功能核磁在针刺改善脑功能治疗功能性便秘中的应用及进展
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摘要
功能性便秘涉及中枢神经和肠自主神经间复杂的交互作用。功能性便秘患者存在不同程度的精神和心理等脑功能障碍的表现,脑功能异常对胃肠活动异常加工和调节起非常关键的作用,对功能性便秘的发生发展至关重要。以功能性便秘为代表的胃肠道疾病一直是针刺临床的优势和有效病种,针刺能改善功能性便秘的临床症状,能特异性激活或负激活相应脑功能区,在针刺治疗过程中,功能核磁为功能性便秘发挥效应的中枢机制提供了影像学依据。本文旨在概述功能性便秘患者脑功能变化和功能核磁在此疾病应用中研究进展,以进一步探究其发病机制。
Functional constipation has complex interactions among central autonomic nervous and intestinal nerve system.Patients with functional constipation have different degrees of mental and psychological dysfunction.Abnormal brain function plays a key role in processing and regulating abnormal gastrointestinal activities and is crucial to the occurrence and development of functional constipation.Acupuncture can improve the clinical symptoms of functional constipation and specifically activate or negatively activate corresponding brain functional areas.In the course of acupuncture treatment,functional MRI provides the imaging basis of the central mechanism of functional constipation.In this paper,the pathophysiology of functional constipation related to brain and its research progress of f MRI were reviewed.
Functional constipation has complex interactions among central autonomic nervous and intestinal nerve system.Patients with functional constipation have different degrees of mental and psychological dysfunction.Abnormal brain function plays a key role in processing and regulating abnormal gastrointestinal activities and is crucial to the occurrence and development of functional constipation.Acupuncture can improve the clinical symptoms of functional constipation and specifically activate or negatively activate corresponding brain functional areas.In the course of acupuncture treatment,functional MRI provides the imaging basis of the central mechanism of functional constipation.In this paper,the pathophysiology of functional constipation related to brain and its research progress of f MRI were reviewed.
引文
[1]DROSSMAN DA,HASLER WL.ROME IV-Functional GIDisorders:Disorders of Gut-Brain Interaction[J].Gastroenterology,2016,150(6):1257-1261.
[2]MAYER EA.Gut feelings:the emerging biology of gut-brain communication[J].Nat Rev Neurosci,2011,12(8):453-466.
[3]JIN Y,ZHAO Q,ZHOU K,et al.Acupuncture for functional dyspepsia:a single blinded,randomized,controlled trial[J].Evid Based Complement Alternat Med,2015:1-9.
[4]SUN J,WU X,MENG Y,et al.Electro-acupuncture decreases 5-HT,CGRP and increases NPY in the brain-gut axis in two rat models of diarrhea-predominant irritable bowel syndrome(D-IBS)[J].BMC Complement Altern Med,2015,15(1):340.
[5]DA N,WANG X,LIU H,et al.The effectiveness of electroacupuncture for functional constipation:a randomized,controlled,clinical trial[J].Evid Based Comple-ment Alternat Med,2015,3(10):1155.
[6]TILLISCH K,MAYER EA,LABUS JS.Quantitative metaanalysis identifies brain regions activated during rectal distension in irritable bowel syndrome[J].Gastroenterology,2011,140(1):91-100.
[7]KESZTHELYI D,TROOST FJ,MASCLEE AA.Irritable bowel syndrome:methods,mechanisms,and pathophysiology.Methods to assess visceral hypersensitivity in irritable bowel syndrome[J].Am J Physiol Gastrointest Liver Physiol,2012,303(2):G141-G154.
[8]HUBBARD CS,LABUS JS,BUELLER J,et al.Corticotropinreleasing factor receptor 1 antagonist alters regional activation and effective connectivity in an emotional-arousal circuit during expectation of abdominal pain[J].J Neurosci,2011,31(35):12491-12500.
[9]BLANKSTEIN U,CHEN J,DIAMANT NE,et al.Altered brain structure in irritable bowel syndrome:potential contributions of pre-existing and disease-driven factors[J].Gastroenterology,2010,138(5):1783-1789.
[10]HOSSEINZADEH ST,POORSAADATI S,RADKANI B,et al.Psychological disorders in patients with chronic constipation[J].Gastroenterol Hepatol Bed Bench,2011,4(3):159-163.
[11]朱丽明,方秀才,刘诗,等.全国多中心慢性便秘患者情绪和睡眠状况的调查[J].中华医学杂志,2012,92(32):2243-2246.
[12]DING C,GE X,ZHANG X,et al.Efficacy of synbiotics in patients with slow transit constipation:a prospective randomized trial[J].Nutrients,2016,8(10):605-607.
[13]迟玉花,赵刚.功能性便秘动力学改变与情志因素的相关性[J].世界华人消化杂志,2012,20(18):1685-1689.
[14]叶彬,陈春晓.老年住院慢性便秘患者的焦虑抑郁状态和睡眠状况[J].中国老年学杂志,2016,4(36):1996-1998.
[15]陈怀俊,对便秘患者进行精神病学评估的临床意义探究[J].当代医药论丛,2014,12(21):195-196.
[16]XIAOYI LI,RUI FENG,HAO WU,et al.Psychological characteristics and Go Nogo research of patients with functional constipation[J].Medicine,2016(95):52.
[17]SHEEHAN J,GAMAN A,VANGEL M,et al.Pooled analysis of brain activity in irritable boeel syndrome and controls during rectal balloon distension[J].Neurogastroenterology Motility,2011,23(4):336-e158.
[18]ZENG F,QIN W,LIANG F,et al.Abnomal resting brain activity in patients with functional dysepsia is related ti symptom severity[J].Gastroenterology,2011,141(2):499-506.
[19]SEMINOWICA DA,LABUD JS,et al.Regional gray matter density changes in brains of patients with irritable bowel syndrome[J].Gastroenterology,2006,131(6):1925-1942.
[20]Q ZHU,W CAI,J ZHENG,et al.Distinct resting-state brain activity in patients with functional constipation[J].Neuroscience Letters,2016(632):141-146.
[21]XIAOFEN MA,SHUMEI LI,JUNZHANG TIAN,et al.Altered brain spontaneous activity and connectivity network in irritable bowel syndrome patients:A resting-state f MRI study[J].Clinical Neurophysiology,2015(126):1190-1197.
[22]MAYER EA.Gut feelings:the emerging biology of gut-brain communication[J].Nat Rev Neurosci,2011,12(8):453-466.
[23]MAYER EA,NALIBOFF BD,CRAIG AD.Neuroimaging of the brain-gut axis:from basic understanding to treatment of functional GI disorders[J].Gastroenterology,2006,131(6):1925-1942.
[24]HUBBARD CS,LABUS JS,BUELLER J,et al.Corticotropinreleasing factor receptor 1 antagonist alters regional activation and effective connectivity in an emotional-arousal circuit during expectation of abdominal pain[J].J Neurosci,2011,31(35):12491-12500.
[25]LARSSON MB,TILLISCH K,CRAIG AD,et al.Brain responses to visceral stimuli reflect visceral sensitivity thresholds in patients with irritable bowel syndrome[J].Gastroenterology,2012,142:463-472.
[26]DAVIDSON RJ.Affective neuroscience and psychophysiology:toward a synthesis[J].Psychophysiology,2003,40(5):655-665.
[27]罗荣.电针大肠下合穴上巨虚对功能性便秘患者r-fMRI脑功能连接即刻效应的影响[D].长沙:湖南中医药大学,2013.
[28]万坚,朱莉,周慧,等.功能性消化不良患者水负荷试验时大脑感知作用的f MRI研究[J].胃肠病学,2011,16(12):721-723.
[29]GAO J,WU XY,OWYANG C,LI Y.Enhanced responses of the anterior cingulate cortex neurons to colonic distension in viscerally hypersensitive rats[J].J Physiol,2006,570(Pt1):169-183.
[30]MAYER EA,Gut feeling:the emerging biology of gut-brain communication[J].Nature Reviews Neuroscience,2011,12(8):453-466.
[31]MAYER EA,NALIBOFF BD.Neuroimaging of the brain-gut axis:from basic understanding to treatment of functional GIdisorders[J].Gastroenterology,2006,131(6):1925-1942.
[32]LI SIYUAN,et al.Use acupuncture to treatment functional constipation:study protocol for a randomized controlled trial[J].Trials,2012,14(1):104.
[33]TAYLOR KS,SEMINOWICZ DA,DAVIS KD.Two systems of resting state connectivity between the insula and cingulate cortex[J].Human brain mapping,2009,30(9):2731-2745.
[34]李东垣.脾胃论[M].靳国印,校注.北京:中国医药科技出版社,2011.
[35]王泽文,王锡宁.颈上人与颈下人的解剖对称性研究[J].科技信息,2008,25(36):606.
[36]徐丽娜,任翱翔,李颖,等.功能磁共振成像技术对针刺老年人支沟穴的中枢响应特征研究[J].老年医学与保健,2018,24(2):164-166.
[37]曾琳岚,吴巧风.老年性便秘针灸治疗进展[J].四川中医,2014,32(3):176-179.
[38]吴巧风,徐世珍,颜贤忠,等.足阳明经穴特异性的代谢组学模式识别研究[J].上海针灸杂志,2010,29(9):552-555.
[39]CHO ZH,CHUNG SC,JONES JP.New findings of the correlation between acupoints and corresponding brain cortices using functional MRI[J].Proc Natl Acad Sci U S A,1998,95(5):2670-2673.
[40]张智龙,吉学群,赵淑华,等.电针支沟穴治疗便秘之气秘多中心随机对照研究[J].中国针灸,2007,27(7):475-478.
[41]PAUL J KENNEDY,GERARD CLARKE,EAMONN M M,et al.Dinan,John F.Cryan.Gut memories:Towards a cognitive neurobiology of irritable bowel syndrome[J].Neuroscience and Biobehavioral Reviews,2012(36):310-340.
[42]MICHELE CRUMEYROLLE-ARIAS,MATHILDE JAGLIN,AURE LIA BRUNEAU,et al.Absence of the gut microbiota enhances anxiety-like behavior and neuroendocrine response to acute stress in rats[J].Psychoneuroendocrinology,2014(42):207-217.
[43]WATERS AM,SCHILPZAND E,BELL C,et al.Functional gastrointestinal symptoms in children with anxiety disorders[J].JAbnorm Child Psychol,2013,41(1):151-163.
[44]DONG YY,CHEN FX,YU YB,et al.A school-based study with Rome III criteria on the prevalence of functional gastrointestinal disorders in Chinese college and university students[J].PLo S One,2013,8(1):2-10.
[2]MAYER EA.Gut feelings:the emerging biology of gut-brain communication[J].Nat Rev Neurosci,2011,12(8):453-466.
[3]JIN Y,ZHAO Q,ZHOU K,et al.Acupuncture for functional dyspepsia:a single blinded,randomized,controlled trial[J].Evid Based Complement Alternat Med,2015:1-9.
[4]SUN J,WU X,MENG Y,et al.Electro-acupuncture decreases 5-HT,CGRP and increases NPY in the brain-gut axis in two rat models of diarrhea-predominant irritable bowel syndrome(D-IBS)[J].BMC Complement Altern Med,2015,15(1):340.
[5]DA N,WANG X,LIU H,et al.The effectiveness of electroacupuncture for functional constipation:a randomized,controlled,clinical trial[J].Evid Based Comple-ment Alternat Med,2015,3(10):1155.
[6]TILLISCH K,MAYER EA,LABUS JS.Quantitative metaanalysis identifies brain regions activated during rectal distension in irritable bowel syndrome[J].Gastroenterology,2011,140(1):91-100.
[7]KESZTHELYI D,TROOST FJ,MASCLEE AA.Irritable bowel syndrome:methods,mechanisms,and pathophysiology.Methods to assess visceral hypersensitivity in irritable bowel syndrome[J].Am J Physiol Gastrointest Liver Physiol,2012,303(2):G141-G154.
[8]HUBBARD CS,LABUS JS,BUELLER J,et al.Corticotropinreleasing factor receptor 1 antagonist alters regional activation and effective connectivity in an emotional-arousal circuit during expectation of abdominal pain[J].J Neurosci,2011,31(35):12491-12500.
[9]BLANKSTEIN U,CHEN J,DIAMANT NE,et al.Altered brain structure in irritable bowel syndrome:potential contributions of pre-existing and disease-driven factors[J].Gastroenterology,2010,138(5):1783-1789.
[10]HOSSEINZADEH ST,POORSAADATI S,RADKANI B,et al.Psychological disorders in patients with chronic constipation[J].Gastroenterol Hepatol Bed Bench,2011,4(3):159-163.
[11]朱丽明,方秀才,刘诗,等.全国多中心慢性便秘患者情绪和睡眠状况的调查[J].中华医学杂志,2012,92(32):2243-2246.
[12]DING C,GE X,ZHANG X,et al.Efficacy of synbiotics in patients with slow transit constipation:a prospective randomized trial[J].Nutrients,2016,8(10):605-607.
[13]迟玉花,赵刚.功能性便秘动力学改变与情志因素的相关性[J].世界华人消化杂志,2012,20(18):1685-1689.
[14]叶彬,陈春晓.老年住院慢性便秘患者的焦虑抑郁状态和睡眠状况[J].中国老年学杂志,2016,4(36):1996-1998.
[15]陈怀俊,对便秘患者进行精神病学评估的临床意义探究[J].当代医药论丛,2014,12(21):195-196.
[16]XIAOYI LI,RUI FENG,HAO WU,et al.Psychological characteristics and Go Nogo research of patients with functional constipation[J].Medicine,2016(95):52.
[17]SHEEHAN J,GAMAN A,VANGEL M,et al.Pooled analysis of brain activity in irritable boeel syndrome and controls during rectal balloon distension[J].Neurogastroenterology Motility,2011,23(4):336-e158.
[18]ZENG F,QIN W,LIANG F,et al.Abnomal resting brain activity in patients with functional dysepsia is related ti symptom severity[J].Gastroenterology,2011,141(2):499-506.
[19]SEMINOWICA DA,LABUD JS,et al.Regional gray matter density changes in brains of patients with irritable bowel syndrome[J].Gastroenterology,2006,131(6):1925-1942.
[20]Q ZHU,W CAI,J ZHENG,et al.Distinct resting-state brain activity in patients with functional constipation[J].Neuroscience Letters,2016(632):141-146.
[21]XIAOFEN MA,SHUMEI LI,JUNZHANG TIAN,et al.Altered brain spontaneous activity and connectivity network in irritable bowel syndrome patients:A resting-state f MRI study[J].Clinical Neurophysiology,2015(126):1190-1197.
[22]MAYER EA.Gut feelings:the emerging biology of gut-brain communication[J].Nat Rev Neurosci,2011,12(8):453-466.
[23]MAYER EA,NALIBOFF BD,CRAIG AD.Neuroimaging of the brain-gut axis:from basic understanding to treatment of functional GI disorders[J].Gastroenterology,2006,131(6):1925-1942.
[24]HUBBARD CS,LABUS JS,BUELLER J,et al.Corticotropinreleasing factor receptor 1 antagonist alters regional activation and effective connectivity in an emotional-arousal circuit during expectation of abdominal pain[J].J Neurosci,2011,31(35):12491-12500.
[25]LARSSON MB,TILLISCH K,CRAIG AD,et al.Brain responses to visceral stimuli reflect visceral sensitivity thresholds in patients with irritable bowel syndrome[J].Gastroenterology,2012,142:463-472.
[26]DAVIDSON RJ.Affective neuroscience and psychophysiology:toward a synthesis[J].Psychophysiology,2003,40(5):655-665.
[27]罗荣.电针大肠下合穴上巨虚对功能性便秘患者r-fMRI脑功能连接即刻效应的影响[D].长沙:湖南中医药大学,2013.
[28]万坚,朱莉,周慧,等.功能性消化不良患者水负荷试验时大脑感知作用的f MRI研究[J].胃肠病学,2011,16(12):721-723.
[29]GAO J,WU XY,OWYANG C,LI Y.Enhanced responses of the anterior cingulate cortex neurons to colonic distension in viscerally hypersensitive rats[J].J Physiol,2006,570(Pt1):169-183.
[30]MAYER EA,Gut feeling:the emerging biology of gut-brain communication[J].Nature Reviews Neuroscience,2011,12(8):453-466.
[31]MAYER EA,NALIBOFF BD.Neuroimaging of the brain-gut axis:from basic understanding to treatment of functional GIdisorders[J].Gastroenterology,2006,131(6):1925-1942.
[32]LI SIYUAN,et al.Use acupuncture to treatment functional constipation:study protocol for a randomized controlled trial[J].Trials,2012,14(1):104.
[33]TAYLOR KS,SEMINOWICZ DA,DAVIS KD.Two systems of resting state connectivity between the insula and cingulate cortex[J].Human brain mapping,2009,30(9):2731-2745.
[34]李东垣.脾胃论[M].靳国印,校注.北京:中国医药科技出版社,2011.
[35]王泽文,王锡宁.颈上人与颈下人的解剖对称性研究[J].科技信息,2008,25(36):606.
[36]徐丽娜,任翱翔,李颖,等.功能磁共振成像技术对针刺老年人支沟穴的中枢响应特征研究[J].老年医学与保健,2018,24(2):164-166.
[37]曾琳岚,吴巧风.老年性便秘针灸治疗进展[J].四川中医,2014,32(3):176-179.
[38]吴巧风,徐世珍,颜贤忠,等.足阳明经穴特异性的代谢组学模式识别研究[J].上海针灸杂志,2010,29(9):552-555.
[39]CHO ZH,CHUNG SC,JONES JP.New findings of the correlation between acupoints and corresponding brain cortices using functional MRI[J].Proc Natl Acad Sci U S A,1998,95(5):2670-2673.
[40]张智龙,吉学群,赵淑华,等.电针支沟穴治疗便秘之气秘多中心随机对照研究[J].中国针灸,2007,27(7):475-478.
[41]PAUL J KENNEDY,GERARD CLARKE,EAMONN M M,et al.Dinan,John F.Cryan.Gut memories:Towards a cognitive neurobiology of irritable bowel syndrome[J].Neuroscience and Biobehavioral Reviews,2012(36):310-340.
[42]MICHELE CRUMEYROLLE-ARIAS,MATHILDE JAGLIN,AURE LIA BRUNEAU,et al.Absence of the gut microbiota enhances anxiety-like behavior and neuroendocrine response to acute stress in rats[J].Psychoneuroendocrinology,2014(42):207-217.
[43]WATERS AM,SCHILPZAND E,BELL C,et al.Functional gastrointestinal symptoms in children with anxiety disorders[J].JAbnorm Child Psychol,2013,41(1):151-163.
[44]DONG YY,CHEN FX,YU YB,et al.A school-based study with Rome III criteria on the prevalence of functional gastrointestinal disorders in Chinese college and university students[J].PLo S One,2013,8(1):2-10.
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