梅花针治疗儿童弱视的神经影像学研究

In the previous studies, we have found the special curative effect of percussopunctator therapy on amplyopic children. In this study, we put forward a hypothesis that "percussopunctator plays the role of treatment by regulating visual evoked potential and improving the function of brain " in order to reveal mechanisms of this therapy. We will collect 250 cases, including ametropic and anisometropic amblyopic children who will be divided into two groups randomizedly.The control group will be treated by lens correction and other therapys .as the case.The percussopunctator group will be co-operated by percussopunctator therapy. Before and after treatment, we will observe vision correction,distance vision and diopter;use the technique of VEP to test the change of P100 wave amplitude and latency in order to reveal the effect on brain's function of this therapy; study the changes of plasticity of visual cortex by using multi-modal magnetic resonance imaging. We also hope to provide theoretical base of modern research for application of traditional medicine in ophthalmology and new ideas for studies on all kinds therapies about ophthalmological diseases in the future.

在确定了梅花针叩刺治疗儿童弱视的独特疗效的基础上，为揭示该方法治疗儿童弱视的基本作用机制，本课题组提出"梅花针治疗弱视是通过调节视觉诱发电位并改善脑功能来发挥作用"的工作假说。采集4-10岁的中、重度弱视病例，包括屈光不正和屈光参差型弱视250 例，随机分为两组，对照组视具体情况进行镜片矫正等基础治疗，梅花针治疗组在基础治疗上结合梅花针叩刺治疗。治疗前后观察患者矫正视力、裸眼远视力、屈光度；并采用VEP技术，测定患者治疗前后P100波的波幅及潜伏期变化曲线和数值，以揭示梅花针叩刺疗法对视功能的影响；采用多模态磁共振成像方法（脑结构、脑功能、弥散张量成像）进行对比观察，研究弱视儿童视皮层在治疗前后的可塑性改变，揭示梅花针对弱视患者脑可塑性变化的作用，探讨梅花针治疗弱视的内在神经康复机制。为独特的传统医学在眼科领域中的推广应用提供现代研究理论基础，并为各种治疗方法在眼科疾病中的研究提供新思路。

目的:探索梅花针治疗弱视在改善脑功能方面的作用机制。方法：采集8例5-9岁的屈光不正性弱视患者（均为右利手，5男3女），观察治疗前后患者矫正视力、裸眼远视力、屈光度；并采用VEP技术，测定患者治疗前后P100波的波幅及潜伏期变化曲线和数值；采用血氧水平依赖的功能磁共振成像（blood oxygenation dependent level functional MRI ，BOLD-fMRI）进行对比观察，研究弱视儿童视皮层在治疗前后的可塑性改变，揭示梅花针对弱视患者脑可塑性变化的作用。结果：8例患者10只弱视眼视力均有不同程度（2～4行）提高，其中6只眼（60%）视力达到正常；治疗后均转为中心注视（100%）；视觉敏感度值也得到改善。大脑枕叶、额内侧回、额上回、额中回、额下回、胼胝体、小脑后叶、颞中下回、脑桥、小脑扁桃体部等部位梅花针治疗信号比治疗前强。结论：梅花针治疗弱视有效，其起效机制可能是促进了高级视觉皮层中枢的代偿功能，同时治疗前后大脑视通路相关皮层激活范围与激活强度均存在显著差异，与其他相关脑区的联系也得以加强。