针刺对脑白质疏松轻度认知障碍功能磁共振的影响

【作者】 侯小兵；

【导师】 张允岭；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2009， 博士

【摘要】 血管源性认知障碍是指由血管源性危险因素导致的各种程度和各种类型的认知障碍,涵盖了血管源性轻度认知障碍、血管性痴呆和混合性痴呆。早期发现、早期诊断、早期干预血管源性轻度认知障碍能够防止或延缓痴呆的发生与进展,这在痴呆缺乏有效和经济的治疗手段的今天,有着极其重要的社会、经济和医学价值。导致血管源性轻度认知障碍的因素具有异质性,包括脑白质疏松症、脑动脉硬化狭窄、脑梗死、脑出血、高血压、糖尿病等。应用磁共振技术发现脑白质疏松症在一般老年人中的患病率即达49.7%,其患病率随年龄增长而增高,80岁以上者几乎达100%。脑白质疏松症不仅仅是一个病理影像学改变,重要的是其临床表现主要为认知障碍,因此兼备认知障碍与病理影像学改变的脑白质疏松症就成为研究血管源性轻度认知障碍的一个良好切入点。针刺是治疗痴呆的一种比较有效的方法,临床大多把注意力集中在以各种神经心理学量表评价针刺的疗效,没有从认知功能的神经影像学角度来探讨针刺作用机理及疗效的客观化标准。功能磁共振技术是重要的一类医学数据可视化技术,它可以将人脑的功能变化信息进行客观的的可视化显示。因此,功能磁共振技术能够为研究针刺干预轻度认知障碍的作用机理和疗效的客观化标准提供了先进的方法和途径。本实验以脑白质疏松轻度认知障碍为研究对象,以功能磁共振为研究手段,参考临床实际情况,长时程针刺干预,通过神经心理学量表评价脑白质疏松轻度认知障碍的临床变化,在此基础上观察针刺前后脑白质疏松轻度认知障碍的脑功能磁共振和脑内神经递质变化,探索针刺干预轻度认知障碍的作用机理和疗效的客观化标准。论文包括文献综述和临床实验研究二部分内容。文献综述部分总结了针灸治疗血管性认知障碍历代文献中关于临床治疗、基础研究等方面的相关内容,评述了脑功能磁共振技术成像技术在轻度认知障碍和针灸研究中的应用,分析了国内外研究现状及存在的问题,提出了未来发展方向。临床实验部分针刺对脑白质疏松轻度认知障碍功能磁共振的影响。观察脑白质疏松轻度认知障碍针刺干预前、后的功能磁共振变化和脑内神经递质情况。纳入LAMCI被试23例,正常被试(对照组)13例。LAMCI被试进一步分层为针刺组10例与自然进程组13例,针刺组治疗3个月,自然进程组动态观察3个月,入组当天、治疗后3个月进行神经心理学测评、功能磁共振和波谱磁共振检查;对照组入组当天进行神经心理学测评、功能磁共振和波谱磁共振检查。神经心理学测评为MMSE和MoCA评价,波谱磁共振检查NAA/Cr、Cho/Cr、MI/Cr。结果:1.在扣带回后部,LAMCI被试与正常被试的NAA/Cr、Cho/Cr、MI/Cr比较无显著差异;2.以年龄为校正匹配因素,各选择8例LAMCI被试与正常被试重新进行神经递质比较,发现两组的NAA/Cr、Cho/Cr无显著差异,LAMCI被试组的MI/Cr明显升高,两组比较有显著差异;3.对5例LAMCI被试针刺干预3个月,针刺前神经心理学评分异常,针刺后神经心理学评分正常。针刺干预组与自然进程组LAMCI被试之间的NAA/Cr、Cho/Cr、MI/Cr无显著差异;4.针刺前听觉音乐工作任务激活的脑区包括颞叶的颞上回(BA22)、颞中回(BA21)、颞极区(BA38);额叶的体感皮层(BA1)和前运动皮层(BA6),针刺后激活的脑区包括颞叶的颞上回(BA22);额叶的额眶叶(BA11)、额极区(BA10)、额叶被盖。被激活脑区明显少于针刺前被激活区。结论:1.脑白质疏松轻度认知障碍受损的脑功能区涉及额、颞叶,表现为执行听觉任务时颞叶皮质激活增多,前额叶皮质未激活。功能磁共振可以为轻度认知障碍诊断、疗效判断以及针刺作用机理研究提供可视化依据。2.脑白质疏松轻度认知障碍扣带回处发生神经递质改变,表现为MI/Cr比值升高,可能是该病的客观化诊断指标之一。3.针刺可以作为脑白质疏松轻度认知障碍的有效干预手段之一,能够减少被激活脑区,提高任务刺激加工效率,但要达到影响脑内神经递质的变化需要更长时间的干预。更多还原

【Abstract】 Vascular cognitive impairment refers to the risk factors derived from blood vessels caused by a variety of levels and types of cognitive impairment,containing the vascular mild cognitive impairment,vascular dementia and mixed dementia. Early detection,early diagnosis,early intervention to the mild vascular cognitive impairment can prevent or delay the occurrence and progress of dementia,which is of significance and an extremely important social,economic and medical value.There is heterogeneity of the factors which lead to vascular mild cognitive impairment,including leukoaraiosis,cerebral artery stenosis,cerebral infarction, cerebral hemorrhage,hypertension,diabetes and so on.To found leukoaraiosis with the application of magnetic resonance technology in the elderly people,the result in the general prevalence rate reached 49.7 percent,and its prevalence increased with age increased,almost 100 percent for the people over 80 years. Leukoaraiosis is not only a pathological image changes,but quite important for its clinical performance in term of cognitive impairment,therefore both imaging and pathology of leukoaraiosis changing has become a good entry point for studying the vascular mild Cognitive.Acupuncture is an effective way for the treatment of dementia,most clinical assessments for the improvement of the patients based on a variety of neuropsychological scales,there is no neuroimaging studies yet to be used as the objective standards for dementia.Functional magnetic resonance technology is an important type of medical data visualization technology,which can function in the human brain and objective information visualized display.Therefore,the functional magnetic resonance technology is an advanced method to study acupuncture intervention for mild cognitive impairment and efficacy of the mechanism of objective standards.In the study of leukoaraiosis in mild cognitive impairment (LAMCI),functional magnetic resonance is applied with the reference of clinical practice,long-term acupuncture intervention,through the neuropsychological scale evaluation of mild leukoaraiosis clinical changes has been done,on the basis of this study,the neurotransmitter changes of the patients of leukoaraiosis mild cognitive impairment can be observed before and after acupuncture intervention with functional magnetic resonance brain,and the mechanism of acupuncture intervention can be unveiled.Two parts including Literature Summary and Clinical Trials.Literature SummaryTo summarize ancient Chinese medicine literature on the vascular dementia, Focus on the treatment and theoretical study.The application of functional magnetic resonance on mild cognitive impairment and the treatment of acupuncture were analyzed in this part,also pointed out the current existing problems,and the directions of the development in the future.Clinical TrialsAcupuncture for mild cognitive impairment leukoaraiosis impact of functional magnetic resonance.To observe the neurotransmitter changes before and after acupuncture intervention in mild cognitive impairment with the functional magnetic resonance brain in the purpose of and the situation.LAMCI 23 cases,and normal subjects(control group) 13 cases were observed. LAMCI was further divided into test acupuncture group and the natural process of group,acupuncture treatment for three months,Dynamic observed the natural process of group for 3 months,neuropsychological evaluation and magnetic resonance spectroscopy check were executed in the beginning day and the end day. Neuropsychological assessment contains:MMSE and MoCA,MRI spectroscopy NAA/Cr,Cho/Cr,MI/Cr.Results:1.there was no significant difference between the LAMCI group and normal group for the NAA / Cr,Cho / Cr,MI / Cr test results in the post cingulate gyrus;2.Taking the age as the correction factors,eight cases of LAMCI group were re-tested with neurotransmitter compared with normal subjects group,NAA / Cr, Cho / Cr was no significant differences,LAMCI trial group was MI / Cr significantly increased,compared to the the other two groups,there were significantly differences;3.5 cases of LAMCI trial of acupuncture intervention were treated with acupuncture for 3 months,neuropsychological scores before the acupuncture were abnormal,but the neuropsychological scores became normal after acupuncture,in term of NAA / Cr,Cho / Cr,MI / Cr,there was no significant difference between Acupuncture group and the control group;4.The brain areas including the temporal lobe of the temporal gyrus(BA22), temporal in the back(BA21),temporal polar region(BA38);prefrontal cortex,the somatosensory(BA1) and pre-motor cortex(BA6) were activated before Acupuncture intervention,when the music hearing task started.Activated brain regions after acupuncture including the temporal gyrus(BA22);the orbital frontal leaf(BA11),the polar regions(BA10),cover of frontal lobe.There was significantly less areas activated than the promoter region of the former acupuncture group.Conclusions:1.Leukoaraiosis mild cognitive impairment related to the frontal and temporal lobes,the activated auditory cortex in the temporal lobe to start increasing,the prefrontal cortex is not activated when the hearing stimulation were started.Functional magnetic resonance can be a tool for the diagnosis of mild cognitive impairment,as well as the efficacy of acupuncture mechanism research based on visualization2.The neurotransmitter changes in the cingulated gyrus,with the MI / Cr ratio increased,which may be an objective indicator for the diagnosis of this disease when Leukoaraiosis mild cognitive impairment occurred3.Acupuncture can be used as an effective means of intervention for the mild cognitive impairment leukoaraiosis,which can reduce activated brain regions in order to raise the efficiency of the task when stimulation was processed,but a longer period of intervention was needed to explore whether there is any neurotransmitters changes in brain.更多还原