针刺舌根部穴对假性延髓麻痹吞咽障碍患者脑区fMRI的影响
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摘要
目的:基于功能性磁共振成像(functional magnetic resonance imaging, f MRI)技术,观察针刺舌根部穴对假性延髓麻痹吞咽障碍患者执行吞咽任务时相关脑功能区的激活情况,从而探索针刺舌根部穴治疗吞咽障碍可能的中枢机制。方法:收集10例假性延髓麻痹吞咽障碍患者,均予针刺舌根部穴进行治疗,并于针刺前、针刺后5 min内执行吞咽任务时进行f MRI脑部扫描,采集相应的f MRI脑功能成像数据,并利用MRIcro及RadiAntDICOM Viewer软件、SPM 8软件对其进行处理、分析,获得针刺前后患者执行吞咽动作时脑功能区激活的情况。结果:针刺前受试者执行吞咽动作时,脑激活区分布在左侧旁中央小叶、右侧后扣带回、双侧额上回、右侧额中回、左侧额下回、右侧颞中回、右侧颞叶、右侧楔前叶、右侧豆状核、右侧脑岛;针刺后受试者执行吞咽动作时,脑激活区分布在右侧中央前回、双侧额中回、双侧额上回、左侧扣带回、左侧顶下小叶、右侧楔前叶、左侧颞上回、右侧枕叶、右侧脑桥、双侧海马旁回、双侧小脑山坡;受试者在针刺前后执行吞咽动作时的差异脑激活区(针刺后-针刺前脑功能激活区)分布在左侧中央后回、左侧额上回、左侧额下回、左侧旁中央小叶、左侧后扣带回、右侧脑桥、右侧内侧苍白球、右侧岛叶、右侧顶上小叶。结论:针刺舌根部穴可激活假性延髓麻痹吞咽障碍患者中央后回、额上回、颞上回、楔前叶、扣带回、岛叶、顶上小叶、脑桥、小脑等多个脑功能区,以上脑功能区的激活可能协同参与吞咽动作的完成,进而治疗卒中后吞咽障碍。
Objective: To observe the activation and activity of brain region, when pseudobulbar palsy patients with dysphagia problem are executing swallowing tasks, by use of the Functional magnetic resonance imaging FMRI technique, in order to explore the possible central mechanism of dysphagia treatment by needling the root of tongue. Methods: 10 Pseudobulbar Palsy patients with dysphagia problem who met selection criteria were included in our study. All patients were treated by needling the root of tongue, and their brains were scanned when executing swallowing tasks before needling and 5 minutes after needling. f MRI data were collected and analyzed with special software, so as to locate the difference in brain activation and activity regions when patients executing swallowing tasks. Results: Before needling, when patients executing swallowing tasks, brain activation and activities are concentrated at following regions: left Paracentral Lobule, right Posterior Cingulate, right Middle Frontal Gyrus, bilateral Superior Frontal Gyrus, right Middle Temporal Gyrus,left Inferior Frontal Gyrus, right Precuneus, right Lentiform Nucleus, right Insula; After needling, when patients executing swallowing tasks, brain activation and activities are concentrated at following regions: right PrecentralGyrus, bilateral Middle Frontal Gyrus, bilateral Superior Frontal Gyrus, left Cingulate Gyrus, left Inferior Parietal Lobule, right Precuneus, left Superior Temporal Gyrus, right Occipital Lobe, right Pons, bilateral ParahippocampaGyrus, bilateral Declive.The difference in brain activation and activity before and after needling are located at the following regions(after needling minus before needling): left PostcentralGyrus, left Superior Frontal Gyrus, left Inferior Frontal Gyrus, left Paracentral Lobule, left Posterior Cingulate, right Pons, right Medial Globus Pallidus, right Insula, right Superior Parietal Lobule. Conclusion: Needling the root of tongue can activate the following brain regions of pseudobulbar palsy patients with dysphagia: PostcentralGyrus, Superior Frontal Gyrus, Superior Temporal Gyrus, Precuneus, Cingulate Gyrus, Insular lobe, Superior Parietal Lobule, Pons, Cerebelum, etc. Hence, more brain regions can work collaborately to complete the swallowing tasks,and thereby curing swallowing disorder after stroke.
Objective: To observe the activation and activity of brain region, when pseudobulbar palsy patients with dysphagia problem are executing swallowing tasks, by use of the Functional magnetic resonance imaging FMRI technique, in order to explore the possible central mechanism of dysphagia treatment by needling the root of tongue. Methods: 10 Pseudobulbar Palsy patients with dysphagia problem who met selection criteria were included in our study. All patients were treated by needling the root of tongue, and their brains were scanned when executing swallowing tasks before needling and 5 minutes after needling. f MRI data were collected and analyzed with special software, so as to locate the difference in brain activation and activity regions when patients executing swallowing tasks. Results: Before needling, when patients executing swallowing tasks, brain activation and activities are concentrated at following regions: left Paracentral Lobule, right Posterior Cingulate, right Middle Frontal Gyrus, bilateral Superior Frontal Gyrus, right Middle Temporal Gyrus,left Inferior Frontal Gyrus, right Precuneus, right Lentiform Nucleus, right Insula; After needling, when patients executing swallowing tasks, brain activation and activities are concentrated at following regions: right PrecentralGyrus, bilateral Middle Frontal Gyrus, bilateral Superior Frontal Gyrus, left Cingulate Gyrus, left Inferior Parietal Lobule, right Precuneus, left Superior Temporal Gyrus, right Occipital Lobe, right Pons, bilateral ParahippocampaGyrus, bilateral Declive.The difference in brain activation and activity before and after needling are located at the following regions(after needling minus before needling): left PostcentralGyrus, left Superior Frontal Gyrus, left Inferior Frontal Gyrus, left Paracentral Lobule, left Posterior Cingulate, right Pons, right Medial Globus Pallidus, right Insula, right Superior Parietal Lobule. Conclusion: Needling the root of tongue can activate the following brain regions of pseudobulbar palsy patients with dysphagia: PostcentralGyrus, Superior Frontal Gyrus, Superior Temporal Gyrus, Precuneus, Cingulate Gyrus, Insular lobe, Superior Parietal Lobule, Pons, Cerebelum, etc. Hence, more brain regions can work collaborately to complete the swallowing tasks,and thereby curing swallowing disorder after stroke.
引文
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[2]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:99-104.
[3]史玉泉.神经病学新理论与新技术[M].上海:上海科技教育出版社,1998:235-237.
[4]汪洁.脑卒中后吞咽困难的康复治疗[J].中国临床康复,2002,6(11):1553-1555.
[5]窦祖林.吞咽障碍评估与治疗[M].北京:人民卫生出版社,2017:2-4.
[6]李宝栋,白晶,刘涛,等.“皮层-咽部-舌根”序贯针刺法治疗脑出血后吞咽障碍临床分析与机理探讨[J].针灸临床杂志,2015,31(2):46-48.
[7]曾燕,梁勋厂.从脑功能成像看针刺作用的中枢机制[J].中国针灸,2004,24(2):143-146.
[8]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):474-478.
[9]胡颖,王丽嘉,聂生东.静息态功能磁共振成像的脑功能分区综述[J].中国图象图形学报,2017,22(10):1325-1334.
[10]石文英,潘江,陈武善,等.静息态脑功能磁共振成像及其在针刺研究中的优势[J].医学综述,2011,17(4):603-606.
[11]方继良,王小玲.脑功能磁共振成像技术简介及针刺研究应用(一)[J].中国中西医结合影像学杂志,2012,10(1):94-96.
[12]吴军发,胡永善,吴毅,等.健康成人吞咽口腔期的功能磁共振成象研究等研究[J].中国康复医学杂志,2013,28(9):789-793.
[13]贾宝辉,刘志顺,聂彬彬,等.不同穴位电针对老年人吞咽功能影响的脑功能磁共振研究[J].中医杂志,2012,53(14):1202-1206.