| 摘要: |
| [目的] 探讨针刺联合重复经颅磁刺激（rTMS）改善脑梗死（AIS）后运动功能障碍的临床疗效及其神经可塑性机制。[方法] 选取2022年3月—2025年3月收治的AIS后运动功能障碍患者160例，采用随机数字表法分为两组，对照组（80例）给予rTMS治疗，联合组（80例）在对照组基础上同时应用针刺疗法。比较两组Fugl-Meyer运动功能量表（FMA）、Berg平衡量表（BSS）、Holden功能性步行分级（FAC）、6 min步行试验（6MWT）、Barthel指数（BI）；分析运动功能恢复与脑血流动力学指标、神经生化指标及神经电生理指标的相关性。[结果] 治疗后联合组FMA评分、BSS评分、FAC分级、6MWT、BI均高于对照组（P < 0.05）；治疗后联合组大脑中动脉血流速度、基底动脉血流速度、椎动脉血流速度高于对照组（P < 0.05）；治疗后联合组BDNF、NGF高于对照组（P < 0.05）；治疗后联合组MEP波幅高于对照组，潜伏期低于对照组（P < 0.05）。相关分析显示，AIS患者FMA评分与大脑中动脉、基底动脉、椎动脉血流速度呈正相关（r=0.642、0.493、0.475，P < 0.001）；FMA评分与BDNF、NGF水平呈正相关（r=0.450、0.464，P < 0.001）；FMA评分与MEP波幅呈正相关，与MEP潜伏期呈负相关（r=0.718、-0.736，P < 0.001）。[结论] 针刺联合rTMS可有效改善AIS后运动功能障碍；改善脑血流动力学、促进神经营养因子表达、刺激运动皮层活性可能是其改善神经可塑性的主要机制。 |
| 关键词: 脑梗死 针刺 重复经颅磁刺激 运动功能障碍 神经可塑性 |
| DOI：10.11656/j.issn.1672-1519.2026.02.05 |
| 分类号:R743.3 |
| 基金项目:河南省中医药科学研究专项课题（20-21ZY3031） |
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| Study on the clinical efficacy and neural plasticity mechanism of acupuncture combined with repetitive transcranial magnetic stimulation in improving motor dysfunction after cerebral infarction |
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WANG Shan, WANG Fan
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Nanyang Central Hospital of Nanyang City Henan Province, Nanyang 473000, China
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| Abstract: |
| [Objective]To explore the clinical efficacy of acupuncture combined with rTMS in improving motor dysfunction after AIS and its neural plasticity mechanism.[Methods]The 160 patients with AIS postoperative motor dysfunction admitted from March 2022 to March 2025 were selected and randomly divided into two groups using a random number table method. The control group(80 cases) was treated with rTMS, and the combined group(80 cases)was simultaneously treated with acupuncture therapy on the basis of the control group. The scores of the Fugl-Meyer Motor Function Scale(FMA), Berg Balance Scale(BSS), Holden Functional Walking Scale (FAC), 6-minute Walk Test(6MWT), and Barthel Index(BI)were compared between the two groups. Analyze the correlation between the recovery of motor function and cerebral hemodynamic indicators, neurobiochemical indicators and neuroelectrophysiological indicators.[Results]After treatment, the FMA score, BSS score, FAC grade, 6MWT, and BI score of the combined group were higher than those of the control group(P < 0.05). After treatment, the blood flow velocities of the middle cerebral artery, basilar artery, and vertebral artery in the combined group were higher than those in the control group(P < 0.05). After treatment, the BDNF and NGF in the combined group were higher than those in the control group(P < 0.05). After treatment, the amplitude of MEP in the combined group was higher than that in the control group, and the latency was lower than that in the control group(P < 0.05). Relevant analysis showed that the FMA score of AIS patients was positively correlated with the blood flow velocities of the middle cerebral artery, basilar artery and vertebral artery(r=0.642, 0.493, 0.475, all P < 0.001). The FMA score was positively correlated with the levels of BDNF and NGF(r =0.450, 0.464;P < 0.001). The FMA score was Positively correlated with the amplitude(r=0.718, P < 0.001)and negatively correlated with the latency of MEP(r=-0.736, P < 0.001).[Conclusion]Acupuncture combined with rTMS can effectively improve motor dysfunction after AIS. Improving cerebral hemodynamics, promoting the expression of neurotrophic factors, and stimulating the activity of the motor cortex may be the main mechanisms by which it improves neural plasticity. |
| Key words: cerebral infarction acupuncture repetitive transcranial magnetic stimulation motor dysfunction neural plasticity |
