【作者】 叶譞斐；

【导师】 雒晓东；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 背景帕金森病(Parkinson Disease, PD)是一种好发于中老年的中枢神经系统变性的终身疾病,目前西医没有一种药物和外科手术能明显阻止疾病的发展。大量临床及实验已经证明,中医针灸可较好地改善运动症状,并控制病情发展,但目前针灸疗效的客观性依据不足。功能磁共振作为无创、方便易行的一种观察手段在PD的诊断与疗效观察上有一定的优势。目的通过观察方氏头针对帕金森病患者fMRI的影响,初步探索针灸治疗帕金森病的机制,为帕金森病的针灸治疗提供理论依据。方法对2010-2011年间广东省中医院神经内科帕金森病门诊符合纳入标准的10例早中期帕金森病患者,予方氏头针针刺冠矢点及双侧呼循,并于治疗前后进行UPDRS评分、运动试验,以及脑功能磁共振扫描,记录治疗前与治疗后量表、计数及计时结果及脑功能磁共振数据,用t检验(符合正态分布的计量资料)和秩和检验方法对其即时疗效结果进行统计学分析,用组间配对T检验分析其对FMRI的影响。结果针刺治疗前后,患者双手运动均稍有改善,但差异无统计学意义(P>0.05)。针刺治疗前后,患者转弯时间、10米行走时间及起身时间无明显改善,差异无统计学意义(P>0.05)。针刺治疗前后,患者UPDRS第三部分评分稍有下降,但差异无统计学意义(P>0.05)。与针刺治疗前相比(P<0.05),针刺治疗后病人双侧海马、左侧杏仁核、左侧岛叶、双侧颞上回、左侧颞中回、左侧额下回、双侧壳核、左侧尾状核、双侧苍白球、胼胝体等脑区局部一致性增高,提示方氏头针治疗前后,部分脑区存在明显差异。结论方氏头针针刺治疗帕金森病患者,针刺后部分运动能力稍有改善,但即时疗效不显著。方氏头针针刺治疗帕金森病患者前后,fMRI显示针刺治疗后病人双侧海马、左侧杏仁核、左侧岛叶、双侧颞上回、左侧颞中回、左侧额下回、双侧壳核、左侧尾状核、双侧苍白球外侧部、胼胝体等脑区局部一致性增高。说明了方氏头针治疗前后部分病理脑区存在明显差异。经方氏头针针刺后脑区一致性变化可能与脑区功能变化存在相关性。方氏头针针刺冠矢点及双侧呼循可能通过改善纹状体的功能而达到改善PD症状的作用及通过改善边缘系统改善患者情感功能。更多还原

【Abstract】 ObjectiveParkinson’s Disease(PD), also named as parelysis agitans, is a kind of neurodegenerative disease, which usually occurs in middle-aged or senile patients. At present, there is no medicine or surgical which is effective enough to stop the development of this disease.A large number of clinical research and experimental studies had shown that acupuncture can improve symptoms of tremor and control the progression of this disease. But the objective evidence is not sufficient. Functional magnetic resonance imaging as an observation which non-invasive and convenient, has the advantage in the diagnosis of PD and the observation of the curative effect. Therefore, by observing the impact of Fang-acupuncture of Parkinson’ s patients, we elementary discuss the immediate result and mechanism of acupuncture to PD.MethodsChosing 10 cases of Parkinson’s disease. Evaluate their UPDRS score, motion experiment and fMRI before and after treatment. Recording its scale and brain functional magnetic resonance data, using paired T test to analysis the impact of treatment on FMRI and its immediate effect. Use T test to analysis the difference between two groups.ResultsTiming motion test of both hands of post-treatment have increased than that of prior-treatment. The difference had no statistical difference(p>0.05).Timing motion test of turning round、standing up and 10 metres walking of post-treatment haven’t decreased than that of prior-treatment.UPDRS scores of part III of post-treatment has decreased than that of prior-treatment. The difference had no statistical difference(p>0.05).Increased ReHo were found in both Parahippocampa Gyrus、Amygdala_L、Insula_L、both Superior Temporal Gyrus、Temporal_Mid_L、both Putamens、Caudate_L、both Lateral Globus Pallidus、Corpus Callosum etc. (p<0.05).ConclusionThe Fang-acupuncture can improve movement in PD’patients immediately to some extend. But the difference had no statistical difference(p>0.05).The Fang-acupuncture may improve movement and sentiment by activating the related brain function.更多还原