针刺“益智调神”穴方对阿尔茨海默病患者海马与全脑功能连接的影响

魏玉婷; 苏明莉; 朱田田; 任德琳; 严兴科

doi:10.13703/j.0255-2930.20230405-0002

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针刺“益智调神”穴方对阿尔茨海默病患者海马与全脑功能连接的影响

针灸影像临床与基础 | 更新时间：2024-06-03

- 针刺“益智调神”穴方对阿尔茨海默病患者海马与全脑功能连接的影响
- Effect of acupuncture at the acupoints for Yizhi Tiaoshen on the functional connectivity between the hippocampus and the brain in the patients with Alzheimer's disease
- 中国针灸 2023年43卷第12期页码：1351-1357
- 作者机构：
  
  甘肃中医药大学针灸推拿学院，兰州730000
- 作者简介：
  
  魏玉婷，甘肃中医药大学博士研究生。E-mail：1416627446@qq.com
  严兴科，教授。E-mail：yanxingke@126.com
- 基金信息：
- DOI：10.13703/j.0255-2930.20230405-0002
  中图分类号： R 246.6
- 收稿：2023-04-05，
  
  网络首发：2023-10-17，
  
  纸质出版：2023-12-12
- 稿件说明：
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魏玉婷,苏明莉,朱田田等.针刺“益智调神”穴方对阿尔茨海默病患者海马与全脑功能连接的影响[J].中国针灸,2023,43(12):1351-1357.

WEI Yu-ting,SU Ming-li,ZHU Tian-tian,et al.Effect of acupuncture at the acupoints for Yizhi Tiaoshen on the functional connectivity between the hippocampus and the brain in the patients with Alzheimer's disease[J].Chinese Acupuncture & Moxibustion,2023,43(12):1351-1357.
魏玉婷,苏明莉,朱田田等.针刺“益智调神”穴方对阿尔茨海默病患者海马与全脑功能连接的影响[J].中国针灸,2023,43(12):1351-1357. DOI： 10.13703/j.0255-2930.20230405-0002.

WEI Yu-ting,SU Ming-li,ZHU Tian-tian,et al.Effect of acupuncture at the acupoints for Yizhi Tiaoshen on the functional connectivity between the hippocampus and the brain in the patients with Alzheimer's disease[J].Chinese Acupuncture & Moxibustion,2023,43(12):1351-1357. DOI： 10.13703/j.0255-2930.20230405-0002.

摘要

目的

采用静息态功能磁共振成像技术（rs-fMRI）分析针刺“益智调神”穴方对阿尔茨海默病（AD）患者海马与全脑功能连接的影响，揭示针刺治疗AD的脑功能机制。

方法

将60例轻中度AD患者随机分为针药组（30例，脱落3例）和西药组（30例，脱落2例）。西药组口服盐酸多奈哌齐片治疗，每次2.5~5 mg，每日1次，治疗4周后每次加量至10 mg；针药组在西药组基础上针刺“益智调神”穴方（百会、四神聪及双侧神门、内关、足三里、三阴交、悬钟）治疗，留针30 min，每日1次，每周6次。两组均治疗6周。采用简易精神状态检查量表（MMSE）、阿尔茨海默病评定量表认知部分（ADAS-Cog）评估两组患者治疗前后整体认知功能；采用rs-fMRI分析两组患者（针药组11例、西药组12例）治疗前后左侧海马与全脑功能连接（FC）变化。

结果

治疗后，两组患者MMSE评分均较治疗前升高、ADAS-Cog评分较治疗前降低（

0.05），且针药组MMSE评分高于西药组、ADAS-Cog评分低于西药组（

≤0.05）。治疗后，西药组患者左侧海马与左侧梭状回、左侧三角部额下回、双侧颞上回、右侧顶上回之间FC较治疗前增强（

0.05），与左侧颞下回、左侧额中回、右背外侧额上回之间FC较治疗前减弱（

0.05）；针药组患者左侧海马与右侧回直肌、左侧枕下回、右侧颞上回、左侧枕中回之间FC较治疗前增强（

0.05），与左侧丘脑之间FC较治疗前减弱（

0.05）。治疗后，针药组患者左侧海马与双侧颞下回、双侧颞中回、右侧回直肌、双侧枕上回、左侧豆状壳核、左侧距状裂周围皮层、左侧岛盖部额下回、左内侧额上回、右侧中央后回之间FC较西药组增强（

0.05）。

结论

针刺“益智调神”穴方可改善AD患者的认知功能，主要脑功能机制为加强左侧海马与默认网络（颞下回、颞中回、额上回、回直肌）及左侧海马与感觉（中央后回）、视觉（距状裂周围皮层、枕上回）支配脑区之间的功能连接。

Abstract

Objective

To analyze the effect of acupuncture at the acupoints for

Yizhi Tiaoshen

(benefiting the intelligence and regulating the spirit) on the functional connectivity between the hippocampus and the whole brain in the patients with Alzheimer's disease (AD)

and reveal the brain function mechanism of acupuncture in treatment of AD using resting state functional magnetic resonance imaging (rs-fMRI).

Methods

Sixty patients with mild to moderate AD were randomly divided into an acupuncture + medication group (30 cases

3 cases dropped out) and a western medication group (30 cases

2 cases dropped out). In the western medication group

the donepezil hydrochloride tablets were administered orally

2.5 mg to 5 mg each time

once daily; and adjusted to be 10 mg each time after 4 weeks of medication. Besides the therapy as the western medication group

in the acupuncture + medicati

on group

acupuncture was supplemented at the acupoints for

Yizhi Tiaoshen

i.e. Baihui (GV 20)

Sishencong (EX-HN 1)

and bilateral Shenmen (HT 7)

Neiguan (PC 6)

Zusanli (ST 36)

Sanyinjiao (SP 6) and Xuanzhong (GB 39). The needles were retained for 30 min in one treatment

once daily; and 6 treatments were required weekly. The duration of treatment was 6 weeks in each group. The general cognitive function was assessed by the mini-mental state examination (MMSE) and Alzheimer's disease assessment scale-cognitive part (ADAS-Cog) before and after treatment in the two groups. Using the rs-fMRI

the changes in the functional connectivity (FC) of the left hippocampus and the whole brain before and after treatment were analyzed in the patients of the two groups (11 cases in the acupuncture + medication group and 12 cases in the western medication group).

Results

After treatment

compared with those before treatment

MMSE scores increased and ADAS-Cog scores decreased in the two groups (

0.05); MMSE score was higher

while the ADAS-Cog score was lower in the acupuncture + medication group when compared with those in the western medication group (

≤0.05). After treatment

in the western medication group

FC of the left hippocampus was enhanced with the left fusiform gyrus

the inferior frontal gyrus of the left triangular region

the bilateral superior temporal gyrus and the right superior parietal gyrus (

0.05)

while FC was weakened with the left inferior temporal gyrus

the left middle frontal gyrus and the right dorsolateral superior frontal gyrus when compared with that before treatment (

0.05). After treatment

in the acupuncture + medication group

FC of the left hippocampus was increased with the right gyrus rectus

the left inferior occipital gyrus

the right superior temporal gyrus and the left middle occipital gyrus (

0.05)

and it was declined with the left th

alamus (

0.05) when compared with those before treatment. After treatment

in the acupuncture + medication group

FC of the left hippocampus was strengthened with the bilateral inferior temporal gyrus

the bilateral middle temporal gyrus

the right gyrus rectus

the bilateral superior occipital gyrus

the left lenticular nucleus putamen

the left calcarine fissure and surrounding cortex

the inferior frontal gyrus of the left insulae operculum

the left medial superior frontal gyrus and the right posterior central gyrus (

0.05) compared with that of the western medication group.

Conclusion

Acupuncture at the acupoints for

Yizhi Tiaoshen

improves the cognitive function of AD patients

and its main brain functional mechanism is related to intensifying the functional connectivity of the left hippocampus with the default network (inferior temporal gyrus

middle temporal gyrus and superior frontal gyrus

gyrus rectus)

as well as with the sensory (posterior central gyrus) and visual (calcarine fissure and surrounding cortex and superior occipital gyrus) brain regions.

关键词

Keywords

references

Lane CA , Hardy J , Schott JM . Alzheimer's disease [J ] . Eur J Neurol , 2018 , 25 ( 1 ): 59 - 70 .

Bo ZY , Wan Y , Meng SS , et al . The temporal trend and distribution characteristics in mortality of Alzheimer's disease and other forms of dementia in China: based on the National Mortality Surveillance System (NMS) from 2009 to 2015 [J ] . PLoS One , 2019 , 14 ( 1 ): e0210621 .

Jia LF , Quan MN , Fu Y , et al . Dementia in China: epidemiology, clinical management, and research advances [J ] . Lancet Neurol , 2020 , 19 ( 1 ): 81 - 92 .

Jia LF , Du YF , Chu L , et al . Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study [J ] . Lancet Public Health , 2020 , 5 ( 12 ): e661 - e671 .

朱丹迪 , 潘伟刚 , 刘超猛 , 等 . 阿尔茨海默病药物联合治疗研究进展 [J ] . 神经疾病与精神卫生 , 2021 , 21 ( 12 ): 898 - 902 .

陈生弟 , 方嵘 . 应重视早期阿尔茨海默病的非药物治疗 [J ] . 中国现代神经疾病杂志 , 2021 , 21 ( 11 ): 913 - 917 .

Liu WH , Chen C , Wang F , et al . Development trend and current situation of acupuncture-moxibustion indications [J ] . World J Acupunct-Moxibust , 2020 , 30 ( 4 ): 245 - 250 .

王昊 , 惠鑫 , 赵百孝 . 针灸治疗阿尔茨海默病临床研究进展 [J ] . 中华中医药杂志 , 2020 , 35 ( 4 ): 1945 - 1948 .

Stickland R , Allen M , Magazzini L , et al . Neurovascular coupling during visual stimulation in multiple sclerosis: a MEG-fMRI study [J ] . Neuroscience , 2019 , 403 : 54 - 69 .

姜同菲 , 郭静 . 应用脑功能磁共振成像技术对经穴特异性研究概况 [J ] . 中华中医药杂志 , 2021 , 36 ( 8 ): 4820 - 4823 .

Pini L , Geroldi C , Galluzzi S , et al . Age at onset reveals different functional connectivity abnormalities in prodromal Alzheimer's disease [J ] . Brain Imaging Behav , 2020 , 14 ( 6 ): 2594 - 2605 .

赵坤 , 丁艳辉 , 韩璎 , 等 . 阿尔茨海默病多中心独立的、可重复的海马影像组学标志物: 早期识别、纵向进展和生物学基础 [J ] . 科学通报(英文版) , 2020 , 65 ( 13 ): 1103 - 1113 .

Serra L , Bozzali M , Fadda L , et al . The role of hippocampus in the retrieval of autobiographical memories in patients with amnestic mild cognitive impairment due to Alzheimer's disease [J ] . J Neuropsychol , 2020 , 14 ( 1 ): 46 - 68 .

Xue JY , Guo H , Gao Y , et al . Altered directed functional connectivity of the hippocampus in mild cognitive impairment and Alzheimer's disease: a resting-state fMRI study [J ] . Front Aging Neurosci , 2019 , 11 : 326 .

Ding N , Jiang J , Xu AP , et al . Manual acupuncture regulates behavior and cerebral blood flow in the SAMP8 mouse model of Alzheimer's disease [J ] . Front Neurosci , 2019 , 13 : 37 .

Lin RH , Li L , Zhang YZ , et al . Electroacupuncture ameliorate learning and memory by improving N-acetylaspartate and glutamate metabolism in APP/PS1 mice [J ] . Biol Res , 2018 , 51 ( 1 ): 21 .

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 .

中国痴呆与认知障碍诊治指南写作组 , 中国医师协会神经内科医师分会认知障碍疾病专业委员会 . 2018中国痴呆与认知障碍诊治指南(七) : 阿尔茨海默病的危险因素及其干预 [J ] . 中华医学杂志 , 2018 , 98 ( 19 ): 1461 - 1466 .

国家质量监督检验检疫总局 , 中国国家标准化管理委员会 . 腧穴名称与定位 : GB/T 12346-2006 [S ] . 北京 : 中国标准出版社 , 2006 .

Folstein MF , Folstein SE , McHugh PR . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician [J ] . J Psychiatr Res , 1975 , 12 ( 3 ): 189 - 198 .

Cano SJ , Posner HB , Moline ML , et al . The ADAS-cog in Alzheimer's disease clinical trials: psychometric evaluation of the sum and its parts [J ] . J Neurol Neurosurg Psychiatry , 2010 , 81 ( 12 ): 1363 - 1368 .

Tzourio-Mazoyer N , Landeau B , Papathanassiou D , et al . Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain [J ] . Neuroimage , 2002 , 15 ( 1 ): 273 - 289 .

夏昆鹏 , 逄静 , 李书霖 , 等 . 督脉电针对阿尔茨海默病患者学习记忆能力及血清APP、Aβ1-42的影响 [J ] . 中国针灸 , 2020 , 40 ( 4 ): 375 - 378 .

Cheng JN , Yang H , Zhang JT . Donepezil's effects on brain functions of patients with alzheimer disease: a regional homogeneity study based on resting-state functional magnetic resonance imaging [J ] . Clin Neuropharmacol , 2019 , 42 ( 2 ): 42 - 48 .

Zheng WM , Su ZZ , Liu XY , et al . Modulation of functional activity and connectivity by acupuncture in patients with Alzheimer disease as measured by resting-state fMRI [J ] . PLoS One , 2018 , 13 ( 5 ): e0196933 .

Jia BH , Liu ZS , Min BQ , et al . The effects of acupuncture at real or sham acupoints on the intrinsic brain activity in mild cognitive impairment patients [J ] . Evid Based Complement Alternat Med , 2015 , 2015 : 529675 .

Hanseeuw BJ , Schultz AP , Betensky RA , et al . Decreased hippocampal metabolism in high-amyloid mild cognitive impairment [J ] . Alzheimers Dement , 2016 , 12 ( 12 ): 1288 - 1296 .

Sun Y , Wang YF , Lu JM , et al . Disrupted functional connectivity between perirhinal and parahippocampal cortices with hippocampal subfields in patients with mild cognitive impairment and Alzheimer's disease [J ] . Oncotarget , 2017 , 8 ( 58 ): 99112 - 99124 .

朱丞 , 赵虎 , 孙晓海 , 等 . 创伤后应激障碍患者海马体积及代谢物水平变化的在体研究 [J ] . 全科医学临床与教育 , 2011 , 9 ( 6 ): 619 - 622 .

冯枫 , 周波 , 王磊 , 等 . 阿尔茨海默病及遗忘型轻度认知功能损害中海马-丘脑功能连接和结构连接的相关性研究 [J ] . 中华内科杂志 , 2019 , 58 ( 9 ): 662 - 667 .

Zhao QH , Sang XS , Metmer H , et al . Functional segregation of executive control network and frontoparietal network in Alzheimer's disease [J ] . Cortex , 2019 , 120 : 36 - 48 .

Wang ZQ , Liang PP , Jia XQ , et al . Baseline and longitudinal patterns of hippocampal connectivity in mild cognitive impairment: evidence from resting state fMRI [J ] . J Neurol Sci , 2011 , 309 ( 1/2 ): 79 - 85 .

Misiura MB , Howell JC , Wu JJ , et al . Race modifies default mode connectivity in Alzheimer's disease [J ] . Transl Neurodegener , 2020 , 9 : 8 .

Xie C , Bai F , Yuan B , et al . Joint effects of gray matter atrophy and altered functional connectivity on cognitive deficits in amnestic mild cognitive impairment patients [J ] . Psychol Med , 2015 , 45 ( 9 ): 1799 - 1810 .

贾静 , 王觉 , 孙燕 , 等 . 视皮层背侧、腹侧流视觉通路的研究进展 [J ] . 中华眼视光学与视觉科学杂志 , 2022 , 24 ( 4 ): 316 - 320 .

Kokubo K , Suzuki K , Hattori N , et al . Executive dysfunction in patients with putaminal hemorrhage [J ] . J Stroke Cerebrovasc Dis , 2015 , 24 ( 9 ): 1978 - 1985 .

Wang ZQ , Nie BB , Li DH , et al . Effect of acupuncture in mild cognitive impairment and Alzheimer disease: a functional MRI study [J ] . PLoS One , 2012 , 7 ( 8 ): e42730 .

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