Study On The Mechanism Of Acupuncture On Limb Motor Dysfu-nction In Stroke Based On Voxel Morphological Analysis

PurposeTo investigate the clinical efficacy of acupuncture treatment of ischemic stroke limb dysfunction in patients with changes on the structure and volume of gray matter in the brain,and provide objective basis for acupuncture treatment of ischemic stroke limb motor dysfunction clinical curative effect mechanism.Methods1.To 176 cases of ischemic stroke in patients with limb motor dysfunction as the research object,according to randomly divided into acupuncture group and rehabilitation group,88 cases in each group,the rehabilitation group received basic treatment and rehabilitation,acupuncture group,acupuncture is a large number of experiments with team research,clinical research and literature research and application of Delphi method in screening of stroke limb motor dysfunction for acupuncture point group study concluded,each acupuncture 30min,1 times/day,5 times/week,two groups were treated for 4 weeks of treatment.Combined with the Fugl-Meyer motor function assessment scale and WOLF motor ability test scale(WOLF),Berg balance scale(BBS)and functional independence scale(FIM)and the SF-36 scale were assessed before and after treatment in patients with motor function and ability of daily life and quality of life,and the motor function respectively and the correlation between the ability of daily life and quality of life.2.To 30 cases of ischemic stroke in patients with limb motor dysfunction were randomly selected from the acupuncture group and the rehabilitation group in the second part of the study and 15 healthy people in healthy group,healthy group only underwent an MRI scan,the acupuncture group and the rehabilitation group before and after treatment.The first nuclear magnetic resonance scans before and after treatment the Fugl-Meyer motor function scale and WOLF motor ability test scale(WOLF);Pro-kin balance and Berg balance scale(BBS)and functional independence scale(FIM)and the SF-36 scale were assessed before and after treatment in patients with motor function,balance function and ability of daily life and quality of life;and on this basis study on structure of acupuncture treatment of ischemic stroke limb motor dysfunction of cerebral gray matter voxel changes,as well as related changes in brain and clinical motor function,balance function Correlation.Results1.Before treatment Fugl-Meyer acupuncture group and rehabilitation group in WOLF function score,motor function score and BBS score were no statistically significant differences(P>0.05);after treatment,Fugl-Meyer score,motor function score and the treatment groups of WOLF motor function score and BBS compared to before,were higher than those before treatment(P<0.05),and the score of acupuncture group Fugl-Meyer movement function score,WOLF scores and BBS were better than that of rehabilitation group(P<0.05).2.The two groups before treatment,FIM,SF-36 were no statistically significant differences(P>0.05);the two groups were subjected to daily life ability of patients after treatment than before treatment improved(P<0.05),acupuncture group FIM,SF-36 score was significantly higher than that of rehabilitation group(P<0.05),that acupuncture group on the quality of life of patients,daily capacity life is better than the rehabilitation group.3.Healthy human brain gray matter voxel was significantly higher than that of limb motor dysfunction in patients with ischemic stroke regions:cerebellum,occipital lobe,thalamus,limbic lobe,parahippocampal gyrus;precentral gyrus,postcentral gyrus and inferior parietal lobule,right superior parietal lobule;the left insula,putamen,putamen,globus ball;frontal lobe,right rectus gyrus and frontal gyrus.4.Motor dysfunction in patients with ischemic stroke after acupuncture than before acupuncture increased gray matter voxel regions of parietal lobe,precuneus,frontal lobe,frontal gyrus,left precentral gyrus,left middle frontal gyrus,left postcentral gyrus,limbic lobe,cingulate gyrus,parahippocampal gyrus,supramarginal gyrus,temporal lobe,superior temporal gyrus,middle temporal gyrus,corpus callosum,left cerebellum,posterior lobe and right cerebellum posterior lobe of cerebellum,occipital lobe,lingual gyrus,cerebellum anterior lobe5.Motor dysfunction in patients with ischemic stroke in acupuncture group after treatment than the rehabilitation group after treatment increased gray matter voxel area for the temporal lobe,right inferior temporal gyrus,limbic lobe,frontal lobe,parahippocampal gyrus,middle frontal gyrus,left inferior temporal gyrus,left superior temporal gyrus,orbital gyrus,cerebellum,left,back straight cerebellar tonsil,posterior lobe of cerebellum,thalamus,left inferior frontal gyrus,right middle frontal gyrus,precuneus and parietal lobe,left precentral gyrus,left postcentral gyrus.6.The healthy group of brain gray matter voxel was significantly higher than that of acupuncture group after treatment of limb motor dysfunction in patients with ischemic stroke regions:cerebellum,posterior lobe,cerebellum,occipital lobe,temporal lobe the left lobe,middle temporal gyrus,superior temporal gyrus,left inferior temporal gyrus,midbrain,thalamus,left brainstem,limbic lobe,parahippocampal gyrus,left middle frontal gyrus,left superior frontal gyrus,left insula,left superior temporal gyrus,left postcentral gyrus,precentral gyrus,frontal lobe,parietal lobe,cingulate gyrus,parietal lobe,left inferior parietal lobule,precuneus,right inferior parietal lobule.7.The healthy group was significantly higher than that of gray matter voxel after ischemic stroke rehabilitation of limb motor dysfunction in patients with regions:left cerebellum,right cerebellum,occipital lobe,left temporal gyrus,limbic lobe,temporal lobe,parahippocampal gyrus,insula,right frontal lobe,midbrain,brainstem,left fusiform gyrus,middle frontal gyrus,inferior frontal gyrus,left central gyrus,precentral gyrus,parietal lobe,orbital gyrus,the left middle temporal gyrus,superior temporal gyrus,left inferior temporal gyrus,supramarginal gyrus,right middle frontal gyrus,superior frontal gyrus,right precentral gyrus,precentral gyrus,postcentral gyrus,precuneus,cingulate.8.Acupuncture group after treatment and rehabilitation after treatment of motor function scale and precentral gyrus(BA 4),postcentral gyrus(BA,6)in the two groups in WOLF score were associated with the primary motor area(BA 4),premotor area(BA 6)are highly correlated,in which Fugl-Meyer and BBS score and BA 4 and BA 6 were positively correlated(P<0.05),and WPL and SA and BA 4,BA 6 showed a negative correlation(P<0.05).9.The results showed that the two groups in WOLF scores in rehabilitation group were with secondary motor area(BA 40)are highly correlated,in which Fugl-Meyer and BBS score and secondary motor area(BA 40)was positively correlated(P<0.05),and two groups of WPL and SA and WOLF score of acupuncture group and the secondary motor area(BA 40)showed a negative correlation(P<0.05).Conclusions1.Acupuncture intervention can improve the motor function,daily living ability and quality of life in patients with ischemic stroke with limb motor dysfunction.2.In healthy subjects,primary motor areas,premotor areas and secondary motor areas were significantly higher than those in patients with ischemic stroke and limb dysfunction.3.Acupuncture intervention to improve limb motor dysfunction in patients with ischemic stroke,motor function,balance function and ability of daily life and quality of life may be related to the increase in the primary motor cortex and premotor cortex and brain secondary motor areas of gray matter.