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中华针灸电子杂志

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. 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. 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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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±2.47a 27.61±1.85b 12.22±3.35c
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±2.55a 25.44±1.41b 10.44±3.08c
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
X Y Z
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 0.41422a
右侧上纵束 53 68 105 20 0.23466a
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