目的利用静息态功能磁共振成像(resting-state functional magnetic resonance imaging,rs-fMRI)技术观察缺血性脑卒中患者重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗前后两侧初级运动皮质(M1)功能连接的特点,进而为康复治疗找寻脑功能重组的证据。方法对5例发病1周内单侧发病的缺血性脑卒中患者在重复经颅磁刺激(rTMS)治疗前后各进行1次静息态功能磁共振(rs-fMRI)检查和临床功能评分。同时选取正常志愿者25例作为正常对照组,只进行1次rs-fMRI检查。通过分析rs-fMRI两侧M1区功能连接值的改变,比较患者治疗前、后组与正常对照组之间功能连接变化的差异。结果患者治疗前组两侧M1区功能连接值降低(z=0.30±0.24),低于正常对照组(z=0.70±0.21),治疗后连接值升高(z=0.58±0.28),治疗前组与正常组之间的差异及治疗前后组的差异具有统计学意义(P<0.05),但治疗后组与正常对照组两侧M1区功能连接值之间无统计学意义(P>0.05)。与患者治疗前组相比,治疗后组患侧肢体美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)评分显著降低(P<0.05)、患侧上下肢体Fugl-Meyer评分(Fugl-Meyer assessment,FMA)显著升高(P<0.05)、日常生活指数(barthel index,BI)显著升高(P<0.05),提示患者治疗后功能改善。结论通过静息态功能磁共振检查可以监测高频rTMS治疗前后两侧M1区功能连接的变化,客观地证实rTMS治疗是安全有效的康复治疗手段,推测康复治疗的黄金时间窗可能位于1个月内。
Objective To investigate the immunologic mechanism of acupuncture at Bǎihuì（百 会 GV 20） and Zúsānlǐ（足三里 ST 36） for treatment of depression. Methods Eighty-four cases of depression patients were randomly divided into an electroacupuncture observation group（group A）, an electroacupuncture control group（group B） and a medication control group（group C）, 28 cases in each group. Bǎihuì（百会 GV 20） and Zúsānlǐ（足三里 ST 36） were used in the group A; Tàichōng （太冲 LR 3）, Sānyīnjiāo （三阴交 SP 6）, Nèiguān （内关 PC 6） and Shénmén （神门 HT 7） were used in the group B; and the group C was treated with oral administration of Fluoxetine. The scores of Hamilton Depression Scale （HAMD） were tested and the level of serum interleukin 1（IL-1β）, interleukin 6 （IL-6）, and tumor necrosis factor α （TNF-α） were measured by Enzyme Linked Immunosorbent Assay （ELISA）before and after treatment. Results Their scores of HAMD were obviously decreased after treatment in three groups（all P0.01）. In the group A, 2 cases were cured, 19 cases were markedly effective, 5 cases were effective and 2 cases were failed. In the group B, 16 cases were markedly effective, 12 cases were effective. While in the group C, 1 case was cured, 17 cases were markedly effective, 7 cases were effective and 3 cases were failed. The grade distribution of clinical effect showed that the effect of group A was better （P0.05）. The levels of serum IL-1β and IL-6 in the three groups were obviously decreased after treatment （P0.05, P0.01）, while there was no significant difference between the level of serum TNF-α before and after treatment. Conclusion The effect of electroacupuncture observation group is superior to those of electroacupuncture control group and medication control group.All of these three methods can clear the inflammatory cytokines such as IL-1β and IL-6 away and improve the symptoms of depression.
