功能磁共振成像技术在针刺治疗中风偏瘫脑机制研究的现状及前景

胡赫其; 鲁海; 韩李莎; 胡佳慧; 张春红

doi:10.12122/j.issn.1674-4500.2021.02.35

功能磁共振成像技术在针刺治疗中风偏瘫脑机制研究的现状及前景

doi: 10.12122/j.issn.1674-4500.2021.02.35

胡赫其^1,2,,
鲁海^1,2,
韩李莎²,
胡佳慧⁴,
张春红^1,3,5, ,

1.
天津中医药大学第一附属医院针灸临床部，天津 300193
2.
天津中医药大学研究生院，天津 301617
3.
宝安纯中医治疗医院针灸推拿康复科，广东深圳 518000
4.
浙江省人民医院康复科，浙江杭州 310014
5.
国家中医针灸临床医学研究中心，天津 300381

基金项目:

国家重点研发计划项目-政府间国际科技创新合作重点专项项目 2018YFE0181700

详细信息

作者简介:
胡赫其，在读硕士研究生，E-mail: hhq1612211369@163.com

通讯作者:
张春红，教授，博士生导师，E-mail: drzch1113@tjutcm.edu.cn

计量
- 文章访问数: 734
- HTML全文浏览量: 335
- PDF下载量: 21
- 被引次数: 0
出版历程
- 收稿日期: 2021-01-25
- 刊出日期: 2021-03-20

A review on the current situation and prospect of fMRI applying in the neural mechanism research of stroke by acupuncture

Heqi HU^{1,2
,},
Hai LU^1,2,
Lisha HAN²,
Jiahui HU⁴,
Chunhong ZHANG^{1,3,5
, ,}

1.
Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Chinese Medicine, Tianjin 300193, China
2.
Graduate School, Tianjin University of Chinese Medicine, Tianjin 301617, China
3.
Department of Acupuncture and Moxibustion, Baoan Pure Traditional Chinese Medicine Treatment Hospital, Shenzhen 518000, China
4.
Department of Rehabilitation, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
5.
National Clinical Medicine Research Center of Traditional Chinese Medicine, Tianjin 300381, China

摘要

摘要: 随着功能磁共振成像分子影像技术的逐步成熟，针刺的脑效应机制研究也步入可视化阶段，且在中风病领域应用较多。功能磁共振成像研究范式主要分为任务态和静息态，分析方法主要包括脑区激活、功能连接、脑网络等。本文根据现有针刺-功能磁共振成像相关文献，归纳出针刺治疗中风偏瘫脑机制的研究进展，针对其试验设计、分析方法等方面分析目前研究可能存在的问题，并展望其应用前景。结果显示针刺可不同程度地激活大脑皮质运动区、感觉区以及小脑、基底节等部位，亦可提高脑区的功能连接，对运动、感觉、语言等脑功能网络发挥一定的调制作用。但仍存在诸多问题需要去改进，未来倡导以中医传统理论为纲，充分融合现代技术，多学科并举，构建针刺治疗中风的特异性脑效应网络。
- 针刺 /
- 中风偏瘫 /
- 功能磁共振成像 /
- 任务态 /
- 静息态 /
- 脑效应机制 /
- 述评
Abstract: As the fMRI molecular imaging technology maturing, the research on the central mechanism for acupuncture effect has also entered the visualization phase, and it is widely used in the field of stroke. At present, fMRI research mainly bases on task-state and resting-state, and analysis methods include brain region activation, functional connection, brain network analysis, etc. Based on the existing literature on acupuncture-fMRI, this review summarizes the progress of central mechanism research on acupuncture in the treatment of stroke, proposes possible problems in the aspects of its experimental design and analysis methods and looks forward to its application prospect. Results show that acupuncture could activate the cerebral cortex motor area, sensory area and cerebellum, basal ganglia to different degrees, and improve the functional connection of some brain regions, regulate brain motor, sensory, language networks. However, there are still many problems that need to be improved. In the future, traditional Chinese medicine theory should be proposed as the outline combine with modern technology through multidisciplinary partnerships to build a specific brain effect network for acupuncture treatment of stroke.
- acupuncture /
- stroke /
- functional magnetic resonance imaging /
- task-state /
- resting-state /
- mechanism of brain effect /
- review

HTML全文

参考文献(44)

[1]	刘露阳, 王鹏琴. 功能磁共振成像技术在针刺机制研究中的应用[J]. 辽宁中医杂志, 2018, 45(1): 203-6. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY201801063.htm
[2]	Ogawa S, Lee TM, Kay AR, et al. Brain magnetic resonance imaging with contrast dependent on blood oxygenation[J]. PNAS, 1990, 87 (24): 9868-72. doi: 10.1073/pnas.87.24.9868
[3]	何昭璇, 侯键, 邱科, 等. 基于功能磁共振成像技术的针刺机制研究现状分析[J]. 针刺研究, 2016, 41(5): 474-8. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ201605021.htm
[4]	尹涛, 何昭璇, 马培宏, 等. 针刺功能磁共振成像研究任务设计方法述评[J]. 中华中医药学刊, 2019, 37(7): 1657-60. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201907029.htm
[5]	Soares JM, Magalhães R, Moreira PS, et al. A hitchhiker's guide to functional magnetic resonance imaging[J]. Front Neurosci, 2016, 10: 515. http://europepmc.org/articles/PMC5102908/
[6]	高璇, 鲁海, 高霄英, 等. 针刺临床研究中常用的Rs-fMRI分析方法: 10年概况[J]. 分子影像学杂志, 2020, 43(4): 568-71. doi: 10.12122/j.issn.1674-4500.2020.04.03
[7]	Chen X, Zhang H, Zou Y. A functional magnetic resonance imaging study on the effect of acupuncture at GB34 (Yanglingquan) on motorrelated network in hemiplegic patients[J]. Brain Res, 2015, 1601: 64-72. doi: 10.1016/j.brainres.2015.01.011
[8]	董培, 崔方圆, 谭中建, 等. 针刺对脑梗死后痉挛期患者脑功能重塑作用的功能磁共振成像研究[J]. 中国康复医学杂志, 2010, 25(6): 507-13. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF201006005.htm
[9]	Qi J, Chen JQ, Huang Y, et al. Acupuncture at Waiguan (SJ5) and sham points influences activation of functional brain areas of ischemic stroke patients: a functional magnetic resonance imaging study[J]. Neural Regen Res, 2014, 9(3): 293-300. doi: 10.4103/1673-5374.128227
[10]	Cho SY, Kim M, Sun JJ, et al. A comparison of brain activity between healthy subjects and stroke patients on fMRI by acupuncture stimulation[J]. Chin J Integr Med, 2013, 19(4): 269-76. doi: 10.1007/s11655-013-1436-4
[11]	Li MK, Li YJ, Zhang GF, et al. Acupuncture for ischemic stroke: cerebellar activation may be a central mechanism following Deqi[J]. Neural Regen Res, 2015, 10(12): 1997-2003. doi: 10.4103/1673-5374.172318
[12]	Huang Y, Chen JQ, Lai XS, et al. Lateralisation of cerebral response to active acupuncture in patients with unilateral ischaemic stroke: an fMRI study[J]. Acupunct Med, 2013, 31(3): 290-6. doi: 10.1136/acupmed-2012-010299
[13]	周玉梅, 孙佳蕾, 武平. 静息态fMRI技术在临床的应用-局部一致性研究[J]. 中风与神经疾病杂志, 2014, 31(4): 382-4. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ201404037.htm
[14]	廖艳辉, 唐劲松, 王绪轶, 等. 氯胺酮依赖者脑功能活动的局部一致性改变-静息态功能磁共振成像研究[J]. 中国药物依赖性杂志, 2010, 19 (5): 343-8. https://www.cnki.com.cn/Article/CJFDTOTAL-YWYB201005008.htm
[15]	付彩红, 宁艳哲, 张勇, 等. 针刺阳陵泉对中风偏瘫病人局部一致性影响的静息态fMRI研究[J]. 中西医结合心脑血管病杂志, 2019, 17 (11): 1623-9. doi: 10.12102/j.issn.1672-1349.2019.11.005
[16]	Chen SQ, Cai DC, Chen JX, et al. Altered brain regional homogeneity following contralateral acupuncture at Quchi (LI 11) and Zusanli (ST 36) in ischemic stroke patients with left hemiplegia: an fMRI study[J]. Chin J Integr Med, 2020, 26(1): 20-5. doi: 10.1007/s11655-019-3079-6
[17]	谢西梅, 米欣晶. 不同针刺方法对缺血性中风患者静息态脑Reho信号的影响[J]. 河南中医, 2019, 39(4): 633-6. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZY201904035.htm
[18]	马浩源, 胡珂宇, 宋怡瑶, 等. 静息态低频振幅在轻度认知功能障碍中的研究[J]. 脑与神经疾病杂志, 2019, 27(5): 325-7. https://www.cnki.com.cn/Article/CJFDTOTAL-LYSJ201905015.htm
[19]	王辉, 卢洁, 李坤成, 等. 应用静息态功能磁共振成像分数低频振幅技术观察脑梗死患者大脑基线功能的变化[J]. 中国医学影像技术, 2010, 26(11): 2041-4. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201011011.htm
[20]	周钰, 贾小飞, 刘佳妮, 等. 低频振幅分析针刺脑卒中痉挛患者拮抗肌的静息态脑功能MRI研究[J]. 宁夏医学杂志, 2020, 42(7): 601-4. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX202007010.htm
[21]	欧芳元, 黄俊浩, 易小琦, 等. 静息态fMRI比率低频振幅技术在针刺治疗脑梗死的研究[J]. 中国医学计算机成像杂志, 2019, 25(3): 236-41. doi: 10.3969/j.issn.1006-5741.2019.03.005
[22]	陈怡, 余成新. 基于静息态功能磁共振成像的静态及动态功能连接分析方法研究进展[J]. 磁共振成像, 2019, 10(8): 637-40. https://www.cnki.com.cn/Article/CJFDTOTAL-CGZC201908019.htm
[23]	陈富琴, 张俊然, 蒋小梅, 等. 有效连接分析在脑功能磁共振数据中的发展和应用[J]. 航天医学与医学工程, 2016, 29(4): 307-12. https://www.cnki.com.cn/Article/CJFDTOTAL-HYXB201604015.htm
[24]	Zhang Y, Li KS, Ren Y, et al. Acupuncture modulates the functional connectivity of the default mode network in stroke patients[J]. Evid Based ComplementAlternat Med, 2014, 2014: 765413. http://pubmedcentralcanada.ca/pmcc/articles/PMC3963376/
[25]	Fu CH, Li KS, Ning YZ, et al. Altered effective connectivity of resting state networks by acupuncture stimulation in stroke patients with left hemiplegia: a multivariate granger analysis[J]. Medicine: Baltimore, 2017, 96(47): e8897. doi: 10.1097/MD.0000000000008897
[26]	刘玉欢, 喻罡, 高燕华. 静息态fMRI观察孤独症大脑功能网络[J]. 中国医学影像技术, 2014, 30(7): 1109-12. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201407051.htm
[27]	Han X, Jin H, Li KS, et al. Acupuncture modulates disrupted wholebrain network after ischemic stroke: evidence based on graph theory analysis[J]. Neural Plast, 2020, 2020: 8838498. http://www.researchgate.net/publication/343767060_Acupuncture_Modulates_Disrupted_Whole-Brain_Network_after_Ischemic_Stroke_Evidence_Based_on_Graph_Theory_Analysis
[28]	张斌龙, 常静玲, 韩奕, 等. 基于脑功能网络分析技术下": 益髓醒神" 针刺治疗不同部位卒中后失语的案例分析[J]. 环球中医药, 2019, 12 (6): 929-32. doi: 10.3969/j.issn.1674-1749.2019.06.032
[29]	Xie Z, Cui F, Zou Y, et al. Acupuncture enhances effective connectivity between cerebellum and primary sensorimotor cortex in patients with stable recovery stroke[J]. Evid Based Complement Alternat Med, 2014, 2014: 603909. http://europepmc.org/abstract/MED/24734108
[30]	Ning Y, Li K, Fu C, et al. Enhanced functional connectivity between the bilateral primary motor cortices after acupuncture at Yanglingquan (GB34) in right-hemispheric subcortical stroke patients: a resting-state fMRI study[J]. Front Hum Neurosci, 2017, 11: 178. http://europepmc.org/abstract/MED/28443010
[31]	Siegel JS, Seitzman BA, Ramsey LE, et al. Re-emergence of modular brain networks in stroke recovery[J]. Cortex, 2018, 101: 44-59. doi: 10.1016/j.cortex.2017.12.019
[32]	陈华, 杨丰, 黄泳, 等. SPM在外关穴针刺脑功能成像中的应用研究[J]. 中国医学物理学杂志, 2011, 28(1): 2369-72. doi: 10.3969/j.issn.1005-202X.2011.01.012
[33]	梁夏, 王金辉, 贺永. 人脑连接组研究: 脑结构网络和脑功能网络[J]. 科学通报, 2010, 55(16): 1565-83. https://www.cnki.com.cn/Article/CJFDTOTAL-KXTB201016008.htm
[34]	He Y, Chen ZJ, Evans AC. Small-world anatomical networks in the human brain revealed by cortical thickness from MRI[J]. Cereb Cortex, 2007, 17(10): 2407-19. doi: 10.1093/cercor/bhl149
[35]	Hagmann P, Kurant M, Gigandet X, et al. Mapping human wholebrain structural networks with diffusion MRI[J]. PLoS One, 2007, 2 (7): e597. doi: 10.1371/journal.pone.0000597
[36]	Li LL, Qin W, Bai LJ, et al. Exploring vision-related acupuncture point specificity with multivoxel pattern analysis[J]. Magn Reson Imaging, 2010, 28(3): 380-7. doi: 10.1016/j.mri.2009.11.009
[37]	Qin W, Tian J, Bai L, et al. FMRI connectivity analysis of acupuncture effects on an amygdala-associated brain network[J]. Mol Pain, 2008, 4: 55. http://pubmedcentralcanada.ca/pmcc/articles/PMC2596101/
[38]	Biswal B, Yetkin FZ, Haughton VM, et al. Functional connectivity in the motor cortex of resting human brain using echo-planar MRI[J]. Magn Reson Med, 1995, 34(4): 537-41. doi: 10.1002/mrm.1910340409
[39]	汪军, 陈笛, 裴建. 基于功能性磁共振成像评价针刺对缺血性脑卒中运动功能障碍中枢作用机制的研究进展[J]. 中国康复医学杂志, 2017, 32(3): 348-53. doi: 10.3969/j.issn.1001-1242.2017.03.023
[40]	李泽宇, 詹逸珺, 裴建. 针刺激活脑卒中后运动功能障碍的脑功能连接研究[J]. 中华针灸电子杂志, 2020, 9(3): 121-4. doi: 10.3877/cma.j.issn.2095-3240.2020.03.012
[41]	Wang JH, Wang L, Zang YF, et al. Parcellation-dependent smallworld brain functional networks: a resting-state fMRI study[J]. Hum Brain Mapp, 2009, 30(5): 1511-23. doi: 10.1002/hbm.20623
[42]	罗诗蕾, 詹松华, 陈义磊, 等. 基于ReHo方法探究针刺百会穴脑效应的性别差异[J]. 中国中西医结合影像学杂志, 2020, 18(1): 3-7, 21. https://www.cnki.com.cn/Article/CJFDTOTAL-JHYX202001004.htm
[43]	Friston KJ, Frith CD, Liddle PF, et al. Functional connectivity: the principal-component analysis of large (PET) data sets[J]. J Cereb Blood Flow Metab, 1993, 13(1): 5-14. doi: 10.1038/jcbfm.1993.4
[44]	Hamilton JP, Chen G, Thomason ME, et al. Investigating neural primacy in Major Depressive Disorder: multivariate Granger causality analysis of resting-state fMRI time-series data[J]. Mol Psychiatry, 2011, 16(7): 763-72. doi: 10.1038/mp.2010.46