Effect of the Integrated Chinese and Western Medicine on the Default Mode Network in the Acute Ischemic Stroke Based on fMRI
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摘要: 目的 采用静息态功能磁共振成像(fMRI)技术, 观察疏血通注射液联合常规治疗(中西医结合治疗)对急性缺血性脑卒中患者的临床疗效, 并探讨默认网络(DMN)内功能连接的改变, 揭示潜在的疗效机制。方法 纳入20例急性缺血性脑卒中患者在中西医结合治疗前后行fMRI, 同时选取20例健康受试者作对照, 比较患者和健康受试DMN内功能连接差异, 观察治疗前后患者临床量表评分和DMN内功能连接差异, 并进一步分析差异脑区与临床量表评分的相关关系。结果 ① 治疗后患者NIHSS、mRS评分显著降低, BI评分显著升高(P＜0.01), 中医病类诊断评分显著改善(P＜0.01)。②与健康受试相比, 治疗前患者DMN内右侧颞上回和右侧楔前叶的功能连接显著降低(P＜0.05), 治疗后患者DMN内无显著差异(P>0.05)。治疗前后比较, 患者DMN内右侧后扣带回和右侧楔前叶的功能连接显著增强(P＜0.05)。③右侧楔前叶功能连接的改变与NIHSS、BI评分显著相关(P＜0.01)。结论 中西医结合治疗缺血性脑卒中可能通过调节DMN内右侧楔前叶功能连接从而改善神经功能缺损和提高生活质量。Abstract: OBJECTIVE To observe the clinical efficacy of Shuxuetong injection combined with conventional treatment on acute ischemic stroke using resting-state functional magnetic resonance imaging (fMRI), and to investigate the changes of functional connectivity within the default mode network (DMN) to reveal the potential mechanism of efficacy.METHODS A total of 20 patients with acute ischemic stroke were included to undergo fMRI before and after the integrated Chinese and Western medicine treatment, while 20 healthy subjects were selected as controls to compare the differences within the DMN between patients and healthy subjects. In addition, the differences in clinical scale scores and functional connectivity within the DMN between patients before and after treatment were also compared to further analyze the correlation between the differential encephalic region and clinical scale scores.RESULTS ① After treatment, patients' NIHSS and mRS scores reduced significantly, BI scores increased significantly (P < 0.01), and diagnosis scores of Chinese medicine disease category improved significantly (P < 0.01). ②Compared with healthy subjects, the functional connectivity of the right superior temporal gyrus and right precuneus in DMN of patients before treatment reduced significantly (P < 0.05), and there was no significant difference in DMN of patients after treatment (P>0.05). The functional connectivity of the right posterior cingulate gyrus and the right precuneus in the DMN enhanced significantly after treatment compared with that before treatment (P < 0.05). ③The change in the functional connectivity of the right precuneus was significantly correlated with the NIHSS and BI scores (P < 0.01).CONCLUSION Integrated treatment of ischemic stroke with Chinese and Western medicine may reduce neurologic impairment and improve the living quality by modulating the functional connectivity of the right precuneus in the DMN.
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表 1 患者治疗前后临床量表评分变化(x±s, n=20)
时点 NIHSS mRS BI 治疗前 4.70±0.92 2.85±0.67 59.75±10.45 治疗后 1.70±1.38** 1.35±0.49** 79.50±6.86** 注: 与治疗前比较, **P＜0.01。 
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表 2 患者治疗前后中风病病类诊断评分变化(x±s, n=20)
时点 神识 语言 面瘫 眼症 上肢瘫 指瘫 下肢瘫 趾瘫 其他症征 中医病类诊断评分 治疗前 0 0.60±1.47 0.60±0.50 0 2.00±0.97 1.00±0.56 1.30±0.47 1.00±0.56 0 6.50±2.54 治疗后 0 0 0** 0 1.25±0.55** 0.35±0.49** 0.80±0.41** 0.20±0.41** 0 2.60±1.50** 注: 与治疗前比较, **P＜0.01。
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表 3 治疗前患者与健康受试DMN内功能连接差异脑区
脑区 峰值MNI坐标 体素 t值 X Y Z 右侧颞上回 57 -60 15 17 4.9 右侧楔前叶 6 -75 48 17 4.53 注: 双样本t检验, P＜0.05, Alphasim校正, cluster size=17。
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表 4 中西医结合治疗前后患者DMN内功能连接差异脑区
脑区 峰值MNI坐标 体素 t值 X Y Z 右侧后扣带回 3 -39 27 15 7.117 右侧楔前叶 3 -48 48 17 6.045 4 注: 配对t检验, P＜0.05, Alphasim校正, cluster size=15。
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