基于r-fMRI技术观察电针曲池、上巨虚对功能性肠病患者大脑的即刻效应
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摘要
目的以静息态功能性磁共振成像(r-f MRI)技术观察电针曲池、上巨虚穴对功能性肠病患者大脑功能活动模式的改变,为探索曲池、上巨虚穴治疗功能性肠病发挥效应的中枢机制提供影像学依据。方法选择功能性便秘患者20例为便秘组,功能性腹泻患者20例为腹泻组。便秘组采用电针上巨虚治疗,腹泻组采用电针曲池治疗,次日两组均取相关非经非穴点进行电针治疗。采集两组电针前后的静息态功能磁共振数据,以功能连接为观察指标,以右侧岛叶为种子点,运用MATLAB、DPARSF和REST等软件得到两组与种子点存在功能连接的脑区图像,进而分析两组自身经电针刺激前后脑功能连接的差异。结果电针刺激功能性便秘患者上巨虚穴可正激活左侧小脑后叶小脑山坡、左侧枕叶舌回、左侧枕叶枕中回、右侧枕叶、右侧顶叶缘上回、右侧穹窿回扣带回、左侧顶叶楔前叶;负激活右侧额叶Sub-Gyral、右侧岛叶、左侧岛叶。电针功能性腹泻患者曲池穴有显著差异的脑区为左侧小脑后叶山顶和左侧边缘叶后扣带回。结论电针曲池、上巨虚穴可引起功能性肠病患者大脑部分内脏高敏相关脑区功能连接的变化,提示针刺对功能性肠病患者的改善效应可能与此有关。
Objective By using resting-state f MRI(r-f MRI), to observe the effect of electroacupuncture at Quchi(LI 11) and Shangjuxu(ST 37) in changing brain activity pattern in functional bowel disorders(FBD), and to provide imaging evidence for seeking the central mechanism of Quchi(LI 11) and Shangjuxu(ST 37) in treating FBD. Method Twenty patients with functional constipation were taken as the constipation group, and 20 patients with functional diarrhea were taken as the diarrhea group. The constipation group was intervened by electroacupuncture at Shangjuxu(ST 37), while the diarrhea group was intervened by electroacupuncture at Quchi(LI 11). On the next day, the two groups both received electroacupuncture at the corresponding non-meridian point. The r-f MRI data of the two groups were collected before and after the interventions. With the functional connectivity taken as the observation index and right insular lobe as the seed point, MTLAB, DPARSF and REST were adopted to obtain the brain images functionally connected with the seed point, to further analyze the difference in brain functional connectivity before and after electroacupuncture. Result After electroacupuncture at Shangjuxu(ST 37), functional constipation patients presented positive activation in left cerebellar declive, left lingual gyrus, left middle occipital gyrus, right occipital lobe, right supramarginal gyrus, right gyrus cingula and left precuneus; the right subgyrus, right insular lobe and left insular lobe were negatively evoked. After electroacupuncture at Quchi(LI 11), patients with functional diarrhea showed significant differences in left cerebellar culmen and left posterior cingulate. Conclusion Electroacupuncture at Quchi(LI 11) and Shangjuxu(ST 37) can induce changes in brain functional connectivity related to visceral hypersensitivity in FBD patients, which is possibly associated with the effect of acupuncture in improving FBD.
Objective By using resting-state f MRI(r-f MRI), to observe the effect of electroacupuncture at Quchi(LI 11) and Shangjuxu(ST 37) in changing brain activity pattern in functional bowel disorders(FBD), and to provide imaging evidence for seeking the central mechanism of Quchi(LI 11) and Shangjuxu(ST 37) in treating FBD. Method Twenty patients with functional constipation were taken as the constipation group, and 20 patients with functional diarrhea were taken as the diarrhea group. The constipation group was intervened by electroacupuncture at Shangjuxu(ST 37), while the diarrhea group was intervened by electroacupuncture at Quchi(LI 11). On the next day, the two groups both received electroacupuncture at the corresponding non-meridian point. The r-f MRI data of the two groups were collected before and after the interventions. With the functional connectivity taken as the observation index and right insular lobe as the seed point, MTLAB, DPARSF and REST were adopted to obtain the brain images functionally connected with the seed point, to further analyze the difference in brain functional connectivity before and after electroacupuncture. Result After electroacupuncture at Shangjuxu(ST 37), functional constipation patients presented positive activation in left cerebellar declive, left lingual gyrus, left middle occipital gyrus, right occipital lobe, right supramarginal gyrus, right gyrus cingula and left precuneus; the right subgyrus, right insular lobe and left insular lobe were negatively evoked. After electroacupuncture at Quchi(LI 11), patients with functional diarrhea showed significant differences in left cerebellar culmen and left posterior cingulate. Conclusion Electroacupuncture at Quchi(LI 11) and Shangjuxu(ST 37) can induce changes in brain functional connectivity related to visceral hypersensitivity in FBD patients, which is possibly associated with the effect of acupuncture in improving FBD.
引文
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[14]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.
[15]宣利倩,许树长.前扣带回在精神应激诱发内脏高敏感中的作用及机制研究[J].国际消化病杂志,2015,35(5):356-357.
[16]王琨,曾祥柱,段丽萍.功能性磁共振成像技术在消化道内脏感知研究中的应用[J].北京大学学报(医学版),2006,38(6):657-659.
[17]刘宗,高峻,魏磊,等.炎症后内脏高敏感大鼠前扣带回皮质NR2A、NR2B表达变化[J].胃肠病学,2010,15(6):330-332.
[18]陈素清,吴斌,林希,等.幼鼠内脏痛高敏感性与不同脑区降钙素基因相关肽表达的关系[J].实用儿科临床杂志,2011,26(7):492-494.
[2]孙纪峰,陈懿.中医药治疗功能性便秘的临床研究进展[J].中华中医药学刊,2014,32(9):2268-2270.
[3]刘新光.解读功能性肠病罗马Ⅲ诊断标准[J].中国实用内科杂志,2006,26(21):1691-1692.
[4]高纺,盛红梅,张田宁,等.针刺上巨虚穴对慢传输型便秘小鼠结肠组织Cajal间质细胞数的影响[J].安徽中医药大学学报,2014,33(3):66-68.
[5]刘颖,陈仪琳.针刺上巨虚穴对人体生物能量信息的影响[J].中国针灸,2010,30(6):481-482.
[6]齐琳婧,苏同生,刘志顺,等.针刺曲池上巨虚治疗功能性肠病临床观察[J].陕西中医,2014,35(2):224-225.
[7]崔立红,彭丽华,杨云生.功能性胃肠病发病机制的研究进展[J].胃肠病学和肝病学杂志,2013,22(5):488-491.
[8]邵辉丽.静息态默认功能网络磁共振成像研究[J].中国医学影像技术,2009,25(Z1):201-203.
[9]沈笠雪.岛叶的结构与功能[J].国际神经病学神经外科学杂志,2012,39(4):393-394,封3-封4.
[10]Ladabaum U,Minoshima S,Owyang C.Pathobiology of visceral pain:molecular mechanisms and therapeutic implications V.Central nervous system processing of somatic and visceral sensory signals[J].Am J Physiol Gastrointest Liver Physiol,2000,279(1):G1-G6.
[11]Costa M,Brookes SH,Zagorodnyuk V.How many kinds of visceral afferents[J].Gut,2004,53(Suppl 2):ii1-ii4.
[12]刘迈兰,常小荣,袁宜勤.基于静息态功能磁共振技术研究针灸调节病理状态的进展[J].针刺研究,2014,39(5):418-420.
[13]陶然君.脑显像在胃肠功能性疾病中的应用进展[J].国外医学(消化系疾病分册),2002,22(2):79-81.
[14]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.
[15]宣利倩,许树长.前扣带回在精神应激诱发内脏高敏感中的作用及机制研究[J].国际消化病杂志,2015,35(5):356-357.
[16]王琨,曾祥柱,段丽萍.功能性磁共振成像技术在消化道内脏感知研究中的应用[J].北京大学学报(医学版),2006,38(6):657-659.
[17]刘宗,高峻,魏磊,等.炎症后内脏高敏感大鼠前扣带回皮质NR2A、NR2B表达变化[J].胃肠病学,2010,15(6):330-332.
[18]陈素清,吴斌,林希,等.幼鼠内脏痛高敏感性与不同脑区降钙素基因相关肽表达的关系[J].实用儿科临床杂志,2011,26(7):492-494.