基于fMRI技术的急性脑卒中中药早期脑保护的认知神经机制研究

Acute ischemic stroke often cause serious cognitive impairment, western medicine treatment has poor efficacy and traditional Chinese medicine (TCM) has favorable curative effect on it. TCM has significant adjustment role in brain function remodeling. However, the neuromechanism remains unclear. This study aims to investigate the effects of Chinese medicine Xueshuan Xinmaining tablets (XXMT) of benefiting qi for activating blood circulation on functional brain network and integrity of white matter fiber bundle for neuromechanism using neuroimaging technology in acute ischemic stroke patients. Sixty acute ischemic stroke patients were randomly classified into XXMT treatment group (thirty patients) and placebo control group (thirty patients). The patients received drug for three weeks and will be undergo follow-up examination at three months. Before and after the treatment and follow-up examination, the therapeutic effectall and cognition of patients were evaluated by common stroke scale and neuropsychological tests, respectively. The resting state imaging data from functional magnetic resonance imaging (fMRI) will be analyzed to obtain the chages of functional brain network. The study will provide insights into neuromechanism of XXMT in improving cognition in acute ischemic stroke patients. As far as we know, there were few reports about the research in TCM field and the study will play an important role in neuromechanism of cognitive impairment treatment by TCM.

急性缺血性脑卒中通常导致严重的认知功能损伤，目前常规西药治疗效果欠佳，中医药在此方面具有一定优势，对患者脑功能重塑具有显著调节作用，但其作用机制尚不清楚，尤其缺乏深入的脑机制研究。本研究拟采用现代脑神经影像技术，观察益气活血复方中药血栓心脉宁片对急性缺血性脑卒中患者脑功能网络和白质纤维束结构完整性的影响，以期深入阐明中药血栓心脉宁片干预缺血性脑卒中认知障碍的神经机制。研究拟纳入60例急性缺血性脑卒中患者，随机分为中药血栓心脉宁治疗组和安慰剂对照组，每组30例，治疗3周及随访3个月后，采用常用脑卒中量表评价药物的疗效，采用神经心理学量表测评患者治疗前后的认知功能；以静息态功能磁共振方法确定复方中药血栓心脉宁片的作用脑区，获得中药血栓心脉宁治疗组患者的脑功能网络变化特征，最终明确益气活血复方中药血栓心脉宁片改善急性缺血性脑卒中患者认知功能的脑神经机制。本研究引入现代脑神经影像学理论和技术，在中医药研究领域鲜有报道，对于阐明中药的脑作用机制、中药干预认知障碍性疾病的机制，具有重要意义。

中医药在缺血性脑卒中的治疗方面具有一定优势，对患者的神经损伤、认识损伤和脑功能重塑具有改善作用，但其作用机制尚不清楚，缺乏深入的脑机制研究。本研究应用行为学量表结合功能磁共振技术探讨了益气活血复方中药改善缺血性脑卒中患者神经功能损伤、生活质量和认知损伤的脑神经机制。采用常用脑卒中量表、神经心理学量观察了益气活血复方中药对缺血性脑卒中患者行为学的影响，结果显示，与对照组相比，中药组患者的NIHSS得分明显降低，SS-QOL和复杂图形回忆测评得分明显增加。采用功能磁共振技术和组间主成分分析方法对患者脑区激活和功能连接进行了分析，结果显示，与对照组相比，中药组患者默认网络中右侧额叶、左侧楔前叶功能连接增强，额顶网络中左侧顶叶中央后回功能连接增强，差异具有统计学意义。行为学量表得分与功能连接值的相关性分析结果显示，左侧楔前叶功能连接值与NIHSS和SSQOL量表得分显著相关，SSQOL量表得分与两侧顶下小叶功能连接值显著相关。研究结果表明，益气活血复方中药通过增强静息态默认网络、额顶网络和运动控制网络的功能连接改善缺血性脑卒中患者的神经功能损伤、生活质量和认知功能损伤。本研究揭示了益气活血复方中药对缺血性脑卒中脑保护作用的神经机制，对中药脑保护作用的药理机制研究具有一定的参考价值。