调神益智艾灸治疗遗忘型轻度认知障碍的弥散张量成像研究

doi:10.3877/cma.j.issn.2095-3240.2024.02.004

中华针灸电子杂志 ›› 2024, Vol. 13 ›› Issue (02) : 58 -64. doi: 10.3877/cma.j.issn.2095-3240.2024.02.004

论著

调神益智艾灸治疗遗忘型轻度认知障碍的弥散张量成像研究

黄灏宇¹, 庄泽森¹, 林万庆², 石娇³, 袁旭³, 王单³, 周晓媚³, 万义文³, 林源², 陈尚杰¹^,^†(

)

^1. 518101　深圳大学第二附属医院康复医学科；350122　福州，福建中医药大学康复医学院
^2. 350004　福州，福建中医药大学附属人民医院康复医学科
^3. 518101　深圳大学第二附属医院康复医学科

收稿日期:2023-11-15 出版日期:2024-05-15
通信作者: 陈尚杰
基金资助:
国家自然科学基金(81973922); 深圳市宝安中医药发展基金(2022KJCX-ZJZL-14); 广东省基础与应用基础研究基金(2021A1515110764); 深圳市科技研发资金(JCYJ20220530142806014); 深圳市科技研发资金(JCYJ20210324110809025); 深圳市"医疗卫生三名工程"项目资助(2017)

Effect of mind-regulating intelligence-enhancing moxibustion in patients with amnestic mild cognitive impairment: a diffusion tensor imaging study

Haoyu Huang¹, Zesen Zhuang¹, Wanqing Lin², Jiao Shi³, Xu Yuan³, Dan Wang³, Xiaomei Zhou³, Yiwen Wan³, Yuan Lin², Shangjie Chen¹^,^†()

^1. Department of Rehabilitation Medicine, the Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China; College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
^2. Department of Rehabilitation Medicine, the Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China
^3. Department of Rehabilitation Medicine, the Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China

Received:2023-11-15 Published:2024-05-15
Corresponding author: Shangjie Chen

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引用本文：

黄灏宇, 庄泽森, 林万庆, 石娇, 袁旭, 王单, 周晓媚, 万义文, 林源, 陈尚杰. 调神益智艾灸治疗遗忘型轻度认知障碍的弥散张量成像研究[J/OL]. 中华针灸电子杂志, 2024, 13(02): 58-64.

Haoyu Huang, Zesen Zhuang, Wanqing Lin, Jiao Shi, Xu Yuan, Dan Wang, Xiaomei Zhou, Yiwen Wan, Yuan Lin, Shangjie Chen. Effect of mind-regulating intelligence-enhancing moxibustion in patients with amnestic mild cognitive impairment: a diffusion tensor imaging study[J/OL]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2024, 13(02): 58-64.

目的

观察调神益智艾灸对遗忘型轻度认知障碍患者(aMCI)的临床疗效，并应用磁共振弥散张量成像技术(DTI)观察艾灸对脑白质(WM)的影响。

方法

将2018年4月至2019年1月深圳大学第二附属医院及附近社区招募的aMCI患者40例随机分为艾灸组和安慰灸组，每组各20例，2组患者于治疗前后采用Rivermead行为记忆测验(RBMT)、简易精神状态检查量表(MMSE)及蒙特利尔认知评估量表(MoCA)评估整体认知功能和记忆功能，行颅脑DTI检查观察艾灸对WM的影响。

结果

与本组治疗前比较，治疗后艾灸组和安慰灸组MoCA、MMSE及RBMT评分均明显升高(t＝6.171、3.093、5.605、2.798、8.018、3.656，P均<0.05)。与安慰灸组比较，艾灸组RBMT、MMSE及MoCA评分差值明显升高(Z＝－3.497、－2.536、－3.888，P均<0.05)。与安慰灸组比较，艾灸组各向异性分数值(FA)明显增加的纤维束主要位于右侧前放射冠，胼胝体辐射线额部，右侧下额枕束，右侧钩束及右侧上纵束(P均<0.05)；未发现FA值明显减少的纤维束。

结论

调神益智艾灸能有效改善aMCI患者的记忆功能，DTI可用于评估艾灸治疗后aMCI患者的WM网络结构变化。

关键词: 认知功能障碍, 白质, 弥散张量成像, 灸法, 基于纤维束追踪的空间统计分析

Objective

To investigate the efficacy of mind-regulating intelligence-enhancing moxibustion in patients with amnestic mild cognitive impairment (aMCI) and its impact on brain white matter (WM) using diffusion tensor imaging (DTI) technology.

Methods

Forty aMCI patients recruited from the Second Affiliated Hospital of Shenzhen University and nearby communities from April 2018 to January 2019 were randomly divided into a real moxibustion group and a sham moxibustion group, with 20 patients in each group. Patients in both groups underwent the rivermead behavioral memory test (RBMT), mini-mental state examination (MMSE), and Montreal cognitive assessment (MoCA) before and after treatment to evaluate the overall cognitive function and memory domain function. Head DTI examination was performed to observe the impact of moxibustion treatment on white matter.

Results

Compared with the pre-treatment in each group, both the real moxibustion group and sham moxibustion group showed significant increases in MoCA, MMSE, and RBMT scores after intervention (t=6.171, 3.093, 5.605, 2.798, 8.018, 3.656, P<0.05 for all). Compared with the sham moxibustion group, the RBMT, MMSE, and MoCA score differences in the real moxibustion group are significantly higher (Z=-3.497, -2.536, -3.888, P<0.05 for all). Additionally, compared with the sham moxibustion group, fractional anisotropy (FA) values of the real moxibustion group exhibited significant increases in fiber bundles mainly located in areas such as right anterior corona radiata, anterior forceps of corpus callosum, right inferior fronto-occipital fasciculus, right uncinate fasciculus, and right superior longitudinal fasciculus(P<0.05 for all); no fiber bundles with significantly decreased FA values were observed.

Conclusions

Mind-regulating intelligence-enhancing moxibustion might effectively improve the memory function in patients with aMCI. Moreover, DTI can be utilized to evaluate changes in WM network structure of aMCI patients after moxibustion therapy.

Key words: Cognitive dysfunction, White matter, Diffusion tensor imaging, Moxibustion, Tract-based spatial statistics

表1 2组aMCI患者治疗前后MoCA、MMSE及RBMT评分组内比较(分，

±s)

组别	例数	MoCA	MMSE	RBMT
艾灸组	18
治疗前		23.00±2.63	24.56±0.86	9.78±2.98
治疗后		26.11±2.47^a	27.61±1.85^b	12.22±3.35^c
安慰灸组	16
治疗前		23.31±3.00	24.50±0.82	9.56±3.16
治疗后		23.88±2.55^a	25.44±1.41^b	10.44±3.08^c

表1 2组aMCI患者治疗前后MoCA、MMSE及RBMT评分组内比较(分，

±s)

组别	例数	MoCA	MMSE	RBMT
艾灸组	18
治疗前		23.00±2.63	24.56±0.86	9.78±2.98
治疗后		26.11±2.47^a	27.61±1.85^b	12.22±3.35^c
安慰灸组	16
治疗前		23.31±3.00	24.50±0.82	9.56±3.16
治疗后		23.88±2.55^a	25.44±1.41^b	10.44±3.08^c

表2 2组aMCI患者MoCA、MMSE及RBMT量表评分差值比较[分，M(P₂₅，P75)]

组别	例数	MoCA	MMSE	RBMT
艾灸组	18	3.00(1.75，4.50)	4.00(0.00，5.00)	2.00(1.75，3.00)
安慰灸组	16	0.00(0.00，1.00)^a	1.00(0.00，2.00)^a	1.00(0.00，1.75)^a
Z值		－3.888	－2.536	－3.497
P值		<0.05	<0.05	<0.05

表2 2组aMCI患者MoCA、MMSE及RBMT量表评分差值比较[分，M(P₂₅，P75)]

组别	例数	MoCA	MMSE	RBMT
艾灸组	18	3.00(1.75，4.50)	4.00(0.00，5.00)	2.00(1.75，3.00)
安慰灸组	16	0.00(0.00，1.00)^a	1.00(0.00，2.00)^a	1.00(0.00，1.75)^a
Z值		－3.888	－2.536	－3.497
P值		<0.05	<0.05	<0.05

图1 2组DTI-TBSS的FA值组水平分析结果呈现图。图1a～c显示的是右侧前放射冠、胼胝体辐射线额部、右侧下额枕束和右侧钩束所在的具有组间统计学差异的WM纤维束团块的水平面、矢状面、冠状面图。图1d～f显示的是右侧上纵束所在的具有组间统计学差异的WM纤维束团块的水平面、矢状面、冠状面图注：红黄色区域是具有组间差异的纤维束团块，绿色区域为平均FA骨架。DTI为磁共振弥散张量成像技术；TBSS为基于纤维束追踪的空间统计分析；FA为各向异性分数；WM为脑白质

表3 2组aMCI患者DTI-TBSS结果显示具有组间差异的脑区

脑区	MNI峰值坐标			体素值	FA值
脑区	X	Y	Z	体素值	FA值
右侧前放射冠；胼胝体辐射线额部；右侧下额枕束；右侧钩束	76	159	66	481	0.41422^a
右侧上纵束	53	68	105	20	0.23466^a

表3 2组aMCI患者DTI-TBSS结果显示具有组间差异的脑区

脑区	MNI峰值坐标			体素值	FA值
脑区	X	Y	Z	体素值	FA值
右侧前放射冠；胼胝体辐射线额部；右侧下额枕束；右侧钩束	76	159	66	481	0.41422^a
右侧上纵束	53	68	105	20	0.23466^a

1	Gómez-soria I, Peralta-marrupe P, Calatayud-sanz E, et al. Efficacy of cognitive intervention programs in amnesic mild cognitive impairment: A systematic review[J]. Arch Gerontol Geriatr, 2021，94: 104332.
2	曾嫱，李新萍，李利民，等. 柴胡疏肝散调节自噬–溶酶体途径抑制Aβ诱导的神经毒性[J]. 深圳中西医结合杂志，2022，32(18): 1-5.
3	中华医学会神经病学分会痴呆与认知障碍学组. 阿尔茨海默病源性轻度认知障碍诊疗中国专家共识2021[J]. 中华神经科杂志，2022，55(5): 421-440.
4	汪海燕，李思妤，胡琼，等. 艾灸对遗忘型轻度认知障碍记忆功能及相关血清蛋白标志物的影响[J]. 针刺研究，2021，46(9): 794-799.
5	Mai W, Zhang AZ, Liu Q, et al. Effects of moxa cone moxibustion therapy on cognitive function and brain metabolic changes in MCI patients: a pilot (1)H-MRS study[J]. Front Aging Neurosci, 2022，14: 773687.
6	Zhou Y, Si X, Chen Y, et al. Hippocampus- and thalamus-related fiber-specific white matter reductions in mild cognitive impairment[J]. Cereb Cortex, 2022，32(15): 3159-3174.
7	Petersen RC.Mild cognitive impairment as a diagnostic entity[J]. J Intern Med, 2004，256(3): 183-194.
8	李旭豪，李金玲，杨继国. 艾灸临床试验中安慰灸的设计方法与思路[J]. 中医杂志，2022，63(19): 1834-1839.
9	Lele PP, Weddell G, Williams CM. The relationship between heat transfer, skin temperature and cutaneous sensibility[J]. J Physiol, 1954，126(2): 206-234.
10	Li T, Zhang Y, Fu X, et al. Microstructural white matter alterations in Alzheimer's disease and amnestic mild cognitive impairment and its diagnostic value based on diffusion kurtosis imaging: a tract-based spatial statistics study[J]. Brain Imaging Behav, 2022，16(1): 31-42.
11	Chen Y, Wang Y, Song Z, et al. Abnormal white matter changes in Alzheimer's disease based on diffusion tensor imaging: A systematic review[J]. Ageing Res Rev, 2023，87: 101911.
12	Zhou Y, Si X, Chao YP, et al. Automated classification of mild cognitive impairment by machine learning with hippocampus-related white matter network[J]. Front Aging Neurosci, 2022，14: 866230.
13	Zhang X, Sun Y, Li W, et al. Characterization of white matter changes along fibers by automated fiber quantification in the early stages of Alzheimer's disease[J]. Neuroimage Clin, 2019，22: 101723.
14	Tarumi T, Thomas BP, Tseng BY, et al. Cerebral White Matter Integrity in Amnestic Mild Cognitive Impairment: A 1-Year Randomized Controlled Trial of Aerobic Exercise Training[J]. J Alzheimers Dis, 2020，73(2): 489-501.
15	Houria L, Belkhamsa N, Cherfa A, et al. Multi-modality MRI for Alzheimer's disease detection using deep learning[J]. Phys Eng Sci Med, 2022，45(4): 1043-1053.
16	刘颖，曾祥柱，王筝，等. 阿尔茨海默病和遗忘型轻度认知功能障碍扩散张量成像随访研究[J]. 临床放射学杂志，2020，39(4): 650-653.
17	Chen Z, Liu P, Zhang C, et al. Neural markers of procrastination in white matter microstructures and networks[J]. Psychophysiology, 2021，58(5): e13782.
18	Wang Z, Bai L, Liu Q, et al. Corpus callosum integrity loss predicts cognitive impairment in Leukoaraiosis[J]. Ann Clin Transl Neurol, 2020，7(12): 2409-2420.
19	Cao J, Chen C, Zhang T, et al. Segmental Abnormalities of White Matter Microstructure in Primary Hypothyroidism Identified by Automated Fiber Quantification[J]. Neuroendocrinology, 2023，113(6): 589-605.
20	Chondrogiorgi M, Astrakas LG, Zikou AK, et al. Multifocal alterations of white matter accompany the transition from normal cognition to dementia in Parkinson's disease patients[J]. Brain Imaging Behav, 2019，13(1): 232-240.
21	Chen HF, Huang LL, Li HY, et al. Microstructural disruption of the right inferior fronto-occipital and inferior longitudinal fasciculus contributes to WMH-related cognitive impairment[J]. CNS Neurosci Ther, 2020，26(5): 576-588.
22	Xiao D, Wang K, Theriault L, et al. White matter integrity and key structures affected in Alzheimer's disease characterized by diffusion tensor imaging[J]. Eur J Neurosci, 2022，56(8): 5319-5331.
23	Mukli P, Csipo T, Lipecz A, et al. Sleep deprivation alters task-related changes in functional connectivity of the frontal cortex: A near-infrared spectroscopy study[J]. Brain Behav, 2021，11(8): e2135.
24	王倩楠，孙慧勤，孙卫红，等. 轻度认知障碍患者内侧颞叶微结构变化的磁共振扩散峰度成像研究[J]. 中国实用神经疾病杂志，2022，25(3): 283-288.
25	Liu Q, Zhong M, Yuan S, et al. Clinical study of central cholinergic pathway damage in two mild cognitive impairment patients[J]. Neurol Sci, 2021，42(11): 4707-4717.

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