Zhang Yan-Li, Wang Tian-Hong, Gu You-Quan, Guo Shun-Lin, Lei Jun-Qiang, Wang Shao-Yu, Nan Jiang, Dou Yu, Wang Shuai-Wen
Department of Radiology, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China.
Department of Neurology, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China.
Zhongguo Zhen Jiu. 2019 Jul 12;39(7):697-702. doi: 10.13703/j.0255-2930.2019.07.005.
Quantitative assessment of white blood flow in semi-oval center of patients with delayed neuropathological sequelae (DNS) after carbon monoxide poisoning treated with acupuncture combined with hyperbaric oxygen (HBO) based on magnetic resonance multi-inversion time arterial spin labeling imaging (mTI-ASL), and to evaluate its efficacy indirectly.
Twenty-six patients with clinically diagnosed DNS were randomly divided into an observation group (13 cases) and a control group (13 cases). The conventional therapy combined with HBO were given in the control group. In the observation group,on the base of the treatment, acupuncture was applied, the main acupoints were Shuigou (GV 26), Neiguan (PC 6), Baihui (GV 20), Shangxing (GV 23), Yintang (GV 29), Sanyinjiao (SP 6) on the affected side, Sishencong (EX-HN 1), Fenglong (ST 40), Lianquan (CV 23) and Jinjin (EX-HN12) for slurred speech, Jianyu (LI 15), Waiguan (TE 5) and Shousanli (LI 10) for upper limb pain, Huantiao (GB 30), Yanglingquan (GB 34), Yinlingquan (SP 9) for lower limb pain, the treatment was given once every day, 5 days as one course, with an interval of 2 days between the course. The treatment for 6 courses was required. The conventional head MR scan, mTI-ASL and diffusion tensor imaging (DTI) scans before and 1 week after treatment were adopted, Matlab (R2014b), Mricron and Syngo.via software were adopted to measure the cerebral blood flow (CBF) and anisotropy (FA) values of the semi-oval center. The correlation between the parameters was evaluated by Pearson method. And the simple intelligent mental state examination scale (MMSE) was uesd to assess cognitive function.
After treatment, the CBF, MMSE scores in both groups and FA values in the observation group were higher than those before treatment (<0.05). After treatment, the CBF, FA and MMSE scores in the observation group were significantly higher than those in the control group (<0.05). There was a positive correlation between CBF, FA and MMSE scores (<0.05), and the correlation between CBF and MMSE was the best ( =0.822).
Acupuncture combined with hyperbaric oxygen can significantly improved early white matter hypoperfusion and improved cognitive function score in patients with DNS. The curative effect is better than that of hyperbaric oxygen therapy alone. The mTI-ASL imaging can quantitatively evaluate its curative effect.
基于磁共振多反转时间动脉自旋标记成像（mTI-ASL）对一氧化碳中毒后迟发性神经病理后遗症（DNS）患者采用针刺联合高压氧（HBO）治疗时半卵圆中心白质血流进行定量评估，并间接评价其疗效。
将26例临床诊断为DNS的患者随机分为观察组（13例）和对照组（13例）。对照组给予常规治疗联合HBO。观察组在治疗基础上施加针刺，主穴为患侧水沟（GV 26）、内关（PC 6）、百会（GV 20）、上星（GV 23）、印堂（GV 29）、三阴交（SP 6），针对言语不清加四神聪（EX-HN 1）、丰隆（ST 40）、廉泉（CV 23）、金津（EX-HN12），针对上肢疼痛加肩髃（LI 15）、外关（TE 5）、手三里（LI 10），针对下肢疼痛加环跳（GB 30）、阳陵泉（GB 34）、阴陵泉（SP 9），每天治疗1次，5天为1个疗程，疗程间间隔2天。共需治疗6个疗程。采用治疗前及治疗后1周的常规头部磁共振扫描、mTI-ASL及扩散张量成像（DTI）扫描，采用Matlab（R2014b）、Mricron及Syngo.via软件测量半卵圆中心的脑血流量（CBF）及各向异性（FA）值。采用Pearson法评估参数间的相关性。并采用简易智能精神状态检查表（MMSE）评估认知功能。
治疗后，两组的CBF、MMSE评分及观察组的FA值均高于治疗前（<0.05）。治疗后，观察组的CBF、FA及MMSE评分显著高于对照组（<0.05）。CBF、FA与MMSE评分之间呈正相关（<0.05），且CBF与MMSE之间的相关性最佳（=0.822）。
针刺联合高压氧可显著改善DNS患者早期白质灌注不足并提高认知功能评分。疗效优于单纯高压氧治疗。mTI-ASL成像可定量评估其疗效。
