功能磁共振成像在评价针药联合治疗脑梗塞疗效中的应用价值

Functional magnetic resonance imaging in evaluating the treatment of cerebral infarction with acupuncture and Chinese medicine

关键词:  功能磁共振成像  针药  脑梗塞  神经功能

Key words:  functional magnetic resonance imaging  acupuncture and moxibustion  cerebral infarction  neurological function

摘要:

目的　探讨功能磁共振成像在针药联合治疗脑梗塞中的应用价值研究。方法　选取2006年1月至2007年11月收治的脑梗塞患者40例，按照治疗方法不同分为针药组以及对照组，每组20例。对照组予以甘露醇，络活喜，倍他乐克，同时予以输液、维持水电解质平衡、抗炎以及营养等支持治疗。针药组在对照组基础上实施针刺治疗，配中药辩证治疗。两组均以1周为1个疗程，共治疗2个疗程。治疗结束后，比较患者临床疗效、神经功能评定、barthel指数、Lovett肌力等级评分、fMRI检查以及不良反应发生情况。结果　与治疗前相比，治疗后两组神经功能缺损评分水平降低，barthel指数以及Lovett肌力分级指数升高（P＜0.05），ADCAVG值水平降低（P＜0.05），FA值水平升高（P＜0.05），激活率及激活体积升高（P＜0.05）。与对照组相比，针药组临床总有效率较高（P＜0.05），针药组神经功能缺损评分水平较低，barthel指数以及Lovett肌力分级指数较高（P＜0.05），ADCAVG值水平较低（P＜0.05），FA值水平较高（P＜0.05），激活率以及激活体积较高（P＜0.05）。结论　针药联合治疗脑梗塞的临床疗效显著，功能磁共振成像尤其是将fMRI 中的BOLD、DTI两种技术结合起来，能够可以为针药联合治疗脑梗塞的疗效评价提供可靠的可视化及可量化依据。

Abstract:

Objective To investigate the value of functional magnetic resonance imaging (FMRI) in evaluating the treatment of cerebral infarction with acupuncture and Chinese medicine. Methods Forty patients with acute cerebral infarction from Shenzhen Traditional Chinese Medicine Hospital (2006.01-2007.11) were selected and divided into experiment group and control group. The patients in the both groups were given mannitol, Norvasc, metoprolol, infusion to maintain water and electrolyte balance, anti-inflammatory and nutritional support, but those in the experiment group received more with acupuncture, and dialectical treatment with traditional Chinese medicine. One week as a course of treatment, all patients were treated a total of 2 courses. After treatment, the clinical efficacy, neurological function, barthel index, lovett strength grade score, fMRI examination and adverse reaction were examined. Results Compared with pre-treatment, levels of neurological deficit score, barthel index and Lovett 's muscle grade index increased(P＜0.05), levels of ADC AVG and FA decreased (P＜0.05), activation rate and activation volume increased(P＜0.05) after treatment. Compared with the control group, levels of neurological deficit score, barthel index and Lovett 's muscle grade index were higher(P＜0.05), levels of ADC AVG and FA lower(P＜0.05), activation rate and activation volume higher(P＜0.05) in the experiment group. Conclusion Functional magnetic resonance imaging (FMRI), especially BOLD and DTI in fMRI could provide a reliable visualization and evaluation of the therapeutic effect of acupuncture combined with medicine on cerebral infarction.