebral infarction patients.