基于经穴效应与颅内经络的关系对针刺高血压病合并脑萎缩患者的fMRI脑功能成像研究
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摘要
目的:运用功能核磁共振(fMRI)脑功能成像原理,观察针刺对于高血压病合并脑萎缩患者的脑功能连通性、经络敏感性、穴位治疗效应的相关改变,分析在病理因素影响下,颅内经络的改变对经穴效应的影响。方法:正常对照组8例,原发性高血压病组10例,原发性高血压病合并脑萎缩组10例。对原发性高血压病患者和原发性高血压病合并脑萎缩患者分别测定针刺太冲穴前后的实验压痛阈值,比较针刺对两组受试者的镇痛效应差异。在手法捻针刺激基础上,3组患者均按照组块设计方案刺激与静留针交替进行,针刺过程中fMRI扫描3组患者静息态脑功能成像特点,通过Matlab软件SPM2模块分析数据,获得效应脑区,采用感兴趣区(ROI)法对3组患者激活差异进行比较。结果:原发性高血压病组患者针刺前后压痛阈值差异有统计学意义(P<0.05),原发性高血压痛合并脑萎缩组患者针刺前后压痛阈值的比较差异无统计学意义(P>0.05)。正常组主要激活区域在左侧扣带回、左侧额叶、左侧顶叶、左侧颞叶,原发性高血压病组患者主要激活区域在左侧扣带回、左侧顶叶、左侧颞叶、右侧额叶,原发性高血压病合并脑萎缩组患者主要激活区域在左侧扣带回、双侧颞叶。正常组与原发性高血压病组患者激活点数无显著性差异(P>0.05);原发性高血压病合并脑萎缩组患者的激活点数比针刺原发性高血压病组明显降低,有显著性差异(P<0.05);在左侧顶叶、左侧扣带回激活点数降低明显,激活强度在左侧扣带回、左侧顶叶、左侧颞叶明显降低,有统计学差异(P<0.05)。结论:脑萎缩等中枢神经系统疾病损伤颅内经络,不仅损伤脑功能,而且使针刺激活脑功能区的区域面积和强度明显减少,降低外周经络的敏感性,影响针刺的疗效,针刺提高颅内相应脑区的连通性是治疗此类疾病的机制之一。
This study was designed to observe the effects of acupuncture in treating hypertension complicated with brain atrophy by the functional magnetic resonance imaging(fMRI).Brain functional connectivity,meridian sensitivity and acupuncture curative effects of all subjects were detected,in order to analyze the changes and effects of intracranial meridians in pathological conditions.In this study,28 subjects were divided into the normal group(n = 8),the primary hypertension group(PH,n = 10) and the PH complicated with brain atrophy(PHBA,n = 10).Experimental tenderness thresholds were tested before and after acupuncture on LR3-Taichong to understand the analgesic effects between PH and PHBA cases.And all subjects received manual acupuncture on LR3 by stimulating and retaining needle alternately in accordance with the block design.In the needling process,characteristics of resting slate functional brain imaging of all subjects were analyzed with Matlab and SPM2 software.And activities of brain areas of all groups were compared by the region of interest(ROI).The results showed that significant differences of tenderness thresholds were found in PH subjects(P < 0.05),but not in PHBA ones(P > 0.05) before and after acupuncture.The activities of brain areas in the normal group were the left cingulate cortex,left frontal lobe,left parietal lobe and the left temporal lobe.The activities of brain areas in the PH group were the left cingulate cortex,left parietal lobe,left temporal lobe and the right frontal lobe.The activities of brain areas in the PHBA group were the left cingulate cortex and the bilateral temporal lobe.There were no significant differences on the activated points between the normal group and PH group(P > 0.05).While,the activated points after acupuncture in the PHBA group were obviously reduced compared to the PH group with significant difference(P < 0.05).The activated points in the left parietal lobe and the left cingulate cortex were obviously reduced.The intensity of activation was obviously reduced in the left cingulate cortex,left parietal lobe and the left temporal lobe with statistical significance(P < 0.05).It was concluded that intracranial meridians were damaged in brain atrophy patients,which was harmful to brain function,as a result of decreasing activated brain regions,weakening intensity of activation in the functional brain regions and sensitivity of peripheral meridians after acupuncture.It may impact the curative effects of acupuncture.So enhancing the intracrannial meridians connectivity of functional brain regions may be a mechanism of acupuncture in treating hypertension complicated brain atrophy.
This study was designed to observe the effects of acupuncture in treating hypertension complicated with brain atrophy by the functional magnetic resonance imaging(fMRI).Brain functional connectivity,meridian sensitivity and acupuncture curative effects of all subjects were detected,in order to analyze the changes and effects of intracranial meridians in pathological conditions.In this study,28 subjects were divided into the normal group(n = 8),the primary hypertension group(PH,n = 10) and the PH complicated with brain atrophy(PHBA,n = 10).Experimental tenderness thresholds were tested before and after acupuncture on LR3-Taichong to understand the analgesic effects between PH and PHBA cases.And all subjects received manual acupuncture on LR3 by stimulating and retaining needle alternately in accordance with the block design.In the needling process,characteristics of resting slate functional brain imaging of all subjects were analyzed with Matlab and SPM2 software.And activities of brain areas of all groups were compared by the region of interest(ROI).The results showed that significant differences of tenderness thresholds were found in PH subjects(P < 0.05),but not in PHBA ones(P > 0.05) before and after acupuncture.The activities of brain areas in the normal group were the left cingulate cortex,left frontal lobe,left parietal lobe and the left temporal lobe.The activities of brain areas in the PH group were the left cingulate cortex,left parietal lobe,left temporal lobe and the right frontal lobe.The activities of brain areas in the PHBA group were the left cingulate cortex and the bilateral temporal lobe.There were no significant differences on the activated points between the normal group and PH group(P > 0.05).While,the activated points after acupuncture in the PHBA group were obviously reduced compared to the PH group with significant difference(P < 0.05).The activated points in the left parietal lobe and the left cingulate cortex were obviously reduced.The intensity of activation was obviously reduced in the left cingulate cortex,left parietal lobe and the left temporal lobe with statistical significance(P < 0.05).It was concluded that intracranial meridians were damaged in brain atrophy patients,which was harmful to brain function,as a result of decreasing activated brain regions,weakening intensity of activation in the functional brain regions and sensitivity of peripheral meridians after acupuncture.It may impact the curative effects of acupuncture.So enhancing the intracrannial meridians connectivity of functional brain regions may be a mechanism of acupuncture in treating hypertension complicated brain atrophy.
引文
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9朱湘文,张志强,许强,等.灰质异位脑功能连接的功能磁共振成像研究.临床放射学杂志,2012,31(7):914-917.
10 Just M A,Cherkassky V L,Keller T A,et al.Cortical activation and synchronization during sentence comprehension in high-functioning autism:evidence of underconnectivity.Brain,2004,127(Pt8):1811-1821.
11 Murrhy C F,Gunning-Dixon F M,Hoptman M J,et al.Whitematter integrity predicts stroop performance in patients with geriatric depression.Biol Psychiatry,2007,61(8):1007-1010.
12 Knott V,Mahoney C,Kennedy S,et al.EEG power,frequency,asymmetry and coherence in male depression.Psychiatry Res,2001,106(2):123-140.
13 Onoda K,Ishihara M,Yamaguchi S.Decreased functional connectivity by aging is associated with cognitive decline.J Cogn Neurosci,2012,24(11):2186-2198.
14张志国,王超,康立源.高血压性认知损伤的流行病学调研研究概述.世界科学技术-中医药现代化,2011,13(3):551-555.
15 Ferreira L K,Busatto G F.Resting-state functional connectivity in normal brain aging.Neurosci Biobehav Rev,2013,37(3):384-400.
16 Zuo X N,Kelly C,Di Martino A,et al.Growing together and growing apart:regional and sex differences in the lifespan developmental trajectories of functional homotopy.J Neurosci,2010,30(45):15034-15043.
17李磊.释“得气”.世界科学技术-中医药现代化,2010,12(1):86-88.
18 Martins R,Joanette Y,Monchi O.The implicatons of age-related neurofunctional compensatory mechanisms in executive function and language processing including the new Temporal Hypothesis for Compensation.Front Hum Neurosci,2015,9(4):221.
2 Chae Y,Chang D S,Lee S H,et al.Inserting needles into the body:a meta-analysis of brain activity associated with acupuncture needle stimulation.J Pain,2013,14(3):215-222.
3徐放明,谢鹏,牟君,等.关于“十二经脉皆入脑”的假设.中国针灸,2007,27(9):695-697.
4莫飞智,邓铁涛.五脏神识系统的形成.世界科学技术-中医药现代化,2011,11(4):545-549.
5中国高血压防治指南修订委员会.中国高血压防治指南2010.中华高血压杂志,2011,19(8):701-743.
6 Vassilouthis J.Ventrieular dilatation and communication hydrocephalus following spontaneous subarachnoid hemorrhage.Neurosurg,1979,51:341-351.
7石学敏.针灸学.北京:中国中医药出版社,2006:101.
8耿连岐.浅探循经感传的影响因素.甘肃中医,2010,23(8):45.
9朱湘文,张志强,许强,等.灰质异位脑功能连接的功能磁共振成像研究.临床放射学杂志,2012,31(7):914-917.
10 Just M A,Cherkassky V L,Keller T A,et al.Cortical activation and synchronization during sentence comprehension in high-functioning autism:evidence of underconnectivity.Brain,2004,127(Pt8):1811-1821.
11 Murrhy C F,Gunning-Dixon F M,Hoptman M J,et al.Whitematter integrity predicts stroop performance in patients with geriatric depression.Biol Psychiatry,2007,61(8):1007-1010.
12 Knott V,Mahoney C,Kennedy S,et al.EEG power,frequency,asymmetry and coherence in male depression.Psychiatry Res,2001,106(2):123-140.
13 Onoda K,Ishihara M,Yamaguchi S.Decreased functional connectivity by aging is associated with cognitive decline.J Cogn Neurosci,2012,24(11):2186-2198.
14张志国,王超,康立源.高血压性认知损伤的流行病学调研研究概述.世界科学技术-中医药现代化,2011,13(3):551-555.
15 Ferreira L K,Busatto G F.Resting-state functional connectivity in normal brain aging.Neurosci Biobehav Rev,2013,37(3):384-400.
16 Zuo X N,Kelly C,Di Martino A,et al.Growing together and growing apart:regional and sex differences in the lifespan developmental trajectories of functional homotopy.J Neurosci,2010,30(45):15034-15043.
17李磊.释“得气”.世界科学技术-中医药现代化,2010,12(1):86-88.
18 Martins R,Joanette Y,Monchi O.The implicatons of age-related neurofunctional compensatory mechanisms in executive function and language processing including the new Temporal Hypothesis for Compensation.Front Hum Neurosci,2015,9(4):221.