基于MR,ASL探讨针刺心包经、心经穴对脑梗死恢复期患者ROI-CBF的影响

大学第一附属医院收治的满足纳入标准的脑梗死恢复期患者27例作为研究对象，按照随机数字表方法随机分为心包经组（n=14）和心经组（n=13），选取脑梗死恢复期患者梗死灶、梗死灶旁及对侧镜像区为感兴趣区（Region of Interest，ROI），以ROI-CBF为观察指标，分别对受试者针刺前、针刺即刻及出针后3个时间段进行ASL扫描，运用磁共振成像自带的软件对图像进行后续处理，测量出ROI-CBF，从而分析2组受试者不同时间段下各ROI-CBF的差异。结果：1）心包经组能够提高各组ROI-CBF，差异有统计学意义（P<0.05），以针刺即刻与针刺后续效应明显;在针刺即刻和出针后时间段，心包经组对各ROI-CBF效应存在差异，CBF效应依次为：镜像区效应>梗死灶旁区效应>梗死灶区效应，差异有统计学意义（P<0.05）。2）心经组能够提高各组ROI-CBF，差异有统计学意义（P<0.05），以针刺后续效应为主;在针刺即刻和出针后时间段，心经组对镜像区与梗死灶旁区CBF效应无明显区别，但两者均与梗死灶区CBF效应存在差异，CBF效应依次为：镜像区效应≈梗死灶旁区效应>梗死灶区效应，差异有统计学意义（P<0.05）。3）2组对各组ROI-CBF效应增高不一致，心包经组改善CBF效应优于心经组，差异有统计学意义（P<0.05）。结论：1）针刺心包经/心经穴均能有效提高梗死灶区、梗死灶旁区、镜像区CBF;2）在同一时间段，针刺两经对梗死灶区、梗死灶旁区、镜像区CBF存在差异，心包经穴效应优于心经穴，提示临床上可以择优选取心包经穴治疗缺血性脑卒中。

关键词 针刺;心包经（穴）;心经（穴）;脑血流量（CBF）;磁共振动脉自旋标记;脑梗死恢复期

Based on MR ASL to Investigate the Effects on ROI-CBF of Patients with Cerebral Infarction during Recovery Period by Acupuncturing Pericardium Meridian and Heart Meridian Acupoints

Zhang Wei，Liao Ling，Li Ping，Shi Wenying，Yang Yu，Pan Jiang，Zhou Youjun，Tang Jian，Huang Lijuan，Lou Bidan，Li Jinxiang

（The First Affiliated Hospital of Hunan University of Chinese Medicine，Changsha 410007，China）

Abstract Objective：To observe the effects of acupuncturing acupoints of the Pericardium Meridian of Hand-Jueyin and the Heart Meridian of Hand-Shaoyin on cerebral blood flow（CBF）in various regions of interest（ROI）of patients with cerebral infarction during convalescence period，providing some imaging evidence for the treatment of ischemic cerebrovascular diseases. Methods：A total of 27 subjects who met the inclusion criteria in The First Affiliated Hospital of Hunan University of Chinese Medicine from October 2015 to August 2017 were randomly divided into Pericardium Meridian group with 14 cases and Heart Meridian group with 13 cases. The infarction focal area of the cerebral infarction，the peripheral infarction focal area and the opposite mirror area were used as the ROI during the convalescence of cerebral infarction. Taking ROI-CBF as the observation indicator，ASL scanning was used before acupuncture，immediately after acupuncture and after needle extraction to obtain the ROI-CBF，using the software that comes with NMR to post-process images and analyze the differences of ROI-CBF in each period. Results：1）Each ROI-CBF in the Pericardial Meridian group can be improved（P<0.05）. The effects of immediately after acupuncture and after needle extraction was obvious; at the time of immediately after acupuncture and after needle extraction，there was a difference among each ROI-CBF effect in the Pericardial Meridian group. The CBF effect was in turn by the opposite mirror area effect>the peripheral infarction focal area effect>infarction focal area effect（P<0.05）. 2）Each ROI-CBF in the Heart Meridian Group was improved（P<0.05），mainly with the follow-up effects of acupuncture; At the time of immediately after acupuncture and after needle extraction，there was no significant CBF effects difference between the opposite mirror area and the peripheral infarction focal area，but the difference in the infarction focal area was found. The CBF effect was in turn by the opposite mirror area effect ≈ the peripheral focal area effect>the infarction focal area effect（P<0.05）. 3）The increase of each ROI-CBF effect in the 2 groups was inconsistent，and the improvement of CBF effect in the Pericardial Meridian group was better than that in the Heart Meridian group（P<0.05）. Conclusion：1）Acupuncture at the Peripheral Meridian or Heart Meridian acupoints can effectively improve CBF in the infarction focal area，the peripheral infarction focal area and the opposite mirror area. 2）At the same period of the acupuncture at the two meridians，there are differences among each CBF of the infarction focal area，the peripheral infarction focal area and the opposite mirror area. The Pericardial Meridian effect is better than that of the Heart Meridian. It suggests a clinical preference for the Pericardium Meridian to treat ischemic stroke.

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