【作者】 沈巍；

【导师】 赖新生；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 目的：通过实验与临本课题拟运用正电子发射型计算机断层显像(PET),以不同脑区的血流、代谢、功能活动为指标,研究中风病人经穴和非穴的脑功能成像特点,从不同脑区功能变化来分析中风患者经穴的相对特异性。旨在解决中风患者针刺外关穴经穴特异性脑功能界定、探索经穴的脑功能成像特点和规律。从脑功能方面界定经穴和非穴,并进一步进行经穴特异性一脑相关的信息的汇集,以明确经穴得气的脑功能反应的实质。方法：利用正电子发射断层摄影技术(positron emission tomography, PET)10例缺血性脑病患者,男性7例,女性3例,年龄45、65岁,随机分为2组,针刺外关组5例,针刺非穴组5例,符合《中风病诊断与疗效评定标准》中风病和《各类脑血管疾病诊断要点》缺血性脑病诊断标准,均为右利手,试验前一月内及试验过程中,其他治疗方法(中、西药物)相对固定者,试验前一月内未接受过针刺治疗者,无正电子发射断层扫描禁忌症者。选穴：经穴选用外关穴,阳池穴与肘尖的连线上,腕背横纹上2寸,尺骨与桡骨之间；非穴,与外关相平,手少阳三焦经与少太阳小肠经连线的中点。进针部位以碘酒、酒精常规消毒,使用英国DONGBANG AcuPrime针灸器械有限公司的专用针灸套针中的真针进针(严格按照说明书进行操作),食指用均衡的力度轻敲针柄使针透过皮肤,然后再垂直进针15±2mm,医生感觉手下得气后采用平补平泻手法,均匀捻转,捻转幅度±180°,频率60次／min,每捻转3min间歇5min,共24min。在针刺开始1.5min后,技师进行静脉弹丸式注射18F-FDG (110μCi/Kg微居里／千克体重),20ml生理盐水冲管。注射显影剂45分钟后,开始PET扫描观察不同处理状态下的PET脑功能成像特点。通过PET分析,用统计参数图(statistical parametri cmapping, SPM)方法进行分析,采用Nomrailez进行功能图像和解剖结构图像的标化,用Smooth进行功能图像的空间平滑。建模,用Estimate估计模型对数据进行双样本t检验,以P<0.001为统计学差异的阈值获得脑功能定位图。通过功能定位,获得脑区代谢图的二维和三维显示图口,根据针刺对中风引起的脑内葡萄糖代谢变化区域,从不同脑区的葡萄糖代谢、功能活动等不同角度分析中风病人经穴的相对特异性,从而区分得气和非得气,经穴与非经穴。结果：1.针刺引起多个脑区的葡萄糖代谢增高,大脑、小脑、丘脑均有激活,左侧激活区有额内侧回(BA6)、中央前回、额上回、前运动区、辅助运动区(BA9)、左侧岛叶(BA13),左侧舌回、楔叶(BA18),左侧枕叶外侧沟(BA19),前扣带回(BA24),扣带回皮层(BA32),尾状核,左侧边缘叶；右侧激活区有顶叶中央后回(BA2)、额叶中央前回(BA4)、海马旁回(BA13)、颞上回(BA22)、颞上回(BA38)、右侧顶下小叶(BA40)、右侧后叶、右侧小脑扁桃体、右侧尾状核、右侧脑干、乳头体丘脑束的葡萄糖代谢增强,增强区域大多与躯体运动、感觉,语言,情志有关。2.葡萄糖降低区域主要见于以下脑区：右侧额上回、额内侧回(BA8)、颞中回、额前回(BA6)、左侧额上回(BA9)、枕叶(BA19)、枕中回、楔叶(BA18)、颞上回(BA22)、小脑山坡、楔前叶、顶下小叶(BA40)、中央后回(BA2),与语言、听力和空间定位等功能区相关。结论：根据脑梗塞后病人PET脑功能成像,能够分析外关穴和非穴的针刺激活的不同效应。针刺外关穴与针刺非穴点比较,外关穴,通过提高与运动相关脑区额后叶运动皮质中枢、背外侧前额叶运动皮质中枢、尾状核、运动前皮质、中央前回和腹外侧核初级运动皮层的葡萄糖代谢,改善缺血性脑梗塞患者的运动功能；调节脑梗塞后与情志相关的脑区岛叶、颞叶前极、前扣带回、眶额皮质葡萄糖代谢；调节空间定位和平衡的小脑、顶下小叶、BA7、BA39、BA40葡萄糖代谢；调节语言听力和语义表达相关脑区BA22、BA40,其激活脑区与脑梗塞后损伤区域有特异性联系,能调节中风后运动、感觉障碍、失语、情志障碍有关的脑区的脑功能活动。同时针刺外关穴与非穴差异的功能脑区与外关穴传统的主治效应高度相关：①外关穴治疗上肢病患(瘫痪、疼痛、麻木、肿胀等等),与躯体运动的脑区(BA4、6、8),躯体感觉相关的脑区(脑干、初级体感皮层BA2,空间定位和平衡BA7、39、40、小脑)的激活有关；②五官病患,主要包括目、耳疾患,与视觉、听觉相关的脑区(BA18、BA19、BA22)有关；③精神情志疾病,与精神情志活动相关的脑区(BA13、24、32、28和海马)的激活相关,说明外关穴具有经穴的特异性,与经络的功效相关,并且与非穴在治疗效应上有明显的区别。更多还原

【Abstract】 Objective:To study Specific Feature of acupoints and non-acupoints with Positron Emission Tomography. We study the cerebral function imaging Feature of acupoints and non-acupoints by analyzing blood stream, metabolism, function index of different encephalic region in this series of Positron Emission Tomography (PET) experiments, in order to explore stroke suffers’Specific Feature of waiguan of metergasis of different encephalic region.Method:Acupuncture stimulation was induced by manipulating acupuncture needle at the acupoint SJ5(waiguan, right arm) of 5 suffers and non-acupoints of 5 suffers in stroke suffers. PET data of scanning the whole brain were established by statistical parametri cmapping (SPM), the picture of functional localization were analyzed by group double sample t-test analysis. We can discriminate specific feature of acupoints and non-acupoints by analyzing blood stream, metabolism, function index of different encephalic region in this series of Positron Emission Tomography (PET) experiments.Results:Stimulation of acupoint SJ5 by right arm acupuncture activated left Superior Frontal Gyrus (BA6)、Medial Frontal Gyrus (L)、Superior Frontal Gyrus、Precentral Gyrus、Superior Frontal Gyrus、Forward rolandic region、supplementary motor area(8)、BA13,BA18, BA19,BA24, BA32 (L), caudate nucleus, limbic lobe(L). In the BA2(R)、BA4(R)、BA9(R)、BA13(R)、BA22(R)、BA38(R)、BA40(R)、BA6(R)、Cerebellar Tonsil (R)、Caudate (R)、Right Thalamus, Mammillary Body, that displayed high glucose metabolism, they were concerned with motion、sensation、algesia、ambition. In the Superior Frontal Gyrus (R), Medial Frontal Gyrus (R), Middle Frontal Cyrus (R), Superior Frontal Gyrus(L), Occipital Lobe(L), Declive Parietal Lobe, Frecuneus、Inferior Parietal Lobule、Middle Temporal Gyrus、superior temporal gyrus、Postcentral Gyrus, that displayed degrade glucose metabolism, they were concerned with language、hearing and spatial orientation。Conclusion:By cerebral funtion imaging of patients with stroke, the therapy effects are distinguished between acupointing SJ5 points and non-point. To acupointing SJ5 of patients with ischemic cerebral infarction,there were four effects on glucose metabolism of cerebral funtion. Firstly, glucose metabolism of corresponding encephalic region is promoted and exercise capacity is enhanced, which are related with body movement.Secondly, glucose metabolism of corresponding encephalic region is regulated, which are related with sensation. Thirdly, glucose metabolism of BA22、BA40 is controled, which are related with speech audiometer and semantic representations. Lastly, there were a specificity of association between acupointing SJ5 with activating encephalic region and cerbral infarction damage zone, and the activity of encephalic region is regulated, which is related with movement with stroke、sensory disability、affective disorder.After acupuncture needle at the acupoint SJ5(waiguan, right arm) and non-point, such conclusions are found:upper limb disease including paralysis, pain, numbness, swell, etc, are correlated with the stimulations of sensorimotor encephalic region (BA、6、8)、somatic sensation (truncus encephalicus、primary somatosensory cortex BA2, spatial orientation and balance BA7、39、40、cerebellum); five senses disease including eyes and ears problems are correlated with the stimulations of vision audition encephalic region (BA18、BA19、BA22); spirit and sensation disease are correlated with the stimulations of corresponding encephalic region (BA、24、32、28 and hippocampus). The effect of acupoint SJ5 has specific meridian feature was significant different with non-acupoints。更多还原