This study aimed to explore the changes in functional connections between cerebral hemispheres and local brain regions functional activities in patients with acute ischemic stroke (AIS) treated with International Standard Scalp Acupuncture (ISSA). Thirty patients with middle cerebral artery AIS in the dominant hemisphere were selected and randomly divided into two groups such as the control group and the scalp acupuncture group, with 15 patients in each group. Patients in the control group were treated with conventional Western medicine, while patients in the scalp acupuncture group received ISSA (acupuncture at the parietal midline [MS5], acupuncture at the left anterior parietotemporal oblique line [MS6] and acupuncture at the left posterior parietotemporal oblique line [MS7]) for one course of treatment. All patients were evaluated for treatment efficacy and received whole brain resting state functional magnetic resonance imaging (Rs-fMRI) scan before and after treatment. The observational indicators included: (a) the National Institutes of Health Stroke Scale (NIHSS) scores and the simplified Fugl-Meyer Assessment (SFMA) scores; (b) analyses of the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and voxel-mirrored homotopic connectivity (VMHC). The results showed a significant difference in the NIHSS scores before and after treatment in the scalp acupuncture group compared with the control group (p < .05), indicating that patients improved better after scalp acupuncture treatment. Compared with the control group, the VMHC, ALFF and ReHo values in the scalp acupuncture group increased after treatment. The VMHC values increased in the brain regions dominated by bilateral BA6 and BA8; the ALFF values increased in the left BA39 and the adjacent superior temporal gyrus and middle temporal gyrus; and the ReHo values increased in the brain regions extending from left middle temporal gyrus (including BA21) to BA37, and the brain regions extending from the left BA40 and angular gyrus to BA7. The present study indicated that scalp acupuncture can specifically strengthen the functional activities of the brain regions related to sensory integration, language processing and motor coordination in the middle aged and elderly patients with AIS of the dominant cerebral hemisphere, and can strengthen bilateral frontal lobe motor control. This study may provide a scientific basis for the clinical application of ISSA treatment in patients with AIS, and may also provide a preliminary research basis for further animal experiments.
本研究为探讨急性期缺血性脑卒中功能障碍患者国际标准头针疗程干预后脑区的脑半球间功能连接和局部功能活动性变化，纳入30名优势半球大脑中动脉供血区急性缺血性脑卒中(Acute ischemic stroke，AIS)患者，随机分为头针组和对照组各15例。对照组采用西医药物常规治疗，头针组在对照组基础上，结合国际标准头针(顶中线、左侧顶颞前斜线和左侧顶颞后斜线)，分别治疗1个疗程。疗程治疗前后，2组患者均进行疗效评定，并接受Rs-fMRI扫描。观察指标包括(1)NIHSS评分及SFMA评分；(2)低频震荡振幅(ALFF)、局部一致性(ReHo)、体素-镜像同伦连接(VMHC)。结果显示头针组治疗前后NIHSS评分差值比对照组有显著改善(P<0.05)。与对照组相比，头针组治疗后的VMHC、ALFF、ReHo值均有增强:以双侧BA6、BA8为主的脑区VMHC值增强；以左侧BA39为主，向邻近的颞上回和颞中回延伸的脑区ALFF值增强；以左侧颞中回(含BA21)为主，向BA37延伸的脑区，及以左侧BA40、角回为主，向BA7延伸的脑区ReHo值增强。本研究初步发现，国际标准头针组穴针刺能特异性加强优势大脑半球中动脉急性梗死的中老年患者感觉整合、语言加工、运动协调相关脑区的局域性功能活动，同时强化双侧额叶运动调控相关脑区的连通性，为国际标准头针治疗急性期缺血性脑卒中的临床应用提供科学依据，也为进一步地动物实验提供前期研究基础。.
Keywords: acute ischemic stroke; amplitude of low-frequency fluctuation (ALFF); international standard scalp acupuncture; regional homogeneity (ReHo); resting state functional magnetic resonance imaging (Rs-fMRI); voxel-mirrored homotopic connectivity (VMHC); 低频震荡振幅; 体素-镜像同伦连接; 国际标准头针; 局部一致性; 急性缺血性脑卒中; 静息态脑功能成像技术.
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