基于静息态脑功能成像技术(fMRI)研究针刺治疗原发性痛经的脑功能网络
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摘要
目的:研究针刺治疗原发性痛经的脑功能机理。方法:运用静息态功能磁共振成像(resting-state functional magnetic resonance imaging,Rf MRI)技术,在16名原发性痛经患者月经来潮的第1或第2天小腹疼痛时对其进行静息态扫描(Rest1,R1)、针刺双侧三阴交和地机穴后留针状态扫描(Acupuncture,AP)、去针后第2次静息态扫描(Rest2,R2)。应用低频振荡振幅(amplitude of low frequency fluctuation,ALFF)作为测量指标,对采集的Rf MRI数据进行相关的处理与统计分析。结果:(1)针刺后患者疼痛值(VAS评分)比针刺前明显降低(P<0.01);(2)R2与AP配对t检验结果显示:ALFF信号减弱(R2 Objective: The purpose of this study was to explore the possible brain functional network of acupuncture treatment on primary dysmenorrhea. Methods: This study adopted the technology of resting- state functional magnetic resonance imaging( Rf MRI). Sixteen patients of primary dysmenorrhea underwent f MRI scans( anatomical images scanning,the resting-state scanning( R1),the stimulating-acupoints( SP6 and SP8) scanning( AP) and the resting-state scanning( R2) after withdrawing the needles when they had the feeling of pain on the first or the second day onset of menstruation period to obtain the data of cerebral blood oxygen content,and the data of f MRI were statisticed and analyzed by softwares( MRI2. 0,FSL,AFNI,and so on). The amplitude of low frequency fluctuations was used as measurement index. Results:( 1) The value of pain after acupuncture was significantly lower than that before acupuncture( P < 0. 01);( 2) The two- sample paired t- tests indicated brain regions with differences in ALFF between R2 and AP. The decreased ALFF( R2
引文
[1]石学敏.针灸学[M].北京:中国中医药出版社,2007:259
[2]郑兆俭.针灸治疗原发性痛经疗效观察[J].浙江中西医结合杂志,2006,16(2):78~81
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[7]孙国杰.针灸学[M].上海:上海科学技术出版社,1997:37~41
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[15]Leopold DA,Murayama Y,Logothetis NK.Very slow activity fluctuations in monkey visual cortex:implications for functional brain imaging.Cereb Cortex,2003,13:422
[16]芮德源,陈立杰.临床神经解剖学[M].北京:人民卫生出版社,2007
[17]张吉,张宁.针刺镇痛机制的探讨[J].中国针灸,2007,27(1):72~75
[18]Huang XQ,Lui S,Deng W,et al.Localization of cerebral functional deficits in treatment-naive,first-episode schizophrenia using resting-state f MRI.Neuroimage 2010,49(4):2901~6
[19]Casey KL.Forebrain mechanisms of nociception and pain:Analysis through imaging.Proc.of the National Academy of Sciences of the United States of America,1999,96(14):7668~7674
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[21]Wu ZJ,Cai RL,Xu CS,Hu L,He L,Hu WB,et al.Study on the relative specificity of the heart and lung meridians in brain with f MRI.Zhongguo Zhenjiu,2011,31(6):529~34
[22]王友京,王双坤.不同强度和频率电针的镇痛效应[J].针刺研究,1993,1:44~47
[23]许建阳,闫镔,王葳,等.针刺合谷穴后效应的脑功能成像研究[J].上海针灸杂志,2005,24(10):33~35
[24]任路,孟安琪,鲁立宪.针刺关元俞加罐治疗血瘀型原发性痛经临床研究[J].中国中医药信息杂志,2001,8(3):73
[2]郑兆俭.针灸治疗原发性痛经疗效观察[J].浙江中西医结合杂志,2006,16(2):78~81
[3]王淑贞.实用妇产科学[M].北京:人民卫生出版社,1987:803
[4]邓海霞,朱南孙,王采文,等.加味没竭片对原发性痛经患者经期血浆催产素的影响[J].中国中西医结合杂志,2003,(5):354~356
[5]彭芝配,腾久祥,马薇,等.理气活血止痛法与痛经大鼠β-内啡肽的相关性研究[J].中国中西医结合急救杂志,2001,8(6):353
[6]Chen FP,Soong YK.The efficacy and complication of laparoscopic presacral neuretomy in pelvic pain[J].Obstet Gynecol,1997,90(6):974~977
[7]孙国杰.针灸学[M].上海:上海科学技术出版社,1997:37~41
[8]任蓉,庄礼兴.电针对原发性痛经子宫动脉血流动力学和血液流变学的影响[J].中华中医药学刊,2010,28(3):649~651
[9]曾燕,梁勋厂.从脑功能成像看针刺作用的中枢机制[J].中国针灸,2004,24(2):143
[10]Mazoyer B,Zago L,Mellet E,et al..Cortical networks for working memory and executive functions sustain the conscious resting state in man.Brain Res Bull.2001,54(3):287~98
[11]Raichle ME,Mac Leod AM,Snyder AZ,Powers WJ,Gusnard DA,Shulman GL.A default mode of brain function.Proc Natl Acad Sci U S A,2001,98(2):676~82
[12]Greicius MD,Krasnow B,Reiss AL,Menon V.Functional connectivity in the resting brain:a network analysis of the default mode hypothesis.Proc Natl Acad Sci U S A.2003,100(1):253~8
[13]Gusnard DA,Akbudak E,Shulman GL,Raichle ME.Medial prefrontal cortex and self-referential mental activity:relation to a default mode of brain function.Proc Natl Acad Sci U S A,2001,98(7):4259~64
[14]Zang YF,He Y,Zhu CZ,et al.Altered baseline brain activity in children with ADHD Revealed by resting-state funtional MRI[J].Brain&Development,2007,29:83~91
[15]Leopold DA,Murayama Y,Logothetis NK.Very slow activity fluctuations in monkey visual cortex:implications for functional brain imaging.Cereb Cortex,2003,13:422
[16]芮德源,陈立杰.临床神经解剖学[M].北京:人民卫生出版社,2007
[17]张吉,张宁.针刺镇痛机制的探讨[J].中国针灸,2007,27(1):72~75
[18]Huang XQ,Lui S,Deng W,et al.Localization of cerebral functional deficits in treatment-naive,first-episode schizophrenia using resting-state f MRI.Neuroimage 2010,49(4):2901~6
[19]Casey KL.Forebrain mechanisms of nociception and pain:Analysis through imaging.Proc.of the National Academy of Sciences of the United States of America,1999,96(14):7668~7674
[20]Mohr C,Binkofski F,Erdmann C,et a1.The anterior cingulate cortex contains distinct areas dissociating external from self-administered painful stimulation:a parametric f MRI study.Pain 2005;114(3):347~357
[21]Wu ZJ,Cai RL,Xu CS,Hu L,He L,Hu WB,et al.Study on the relative specificity of the heart and lung meridians in brain with f MRI.Zhongguo Zhenjiu,2011,31(6):529~34
[22]王友京,王双坤.不同强度和频率电针的镇痛效应[J].针刺研究,1993,1:44~47
[23]许建阳,闫镔,王葳,等.针刺合谷穴后效应的脑功能成像研究[J].上海针灸杂志,2005,24(10):33~35
[24]任路,孟安琪,鲁立宪.针刺关元俞加罐治疗血瘀型原发性痛经临床研究[J].中国中医药信息杂志,2001,8(3):73