电针治疗对脑梗死后相关神经纤维继发性损伤影响的磁共振弥散张量成像研究

Diffusion tensor imaging (DTI) is a relatively new MRI technique which diagrams white matter tracts. Previous studies have shown that the progressive secondary degeneration of in pyramid tract and bilateral middle cerebral peduncles revealed by DTI may hinder the process of neurological recovery after a focal pontine infarct，yet，none on about the effects of electro-acupuncture. Now with the help of DTI-MR we can detect how the electro-acupuncture work on reducing the progressive secondary degeneration of neural fibers outside the infarct foci after cerebral infarction and provide a strong theory evidence for the clinical treatment. Methods: forty patients with a recently isolated MCA infarct would be divided into 2 groups randomly and named them "A"and"B". All the patients would receive the same basic medicine treatment，while the members of the"B"would get electro-acupuncture treatment in addition. Then all the patients would undergo Diffusion Tensor imaging(DTI)examinations and evaluations with the NIH stroke scale(NIHss)，the Fugl--Meyer motor scale(FM)and the barthel index(BI) after first week(W1)，the end of the fourth week(W4)and the twelfth week(W12)，the end of the twenty-fourth week(w24), respectively. Mean diffusion（MD）and fractional anisotropy(FA) measured on bilateral sides at internal capsule，cerebral peduncle，pons and medulla were analyzed．The purpose of this project is to investigate the effects of electro-acupuncture and the relationship between FA and NIHSS、FM、BI.

针灸治疗脑梗塞的疗效肯定，治疗机理还未完全清楚。弥散张量成像 (DTI) 是利用组织中水分子扩散运动的各向异性的原理，定量分析组织的弥散特征，是目前唯一无创性活体研究脑白质结构及神经束形态的检查技术。前期对脑梗死患者的DTI研究显示梗死后其远隔部位神经的继发性损害持续存在并影响神经功能的恢复。但尚缺乏电针治疗对脑梗死后相关神经纤维继发性损伤影响的研究。本项目以单侧大脑中动脉供血区、累及内囊的单一病灶的脑梗死的患者为研究对象,将符合要求的患者随机分为单纯药物组和针药组，分别在治疗后第1、第4、第12周、第2４周进行DTI检测，测量患者远离梗死灶的脑干、颈髓第2及第4节段等部位的MD和FA值。每次行DTI检测前均采用NIHSS、FMS、BI对患者评分。比较两组MD和FA值的变化差异程度及神经功能评分变化之间的关系，以明确电针治疗脑梗死对神经纤维继发性损害的作用特点、规律及与神经功能恢复的关系。

为进一步探索针灸治疗脑梗塞的机理，研究电针治疗对脑梗死后相关神经纤维继发性损伤影响。本项目利用弥散张量成像 (DTI)技术，以单侧大脑中动脉供血区、累及内囊的单一病灶的脑梗死的患者为研究对象,将符合要求的患者随机分为单纯药物组和针药组，分别在治疗后第1、第4、第12周、第2４周进行DTI检测，测量患者远离梗死灶的脑干、颈髓第2及第4节段等部位的MD和FA值。每次行DTI检测前均采用NIHSS、FMS、BI对患者评分。通过比较分析，发现脑梗塞病人脑梗塞后远隔部位神经纤维存在有损伤现象，这种损伤与临床神经功能损伤（NIHSS、FMS、BI评分）一致，电针治疗对此有一定的保护作用。结合动物实验数据，提示电针可以通过提高脑缺血大鼠突触数密度、突触面密度、突触后膜致密物厚度促进脑梗死大鼠突触结构可塑性作用的发挥。该课题探索电针的干预效应、规律及中枢神经机制，部分阐明和丰富针灸治疗脑梗死的机理和科学内涵。