基于动脉自旋标记技术观察针刺对不同敏感度体质人群压痛阈影响的中枢效应
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摘要
目的:观察不同敏感度体质对针刺镇痛效应的影响,运用脑功能磁共振动脉自旋标记(fMRIASL)技术,观察不同体质影响针刺镇痛效应的脑区激活变化特征,探讨体质因素影响针刺效果的中枢响应机制。方法:按标准筛选对针刺不同敏感度受试者,分为不敏感组20例和敏感组20例。针刺受试者左侧足三里穴,测定针刺前后两组受试者的体表压痛阈(PPT),比较两组针刺后的镇痛效应和PPT变化率;行脑功能磁共振ASL扫描,应用SPM 8、ASLtbx等软件对结果进行预处理,Pearson相关分析法分析局部脑血流(rCBF)与针感视觉模拟量尺(VAS)评分的相关性。结果:敏感组受试者的针感VAS评分显著高于不敏感组(P<0.05);针刺后敏感组的PPT变化率大于不敏感组(P<0.05)。不敏感组激活脑区包括右侧海马旁回、左侧海马、胼胝体、左侧扣带回中部、右侧扣带回中部、额叶、右侧扣带回前部等,敏感组激活脑区包括双侧扣带回中部、双侧扣带回后部、颞叶、右侧海马、丘脑、额中回、双侧扣带回前部、内侧额上回、左侧扣带回前部等。相关分析结果显示,不敏感组右侧扣带回前部和敏感组内侧额上回rCBF与VAS评分存在负相关(r>0.3,P<0.05)。结论:不同针刺敏感度体质是影响针刺镇痛效应的重要因素,敏感组针刺镇痛的疗效优于不敏感组,针刺可能使不同大脑功能区负激活而产生镇痛效应,内侧额上回、双侧前扣带回的负激活对敏感体质人群的针刺镇痛效应起到积极作用,这可能是针刺敏感体质人群针刺镇痛的中枢效应脑区之一。
Objective To examine the effects of different sensitivities on the effectiveness of acupuncture analgesia by observing activation change characteristics of cerebral areas resulting from the influences of constitutions on analgesia effects and to discuss the response mechanism of central nervous system(CNS)to determine the factor of constitutions on acupuncture efficacy using cerebral functional magnetic resonance imaging arterial spin labeling(fMRI-ASL).Methods Participants with different sensitivities were assessed according to standard screening and grouped into two groups:insensitivity group(n=24)and sensitivity group(n=22).All participants were given acupuncture at the left-sided Zusanli point.Pressure pain threshold(PPT)of their body surface was determined before and after the acupuncture,and the two groups were subsequently compared in terms of analgesic effects and PPT rate of change;cerebral fMRI-ASL was performed;software such as SPM 8 and ASLtbx were utilized to preprocess the results,and correlation between regional cerebral blood flow(rCBF)and visual analog scale(VAS)score was determined using Pearson's correlational analysis.Results VAS score in the sensitivity group was significantly higher than that in the insensitivity group(P< 0.05);after acupuncture,PPT rate of change in the sensitivity group was higher than that in the insensitivity group(P< 0.05).The analyses revealed that there was a negative correlation between rCBF and VAS score for the right-sided anterior cingulate cortex in the insensitivity group and superior frontal gyrus in the sensitivity group( r >0.3 and P<0.05).Conclusion Different sensitivity to acupuncture is one of the crucial factors influencing analgesia effects.The sensitivity group had superior analgesia effect than the insensitivity group.Acupuncture might deactivate cerebral functional areas to generate analgesic effects.The superior frontal gyrus and bilateral anterior cingulate cortex,because of deactivation,play apositive role in sensitive patients,which is probably one of the CNS cerebral areas responding to acupuncture analgesia of people who are sensitive to acupuncture.
Objective To examine the effects of different sensitivities on the effectiveness of acupuncture analgesia by observing activation change characteristics of cerebral areas resulting from the influences of constitutions on analgesia effects and to discuss the response mechanism of central nervous system(CNS)to determine the factor of constitutions on acupuncture efficacy using cerebral functional magnetic resonance imaging arterial spin labeling(fMRI-ASL).Methods Participants with different sensitivities were assessed according to standard screening and grouped into two groups:insensitivity group(n=24)and sensitivity group(n=22).All participants were given acupuncture at the left-sided Zusanli point.Pressure pain threshold(PPT)of their body surface was determined before and after the acupuncture,and the two groups were subsequently compared in terms of analgesic effects and PPT rate of change;cerebral fMRI-ASL was performed;software such as SPM 8 and ASLtbx were utilized to preprocess the results,and correlation between regional cerebral blood flow(rCBF)and visual analog scale(VAS)score was determined using Pearson's correlational analysis.Results VAS score in the sensitivity group was significantly higher than that in the insensitivity group(P< 0.05);after acupuncture,PPT rate of change in the sensitivity group was higher than that in the insensitivity group(P< 0.05).The analyses revealed that there was a negative correlation between rCBF and VAS score for the right-sided anterior cingulate cortex in the insensitivity group and superior frontal gyrus in the sensitivity group( r >0.3 and P<0.05).Conclusion Different sensitivity to acupuncture is one of the crucial factors influencing analgesia effects.The sensitivity group had superior analgesia effect than the insensitivity group.Acupuncture might deactivate cerebral functional areas to generate analgesic effects.The superior frontal gyrus and bilateral anterior cingulate cortex,because of deactivation,play apositive role in sensitive patients,which is probably one of the CNS cerebral areas responding to acupuncture analgesia of people who are sensitive to acupuncture.
引文
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[23]陈维翠,侯小燕,陈俊,等.组穴针刺治疗对颈型颈椎病患者疼痛矩阵局部一致性磁共振研究[J].中国针灸,2015,35(10):1005-1009.
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[28]张超,陈楠,李坤成.前扣带回结构和功能影像学研究进展[J].中国医学影像技术,2012,28(1):28-31.
[29]刘菲,杨晓光,李学智,等.不同中医体质人群足三里穴针刺得气规律研究[J].针刺研究,2016,41(6):535-539.
[30]沈慈敏,许金森,郑淑霞,等.电针中脘对阴虚体质人群任脉上浅表微循环血流灌注量的影响[J].针刺研究,2015,40(4):309-312.
[31]沈慈敏,许金森,郑淑霞,等.电针中脘对阳虚体质任脉上浅表微循环血流灌注量的影响[J].中国针灸,2016,36(2):159-162.
[32]张新普,薛丹,李敏,等.傅杰英针灸调理上热下寒体质研究[J].中国中医基础医学杂志,2017,23(6):848-849.
[2]韩济生.针刺镇痛原理研究[J].针刺研究,1984,9(3):231-245.
[3]HAN J S.Acupuncture and endorphins[J].Neurosci Lett,2004,361(1/3):258-261.
[4]李其松,汤耀法,曹凤根,等.电针对“阴虚”和“阳虚”病人痛反应的作用——皮肤电、呼吸活动和肢体血流量的观察[J].中国针灸,1981,1(1):5-10.
[5]季庆洁,杨继国.针刺镇痛的研究现状[J].山东中医杂志,2012,31(10):770-771.
[6]杨晓光,李学智,付妮妮,等.针刺对不同体质人群痛阈效应研究[J].中国针灸,2016,36(5):491-495.
[7]张贵锋,黄泳,曾统军,等.基于fMRI观察正常人脑中枢对针刺得气感反应的初步研究[J].现代生物医学进展,2016,16(21):4050-4054.
[8]MALEKI N,BRAWN J,BARMETTLER G,et al.Pain response measured with arterial spin labeling[J].NMR Biomed,2013,26(6):664-673.
[9]卢琦,武红利,王安琴,等.动脉自旋标记技术在针刺fMRI研究中的可行性分析[J].中国中西医结合影像学杂志,2016,14(2):125-130.
[10]HENSON R.Chapter 15-efficient experimental design for fMRI[J].Statist Parametric Map,2007:193-210.
[11]KNIGHT D C,WATERS N S,BANETTINI P A.Neural substrates of explicit and implicit fear memory[J].Neuroimage,2008,45(1):208-214.
[12]CARTER M K,ODOHERTY J P,SEYMOUR B,et al.Contingency awareness in human aversive conditioning involves the middle frontal gyrus[J].Neuroimage,2006,29(3):1007-1012.
[13]公维义,薛蕴菁,宋施委,等.轻、中度疼痛对第一、第二躯体感觉皮质激活的功能磁共振成像研究[J].中国康复理论与实践,2012,18(5):423-425.
[14]HESCHAM S,JAHANSHAHI A,MERIAUX C,et al.Behavioral effects of deep brain stimulation of different areas of the Papez circuit on memory-and anxiety-related functions[J].Behav Brain Res,2015,292:353-360.
[15]LEI L G,ZHANG Y Q,ZHAO Z Q.Pain-related aversion and Fos expression in the central nervous system in rats[J].Neuroreport,2004,15(1):67-71.
[16]FOLTZ E L,JR W L.Pain“relief”by frontal cingulumotomy[J].J Neurosurg,1962,19:89-100.
[17]LEECH R,SHARP D J.The role of the posterior cingulate cortex in cognition and disease[J].Brain,2014,137(1):12-32.
[18]方继良,王小玲,王寅,等.电针正常人足三里和关元穴中枢效应的fMRI脑功能成像比较[J].针刺研究,2012,37(1):46-52.
[19]HUI K K,LIU J,MARINA O,et al.The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36as evidenced by fMRI[J].Neuroimage,2005,27(3):479-496.
[20]FOX M D,SNYDER A Z,VINCENT J L,et al.The human brain is intrinsically organized into dynamic,anticorrelated functional networks[J].Proc Nat Acad Sci,2005,102(27):9673-9678.
[21]WIECH K,LIN C S,BRODERSEN K H,et al.Anterior insula integrates information about salience into perceptual decisions about pain[J].J Neurosci Official J Soci Neurosci,2010,30(48):16324-16331.
[22]陈俊,刘波,叶泳松,等.慢性腰背痛患者的脑静息态功能磁共振成像[J].中国医学影像技术,2011,27(6):1116-1120.
[23]陈维翠,侯小燕,陈俊,等.组穴针刺治疗对颈型颈椎病患者疼痛矩阵局部一致性磁共振研究[J].中国针灸,2015,35(10):1005-1009.
[24]SOHLBERG M K M,MATEER C A.Introduction to cognitive rehabilitation:theory and practice[J].J Head Trauma Rehabil,1990,5(3):83-86.
[25]MCKIERNAN K,KAUFMAN J,KUCERA-THONPSON J,et al.A parametric manipulation of factors affecting taskinduced deactivation in functional neuroimaging[J].J Cognit Neurosci,2006,15(3):394-408.
[26]POSNER M I,PETERSEN S E.The attention system of the human brain[J].Ann Rev Neurosci,1990,13(1):73-89.
[27]COULL J T,FRITH C D,FRACKOWIAK R S J,et al.A fronto-parietal network for rapid visual information processing:a PET study of sustained attention and working memory[J].Neuropsychologia,1996,34(11):1085-1095.
[28]张超,陈楠,李坤成.前扣带回结构和功能影像学研究进展[J].中国医学影像技术,2012,28(1):28-31.
[29]刘菲,杨晓光,李学智,等.不同中医体质人群足三里穴针刺得气规律研究[J].针刺研究,2016,41(6):535-539.
[30]沈慈敏,许金森,郑淑霞,等.电针中脘对阴虚体质人群任脉上浅表微循环血流灌注量的影响[J].针刺研究,2015,40(4):309-312.
[31]沈慈敏,许金森,郑淑霞,等.电针中脘对阳虚体质任脉上浅表微循环血流灌注量的影响[J].中国针灸,2016,36(2):159-162.
[32]张新普,薛丹,李敏,等.傅杰英针灸调理上热下寒体质研究[J].中国中医基础医学杂志,2017,23(6):848-849.