电针周围性面瘫患者穴位的功能磁共振成像研究
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摘要
目的:用功能磁共振成像(fMRI)方法研究电针(EA)对周围性面瘫患者不同穴位时脑功能区变化,探讨针灸理论基础,进一步论证“面口合谷收”这一经典理论和针刺镇痛的机制。
方法:采用电针不同穴位方法,将18例左侧周围性面瘫患者随机分为3组,分别电针左侧周围性面瘫患的左侧仓穴(6例),左侧合谷穴(6例),左侧后溪穴(6例);18例右侧周围性面瘫患者随机分为3组,分别电针右侧周围性面瘫患的右侧地仓穴(6例),右侧合谷穴(6例),右侧后溪穴(6例),同时行全脑fMRI扫描; SPM和AFNI软件进行图像后处理, t检验( P< 0.05)分析得出电针不同穴位的脑功能图像。
结果:①电针左侧地仓信号降低区:双侧额上回,双侧额中回,左扣带回,左额内侧回,左楔前叶中央旁小叶;信号升高区:右侧中央前回,双侧中央后回,右侧脑岛,左侧角回;
②电针左侧合谷信号降低区:左侧扣带回,双侧额中回,右侧枕中回,信号升高区:双侧中央后回,右侧额下回,右侧颞上回,右侧脑岛,右侧中央前回;
③电针左侧后溪信号降低区:双侧额下回,左侧额中回,左侧尾状核头,左侧豆状核,右侧颞中回,右侧小脑扁桃体,信号升高区:右侧尾状核头,右侧扣带回,双侧脑干,小脑蚓,右侧海马回;
④电针右侧地仓信号降低区:左侧额上回,左侧额中回,左侧脑岛,左侧下丘脑核,左侧扣带回,左侧小脑扁桃体,左侧楔叶,左侧枕中回,信号升高区:右侧额下回,右侧脑岛,右侧中央前回,左侧中央后回,右侧颞上回;
⑤电针右侧合谷信号降低区:右侧额内侧回,左侧海马回,左侧下半月小叶,左侧楔叶,信号升高区:右侧额内侧回,左侧扣带回前部,右侧扣带回,左侧额中回,右侧颞上回;
⑥电针右侧后溪信号降低区:左侧额上回,右侧额内侧回,左侧小脑扁桃体,信号升高区:左侧额下回,右侧中央前回,右侧扣带回,左侧尾状核,左侧顶下小叶,右侧颞上回,左侧舌回。
结论:电针治疗周围性面瘫临床常用穴合谷穴和地仓穴可以引起大脑相似的功能区的激活,而电针与合谷位置相近后溪穴未见和前两者有相似的激活区域,由此可以推测穴位与大脑的联系和穴位的解剖位置关系不大,而与其所属的经脉有着密切的联系。本实验结果同时也进一步为“面口合谷收”这一歌诀提供了佐证。电针穴位镇痛的作用可能是通过抑制和兴奋与痛觉调制相关的多个脑功能区而实现的。电针后溪穴既有得气感的产生,也有相关的针感,可能更多的是一种不良的刺激。
Purpose:To compare the brain response changes between different acupoints of peripheral facial paralysis by electroacupuncture(EA) using functional magnetic resonance imaging(fMRI) . To probe the theoretical basis of acupuncture ,to demonstrate the classic theory that the diseases of mouth and face are cured with Hegu further and investigate the analgesic mechanism of acupuncture.
Methods:In this study different acupoints EA methods were devised, Eighteen patient with peripheral facial paralysis on the left were randomly divided into three groups.six of them received electroacupuncture(EA) at left dicang,6 received electroacupuncture(EA) at left hegu, and 6 received electroacupuncture(EA) at left houxi; Eighteen patient with peripheral facial paralysis on the right were randomly divided into three groups. six of them received electroacupuncture(EA) at right dicang,6 received electroacupuncture(EA) at right hegu, and 6 received electroacupuncture(EA) at right houxi;Functional MRI data were obtained from s canning the whole brain . Acquired functional datawere processed by SPM99 software and functional responses were established by students’group t-test analysis(P<0.05).
Results: Electroacupuncture(EA)dicang on the left induced signal decreases of bilateral superior frontal gyrus , bilateral middle frontal gyrus, left cingulate gyrus,left medial frontal gyrus,left precuneus or left paracentral lobule,signal increases of right precentral gyrus ,left superior temporal gyrus,bilateral postcentral gyrus,left angular gyrus; Electroacupuncture(EA) hegu on the left induced signal decreases of left cingulate gyrus,bilateral middle frontal gyrus , induced signal increases of bilateral postcentral gyrus ,right inferior frontal gyrus,right superior temporal gyrus,right inferior frontal gyrus,right insula, left precentral gyrus;Electroacupuncture(EA) houxi on the left induced signal decreases of bilateral inferior frontal gyrus ,left middle frontal gyrus,left caudate head,left lentiform nucleus right middle temporal gyrus,right cerebellar tonsil, signal increases of right caudate head,right cingulate gyrus,left brainstem or cerebellar vermis, right parahippocampal gyrus or thalamus,right superior temporal Gyrus or thalamus; Electroacupuncture(EA)dicang on the right induced signal decreases of left superior frontal gyrus,left middle frontal gyrus,left claustrum,left subthalamic nucleus,left cingulate gyrus,left cerebellar Tonsil,left cuneus or left middle occipital gyrus, signal increases of right inferior frontal gyrus,right Insula,right precentral gyrus,left postcentral gyrus,right superior temporal gyrus ; Electroacupuncture(EA) hegu on the right induced signal decreases of right medial frontal gyrus, left parahippocampal gyrus,left inferior semi-lunar lobule, signal increases of left anterior cingulated,right cingulate gyrus,left middle frontal gyrus,right superior temporal gyrus; Electroacupuncture(EA) houxi on the right induced signal decreases of left superior frontal gyrus,right medial frontal gyrus,left cerebellar tonsil, signal increases of left inferior frontal gyrus,right precentral gyrus,right cingulate gyrus,left caudate,left inferior parietal lobule,right superior temporal gyrus,left lingual gyrus.
Conclusion:Hegu and Dicang are frequently used acupoints on clinic to cure peripheral facial paralysis, Electroacupuncture the two acupoints can cause homoplastic domain activation in cerebrum, while electric needle Houxi acupiont can not stimulate the homoplastic domain with upon, though it located close to Hegu acupoint. We can infer that the association between acupoint and cerebral is intimate to subordinates meridian but little to the anatomical position of the acupoint. Our experimental results provid evidences that the diseases of face and mouth are cured with Hegu acuacupoint. The effect of analgesia with electric acupuncture may implement through suppress and excite many brain domains related to algesthesia concoction. Electroacupuncture Houxi bring about not only acu-feeling, but Deqi sensation, and furthermore, it maybe a sort of infaust stimulation.
方法:采用电针不同穴位方法,将18例左侧周围性面瘫患者随机分为3组,分别电针左侧周围性面瘫患的左侧仓穴(6例),左侧合谷穴(6例),左侧后溪穴(6例);18例右侧周围性面瘫患者随机分为3组,分别电针右侧周围性面瘫患的右侧地仓穴(6例),右侧合谷穴(6例),右侧后溪穴(6例),同时行全脑fMRI扫描; SPM和AFNI软件进行图像后处理, t检验( P< 0.05)分析得出电针不同穴位的脑功能图像。
结果:①电针左侧地仓信号降低区:双侧额上回,双侧额中回,左扣带回,左额内侧回,左楔前叶中央旁小叶;信号升高区:右侧中央前回,双侧中央后回,右侧脑岛,左侧角回;
②电针左侧合谷信号降低区:左侧扣带回,双侧额中回,右侧枕中回,信号升高区:双侧中央后回,右侧额下回,右侧颞上回,右侧脑岛,右侧中央前回;
③电针左侧后溪信号降低区:双侧额下回,左侧额中回,左侧尾状核头,左侧豆状核,右侧颞中回,右侧小脑扁桃体,信号升高区:右侧尾状核头,右侧扣带回,双侧脑干,小脑蚓,右侧海马回;
④电针右侧地仓信号降低区:左侧额上回,左侧额中回,左侧脑岛,左侧下丘脑核,左侧扣带回,左侧小脑扁桃体,左侧楔叶,左侧枕中回,信号升高区:右侧额下回,右侧脑岛,右侧中央前回,左侧中央后回,右侧颞上回;
⑤电针右侧合谷信号降低区:右侧额内侧回,左侧海马回,左侧下半月小叶,左侧楔叶,信号升高区:右侧额内侧回,左侧扣带回前部,右侧扣带回,左侧额中回,右侧颞上回;
⑥电针右侧后溪信号降低区:左侧额上回,右侧额内侧回,左侧小脑扁桃体,信号升高区:左侧额下回,右侧中央前回,右侧扣带回,左侧尾状核,左侧顶下小叶,右侧颞上回,左侧舌回。
结论:电针治疗周围性面瘫临床常用穴合谷穴和地仓穴可以引起大脑相似的功能区的激活,而电针与合谷位置相近后溪穴未见和前两者有相似的激活区域,由此可以推测穴位与大脑的联系和穴位的解剖位置关系不大,而与其所属的经脉有着密切的联系。本实验结果同时也进一步为“面口合谷收”这一歌诀提供了佐证。电针穴位镇痛的作用可能是通过抑制和兴奋与痛觉调制相关的多个脑功能区而实现的。电针后溪穴既有得气感的产生,也有相关的针感,可能更多的是一种不良的刺激。
Purpose:To compare the brain response changes between different acupoints of peripheral facial paralysis by electroacupuncture(EA) using functional magnetic resonance imaging(fMRI) . To probe the theoretical basis of acupuncture ,to demonstrate the classic theory that the diseases of mouth and face are cured with Hegu further and investigate the analgesic mechanism of acupuncture.
Methods:In this study different acupoints EA methods were devised, Eighteen patient with peripheral facial paralysis on the left were randomly divided into three groups.six of them received electroacupuncture(EA) at left dicang,6 received electroacupuncture(EA) at left hegu, and 6 received electroacupuncture(EA) at left houxi; Eighteen patient with peripheral facial paralysis on the right were randomly divided into three groups. six of them received electroacupuncture(EA) at right dicang,6 received electroacupuncture(EA) at right hegu, and 6 received electroacupuncture(EA) at right houxi;Functional MRI data were obtained from s canning the whole brain . Acquired functional datawere processed by SPM99 software and functional responses were established by students’group t-test analysis(P<0.05).
Results: Electroacupuncture(EA)dicang on the left induced signal decreases of bilateral superior frontal gyrus , bilateral middle frontal gyrus, left cingulate gyrus,left medial frontal gyrus,left precuneus or left paracentral lobule,signal increases of right precentral gyrus ,left superior temporal gyrus,bilateral postcentral gyrus,left angular gyrus; Electroacupuncture(EA) hegu on the left induced signal decreases of left cingulate gyrus,bilateral middle frontal gyrus , induced signal increases of bilateral postcentral gyrus ,right inferior frontal gyrus,right superior temporal gyrus,right inferior frontal gyrus,right insula, left precentral gyrus;Electroacupuncture(EA) houxi on the left induced signal decreases of bilateral inferior frontal gyrus ,left middle frontal gyrus,left caudate head,left lentiform nucleus right middle temporal gyrus,right cerebellar tonsil, signal increases of right caudate head,right cingulate gyrus,left brainstem or cerebellar vermis, right parahippocampal gyrus or thalamus,right superior temporal Gyrus or thalamus; Electroacupuncture(EA)dicang on the right induced signal decreases of left superior frontal gyrus,left middle frontal gyrus,left claustrum,left subthalamic nucleus,left cingulate gyrus,left cerebellar Tonsil,left cuneus or left middle occipital gyrus, signal increases of right inferior frontal gyrus,right Insula,right precentral gyrus,left postcentral gyrus,right superior temporal gyrus ; Electroacupuncture(EA) hegu on the right induced signal decreases of right medial frontal gyrus, left parahippocampal gyrus,left inferior semi-lunar lobule, signal increases of left anterior cingulated,right cingulate gyrus,left middle frontal gyrus,right superior temporal gyrus; Electroacupuncture(EA) houxi on the right induced signal decreases of left superior frontal gyrus,right medial frontal gyrus,left cerebellar tonsil, signal increases of left inferior frontal gyrus,right precentral gyrus,right cingulate gyrus,left caudate,left inferior parietal lobule,right superior temporal gyrus,left lingual gyrus.
Conclusion:Hegu and Dicang are frequently used acupoints on clinic to cure peripheral facial paralysis, Electroacupuncture the two acupoints can cause homoplastic domain activation in cerebrum, while electric needle Houxi acupiont can not stimulate the homoplastic domain with upon, though it located close to Hegu acupoint. We can infer that the association between acupoint and cerebral is intimate to subordinates meridian but little to the anatomical position of the acupoint. Our experimental results provid evidences that the diseases of face and mouth are cured with Hegu acuacupoint. The effect of analgesia with electric acupuncture may implement through suppress and excite many brain domains related to algesthesia concoction. Electroacupuncture Houxi bring about not only acu-feeling, but Deqi sensation, and furthermore, it maybe a sort of infaust stimulation.
引文
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14 Wiggins AK, Shen PJ, Gundlach AL. Neuronal-NOS adaptor protein expression after spreading depression: implications for NO production and ischemic tolerance. J Neurochem, 2003, 87(6):1368-1380.
15 Lambert GA, Michalicek J, Storer RJ, et al. Effect of cortical spreading depression on activity of trigeminovascular sensory neurons. Cephalalgia, 1999, 19(7):631-638.
16 Bradley DP, Smith JM, Smith MI, et al. Cortical spreading depression in the feline brain following sustained and transient stimuli studied using diffusion-weighted imaging. J Physiol, 2002, 544(1):39-56.
17 Yuan LL, Ganetzky B. A glial-neuronal signaling pathway revealed by mutations in a neurexin-related protein. Science, 1999, 283(5460):1343-1345.
18 Kager H, Wadman WJ, Somjen GG. Conditions for the triggering of spreading depression studied with computer simulations. J Neurophysiol, 2002, 88(5):2700-2712.
19 Bradley DP, Smith MI, Netsiri C, et al. Diffusion-weighted MRI used to detect in vivo modulation of cortical spreading depression: comparison of sumatriptan and tonabersat. Exp Neurol, 2001, 172(2):342-353.
20 Back T, Hirsch JG, Szabo K, et al. Failure to demonstrate peri-infarct depolarizations by repetitive MR diffusion imaging in acute human stroke. Stroke, 2000, 31(12):2901-2906.
21 Guiou M, Sheth S, Nemoto M, et al. Cortical spreading depression produces long-term disruption of activity-related changes in cerebral blood volume and neurovascular coupling. J Biomed Opt, 2005, 10(1):11004.
22 Tomita M, Schiszler I, Tomita Y, et al. Initial oligemia with capillary flow stop followed by hyperemia during K+-induced cortical spreading depression in rats. J Cereb Blood Flow Metab, 2005, 25(6):742-747.
23 Netsiri C, Bradley DP, Takeda T, et al. A delayed class of BOLD waveforms associated with spreading depression in the feline cerebral cortex can be detected and characterised using independent component analysis (ICA). Magn Reson Imaging, 2003,21(9):1097-1110.
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26 Smith JM, James MF, Bockhorst KH, et al. Investigation of feline brain anatomy for the detection of cortical spreading depression with magnetic resonance imaging. J Anat, 2001, 198(5):537-554.
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12 Selman WR, Lust WD, Pundik S, et al. Compromised metabolic recovery following spontaneous spreading depression in the penumbra. Brain Res, 2004, 999(2):167-174.
13 Yanamoto H, Xue JH, Miyamoto S, et al. Spreading depression induces long-lasting brain protection against infarcted lesion development via BDNF gene-dependent mechanism. Brain Res, 2004, 1019(1-2):178-188.
14 Wiggins AK, Shen PJ, Gundlach AL. Neuronal-NOS adaptor protein expression after spreading depression: implications for NO production and ischemic tolerance. J Neurochem, 2003, 87(6):1368-1380.
15 Lambert GA, Michalicek J, Storer RJ, et al. Effect of cortical spreading depression on activity of trigeminovascular sensory neurons. Cephalalgia, 1999, 19(7):631-638.
16 Bradley DP, Smith JM, Smith MI, et al. Cortical spreading depression in the feline brain following sustained and transient stimuli studied using diffusion-weighted imaging. J Physiol, 2002, 544(1):39-56.
17 Yuan LL, Ganetzky B. A glial-neuronal signaling pathway revealed by mutations in a neurexin-related protein. Science, 1999, 283(5460):1343-1345.
18 Kager H, Wadman WJ, Somjen GG. Conditions for the triggering of spreading depression studied with computer simulations. J Neurophysiol, 2002, 88(5):2700-2712.
19 Bradley DP, Smith MI, Netsiri C, et al. Diffusion-weighted MRI used to detect in vivo modulation of cortical spreading depression: comparison of sumatriptan and tonabersat. Exp Neurol, 2001, 172(2):342-353.
20 Back T, Hirsch JG, Szabo K, et al. Failure to demonstrate peri-infarct depolarizations by repetitive MR diffusion imaging in acute human stroke. Stroke, 2000, 31(12):2901-2906.
21 Guiou M, Sheth S, Nemoto M, et al. Cortical spreading depression produces long-term disruption of activity-related changes in cerebral blood volume and neurovascular coupling. J Biomed Opt, 2005, 10(1):11004.
22 Tomita M, Schiszler I, Tomita Y, et al. Initial oligemia with capillary flow stop followed by hyperemia during K+-induced cortical spreading depression in rats. J Cereb Blood Flow Metab, 2005, 25(6):742-747.
23 Netsiri C, Bradley DP, Takeda T, et al. A delayed class of BOLD waveforms associated with spreading depression in the feline cerebral cortex can be detected and characterised using independent component analysis (ICA). Magn Reson Imaging, 2003,21(9):1097-1110.
24 James MF, Smith MI, Bockhorst KH, et al. Cortical spreading depression in the gyrencephalic feline brain studied by magnetic resonance imaging. J Physiol, 1999, 519(2):415-425.
25 Yenari MA, Onley D, Hedehus M, et al. Diffusion- and perfusion-weighted magnetic resonance imaging of focal cerebral ischemia and cortical spreading depression under conditions of mild hypothermia. Brain Res, 2000, 885(2):208-219.
26 Smith JM, James MF, Bockhorst KH, et al. Investigation of feline brain anatomy for the detection of cortical spreading depression with magnetic resonance imaging. J Anat, 2001, 198(5):537-554.