脳梗塞片麻痺患者における灰白質リモデリングに対する前斜側頭側頭側頭線への鍼治療の効果．

[Effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction].

• Yi Lang
• Kuang Shi Li
• Jia Yi Yang
• Fang Yuan Cui
• Wen Bai
• Chu Xi Liang

抄録

目的:

脳梗塞片麻痺患者の灰白質リモデリングに対する前斜側頭頂部ラインでの鍼治療の介入効果をボクセルベースの形態学（VBM）に基づいて観察し、脳梗塞片麻痺に対する頭皮鍼治療の利点と中心的な効果部位を明らかにすること。

OBJECTIVE: To observe the intervention effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction based on voxel-based morphology (VBM), and to reveal the advantages and central effect sites of scalp acupuncture for hemiplegia of cerebral infarction.

方法:

右基底核の脳梗塞片麻痺患者と健常者18名の計18名を登録し、T1構造検査を行った。患者を頭皮鍼灸群と非頭皮鍼灸群に無作為に分け、各群9名とした。治療前と治療後の神経学的欠損の程度（NIHSS）をSPSS20.0で解析し、治療後の灰白質の変化を2群間で比較するためにSPM8ソフトウェアパッケージを使用し、患者と健常者の間の灰白質の差を比較した。

METHODS: A total of 18 patients with hemiplegia of cerebral infarction in the right basal ganglia and 18 healthy subjects were enrolled and T1 structural scan was performed. The patients were randomly divided into scalp acupuncture group and non-scalp acupuncture group, with 9 patients in each group. SPSS20.0 was used to analyze the degree of neurological deficit (NIHSS) before and after treatment, and SPM8 software package was used to compare the change in gray matter after treatment between the two groups, the difference in gray matter between patients and healthy subjects.

結果:

治療後、頭皮鍼治療群ではNIHSSが有意に低下した（<0.05）のに対し、非頭皮鍼治療群ではNIHSSに有意な変化がなかった（>0.05）；頭皮鍼治療群では治療後のNIHSSが非頭皮鍼治療群に比べて有意に低下した（<0.05）。健康な被験者と比較して、脳梗塞患者は両側小脳の灰白質のボクセル増加を持っていた。2週間の治療後、頭皮鍼灸群では運動関連皮質（小脳、前帯状体、基底核、内側前頭回など）と感覚野の一部に灰白質のボクセル増加が認められたのに対し、非頭皮鍼灸群では運動とは無関係ないくつかの脳領域にわずかな灰白質のボクセル増加が認められました。治療後、スカルプ鍼灸群は、主に羊膜核と手綱を中心とした大脳基底核の脳領域でボクセル増加を示した。頭皮鍼治療群は治療後、非鍼治療群に比べて両側小脳皮質を中心とした脳領域で灰白質の増加が認められた。

RESULTS: After treatment, the scalp acupuncture group had a significant reduction in NIHSS (<0.05), while the non-scalp acupuncture group had no significant change in NIHSS (>0.05); the scalp acupuncture group had a significantly lower NIHSS than the non-scalp acupuncture group after treatment (<0.05). Compared with the healthy subjects, the patients with cerebral infarction had a voxel increase of gray matter in the bilateral cerebellum; after 2 weeks of treatment, the scalp acupuncture group had a voxel increase of gray matter in the motor-related cortex (such as the cerebellum, the anterior cingulate, the basal nucleus, and the medial frontal gyrus) and some parts of the sensory cortex, while the non-scalp acupuncture group had a slight voxel increase of gray matter in few brain regions which were not associated with motor. After treatment, the scalp acupuncture group had a voxel increase in the brain regions of the basal ganglia, mainly the lenticular nucleus and the claustrum. Compared with the non-scalp acupuncture group after treatment, the scalp acupuncture group had a greater gray matter increase in the brain regions mainly in the bilateral cerebellar cortex.

結論:

前斜位側頭側頭側頭線における鍼治療は、錐体外路系の運動中枢（主に両側小脳と対側大脳基底核）と感覚野の一部における灰白質リモデリングを促進し、対応する脳領域の機能補償を誘導することにより、片麻痺患者の神経機能回復を促進することができます。

CONCLUSION: Acupuncture at the anterior oblique parietotemporal line can promote neurological function recovery in patients with hemiplegia, possibly by promoting gray matter remodeling in the motor centers of the extrapyramidal system (mainly the bilateral cerebellum and the contralateral basal ganglia) and some parts of the sensory cortex and inducing functional compensation in corresponding brain regions.