基于复杂脑网络的针刺改善脑卒中肢体麻木效应机制的时空模态研究

Stroke is a disease with high morbidity and disability rate. It often leaves behind sensorimotor disorders. Based on our previous brain network researches on motor disorders post stroke and sensory related networks, this project focuses on somatosensory disorders as limb numbness in chronic stroke patients. And the mechanism of double effect in theory of “co-regulation of the body and the spirit” in acupuncture is emphasized by this project, while focusing on the thalamocortical circuit and sensorimotor network. Twenty-four chronic stroke patients with limb numbness will be recruited as the research group and healthy persons are matched as the control group. Data will be collected before and after acupuncture intervention including EEG examination and fMRI scan, with features of which are the combination of both high temporal and spatial resolution. The parameters of structural and functional connectivity network based on the thalamocortical circuit and sensorimotor network will be further analyzed. The complex brain network will be constructed on the basis of structural connection and functional connection analysis, and data mining will be carried out by using Inter-Subject Functional Correlation (ISFC) in acupuncture task state fMRI. Firstly, the characteristics of spatio-temporal modality of brain network in chronic stroke patients with limb numbness will be described. The local spatio-temporal dynamic changes and the entire property alters of complex brain network, both of which caused by the persistent effect of acupuncture in stroke patients with limb numbness will also be further explored. Besides, with the application of frontier method of data analysis, Group-crossed brain network response result from the instant effect of acupuncture will be excavated. This study will provide further convinced proof for the effect of acupuncture in accelerating the activation of transcortical in sensorimotor cortex induced by the sensory stimulation, and the mechanism of double effect in theory of “co-regulation of the body and the spirit” in acupuncture. In order to promote the internationalization application of acupuncture in the sensorimotor function rehabilitation during the sequelae of stroke.

脑卒中是高发病率和高致残率的疾病，常遗留感觉运动障碍，基于前期团队在脑卒中运动障碍和感觉相关网络的脑网络研究，本项目着眼于脑卒中肢体麻木的感觉障碍患者，以针刺“形神并调”的双重效应机制为切入点，重点关注丘脑皮质环路和感觉运动网络，拟选取24例脑卒中后遗症期肢体麻木患者为研究对象，匹配健康人作为对照；联合高时间分辨率的EEG和高空间分辨率的fMRI采集针刺干预前后数据，围绕丘脑皮层环路和感觉运动网络构建结构和功能连接网络，进一步分析复杂网络属性。力求描绘脑卒中肢体麻木感觉障碍患者的脑网络时空模态特点，阐明针刺的持续效应在局部脑网络和整体复杂脑网络层面引起的时空动态改变，借助前沿数据分析方法，深入挖掘针刺的即时效应对丘脑皮质环路引起的群体脑网络响应模态。为针刺“形神并调”的双重效应机制增加感觉诱发的跨感觉运动皮层功能激活提供新的力证，促进针刺在脑卒中后遗症期整体感觉运动功能康复的国际化推广。

肢体麻木是脑卒中感觉障碍的常见症状，在肢体麻木康复中丘脑皮层环路的重塑是影响远期整体感觉运动功能康复的关键因素。针刺“形神共调”的双重效应机制在局部丘脑皮层环路、感觉运动网络和整体复杂脑网络的时空模态重塑机制，是亟待解决的重要科学问题。联合EEG和fMRI基于复杂网络分析在时空维度探索针刺的双重效应机制，应用被试间功能相关算法（ISFC）挖掘连续针刺状态下的群体脑响应。本研究以脑卒中后遗症期肢体麻木患者作为研究对象，同时以年龄性别匹配的健康人做为对照。两组均接受针刺干预方案并进行针刺前后的EEG联合fMRI检查，以远红外热成像结合量表对临床信息评价，应用前沿数据分析方法，重点关注丘脑皮层环路与感觉运动网络，对针刺“形神共调”双重效应机制在脑卒中后遗症期肢体麻木患者的局部和整体脑网络在结构和功能可塑性等科学问题开展进一步的研究。结果发现发现脑卒中后遗症期肢体麻木患者在大脑中央前回、中央后回、岛盖部额下回、颞上回的局部一致性增强，颞中回的局部一致性减弱，表明在脑卒中后遗症期大脑皮质存在损伤与功能重塑，且以功能重塑为主。同时以中央前回和中央后回为感觉运动网络的关键节点，可用于后续网络特征分析。针刺的持续性效应神经影像机制表现为，在整体上增加以感觉运动区为主的脑区及与其他脑区间的连通性；在局部一致性的表现中，以丘脑、岛叶、小脑、小脑蚓部、中央后回等丘脑皮层环路与感觉运动网络分布脑区的神经元活动的增强，从而提高患者的感觉运动功能及认知控制能力。针刺的持续性效应神经电生理机制主要涉及整体方面上，枕叶-顶叶、顶叶之间、中央区-顶叶、额叶-颞叶、额叶之间脑电信号同步性增强。在局部方面表现出额区β波功率有较好的一致性。中医体质学量表结合经颅多普勒脑血流检查对中风后肢体麻木的患者的脑血流评价中，通过进一步挖掘TCD评价参数，并应用机器学习在对脑血流动力学的中医特征参数可进行有效判别，对于进一步指导中医药治疗脑血管具有诊断判别意义。