苟平平,董友朋.腹针联合重复经颅磁刺激治疗缺血性脑卒中后抑郁的临床疗效及相关脑网络重塑机制研究[J].中华物理医学与康复杂志,2026,48(6):509-517
扫码阅读全文
|
| 腹针联合重复经颅磁刺激治疗缺血性脑卒中后抑郁的临床疗效及相关脑网络重塑机制研究 |
|
| |
| DOI：10.3760/cma.j.cn421666-20251016-00918 |
| 中文关键词: 腹针 重复经颅磁刺激 缺血性脑卒中后抑郁 前扣带回认知亚区 功能连接 |
| 英文关键词: Acupuncture Repetitive transcranial magnetic stimulation Depression Stroke Anterior cingulate cortex Functional brain connectivity |
| 基金项目: |
|
| 摘要点击次数: 132 |
| 全文下载次数: 102 |
| 中文摘要: |
| 目的 探讨腹针联合重复经颅磁刺激（rTMS）治疗缺血性脑卒中后抑郁（PSD）的临床疗效及其对前扣带回认知亚区（S5、S6）脑网络功能连接（FC）的影响。 方法 将240例缺血性PSD患者按照随机数字表法分为常规组、腹针组、rTMS组、联合组，每组60例。4组患者均给予基础治疗，在此基础上，腹针组增加腹针疗法，rTMS组增加rTMS干预，联合组增加腹针疗法和rTMS干预。治疗前及治疗4周后（治疗后），分别采用汉密尔顿抑郁量表（HAMD）、美国国立卫生研究院卒中量表（NIHSS）、蒙特利尔认知评估量表（MoCA）评估4组患者的临床疗效，并通过双重差分模型评估治疗的净效果。利用静息态功能磁共振成像（rs-fMRI）分析患者治疗前、后前扣带回认知亚区（左侧S5、右侧S5、左侧S6、右侧S6）与全脑的FC变化，采用广义估计方程（GEE）分析组间FC差异。 结果 与组内治疗前比较，4组患者治疗后的HAMD、NIHSS评分均降低，MoCA评分均增加（P＜0.05）。与常规组、腹针组、rTMS组比较，联合组HAMD评分［（10.16±1.08）分］、NIHSS评分［（4.03±1.02）分］较低，MoCA评分［（24.12±3.11）分］较高。双重差分模型显示，联合组在HAMD评分下降幅度、NIHSS评分下降幅度及MoCA评分增加幅度上均显著优于常规组（P<0.05）。与常规组比较，联合组治疗后表现出以下FC显著增强（P<0.05）：左侧S5与左侧楔前叶、右侧丘脑、左侧额上回；右侧S5与左侧额上回、左侧楔前叶、左侧额中回、右侧壳核、右侧小脑、左侧小脑；左侧S6与左侧顶上小叶、左侧楔前叶、左侧小脑、右侧苍白球、左侧额上回；右侧S6与左侧顶上小叶、左侧小脑、右侧小脑、右侧苍白球、右侧楔前叶、左侧楔前叶。上述前扣带回认知亚区与特定脑区间增强的FC强度，与HAMD、NIHSS评分呈显著负相关（P<0.05），与MoCA评分呈显著正相关（P<0.05）。校正基线因素后，GEE模型进一步证实，联合组治疗后前扣带回认知亚区（左侧S5、右侧S5、左侧S6、右侧S6）与上述多个脑区的FC强度均显著高于常规组（P<0.05）。 结论 腹针联合rTMS治疗能显著改善缺血性PSD患者的抑郁症状、神经功能缺损及认知功能障碍，且疗效优于单一疗法。其作用机制可能涉及前扣带回认知亚区（S5、S6）与情绪调节、认知控制及感觉运动整合相关脑区（楔前叶、额上/中回、丘脑、基底节、小脑等）FC的增强。 |
| 英文摘要: |
| Objective To determine the clinical efficacy of combining abdominal acupuncture with repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression (PSD), and to document its effects on the functional connectivity (FC) of brain networks in the cognitive subregions (S5, S6) of the anterior cingulate cortex. Methods A total of 240 stroke survivors with PSD were randomly divided into a conventional group, an abdominal acupuncture group, an rTMS group, and a combined group, each of 60. All four groups received basic treatment, while the abdominal acupuncture, rTMS and combined groups additionally received those treatments. Before the experiment and after 4 weeks, clinical efficacy was assessed using the Hamilton Depression Rating Scale (HAMD), the National Institutes of Health Stroke Scale (NIHSS), and the Montreal Cognitive Assessment (MoCA). The net treatment effect was evaluated using a difference-in-differences (DID) model. Resting-state functional magnetic resonance imaging (rs-fMRI) was used to analyze changes in functional connectivity (FC) between the cognitive subregions of the anterior cingulate cortex (left S5, right S5, left S6, right S6) and the whole brain before and after treatment. Generalized estimating equations were applied to analyze the intergroup differences in FC. Results After the treatment, all four groups showed decreased average HAMD and NIHSS scores, and increased average MoCA scores (P≤0.05). Compared with the other three groups, the combined group had significantly lower average HAMD and NIHSS scores ［(10.16±1.08) and (4.03±1.02)］, but a significantly higher MoCA score (24.12±3.11). According to the DID model, the combined group was showing significantly superior performance in terms of those measures. The combined group also exhibited significantly enhanced FC between the left S5 and the left precuneus, the right thalamus, and the left superior frontal gyrus; the right S5 with the left superior frontal gyrus, the left precuneus, the left middle frontal gyrus, the right putamen, the right cerebellum, and the left cerebellum; the left S6 with the left superior parietal lobule, the left precuneus, the left cerebellum, the right globus pallidus, and the left superior frontal gyrus; the right S6 with the left superior parietal lobule, the left cerebellum, the right cerebellum, the right globus pallidus, the right precuneus, and the left precuneus after the treatment. That enhanced FC was significantly negatively correlated with the HAMD and NIHSS scores and significantly positively correlated with the MoCA scores. After adjusting for baseline factors, the generalized estimating equation model further confirmed that the strength of the FCs between the anterior cingulate cognitive subregions (left S5, right S5, left S6, right S6) and the above-mentioned multiple brain regions was significantly greater in the combined group than in the conventional group. Conclusions Abdominal acupuncture combined with rTMS significantly relieves the depressive symptoms, neurological deficits and cognitive impairment of persons with PSD. Its therapeutic effect is superior to that of monotherapy. The underlying mechanism may involve enhanced functional connectivity between the cognitive subregions (S5, S6) of the anterior cingulate cortex and brain regions associated with emotion regulation, cognitive control, and sensorimotor integration, including the precuneus, superior/middle frontal gyrus, thalamus, basal ganglia, and cerebellum. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|