摘要
实验目的：
利用fMRI技术,观察比较电针躯干部不同神经节段支配穴位的脑激活功能区、及功能区之间的功能连接的异同。分析针刺不同穴位产生的特征性脑功能网络,同时探讨电针能否改变脑静息态默认功能模式,是否存在针刺即时后效应。材料和方法：
共纳入21名健康志愿者,男10名,女11名,年龄22-28岁,实验通过广安门医院伦理委员会批准,实验前每位受试者均填写知情同意书。每位受试者在同日接受两个穴位的fMRI试验,选择位于躯干、由不同神经节段支配的、同经络、同为结缔组织的关元穴和中脘穴(CV4、CV12),fMRI扫描分别在针刺前静息状态、针刺单个穴位留针状态、电针刺激状态、针刺后静息态采集脑功能数据；并对电针针感进行了记录。采用SPM2、短程和长程“中心度”脑功能网络分析方法,分析电针不同穴位时脑激活功能区、及功能区之间的功能网络连接。
结果：
两穴位的各针感频率和强度分别比较,发现只存在胀满感强度有显著性差异(p<0.05),关元穴显示更为强烈的胀满感觉,其余针感频率和强度无显著性差异。通过分析发现,电针关元、中脘穴均诱导产生了额叶内侧部的明显负激活现象,留针及电针能改变脑静息默认功能模式,额叶内侧回、扣带前回前下部及海马区(脑边缘叶-旁边缘叶-新皮层系统,LPNN)脑功能网络出现了明显的即时针刺后效应。两穴位脑效应比较显示只存在较小的差异。
结论：
针刺关元、中脘穴均具有对脑边缘叶-旁边缘叶-新皮层网络的调制作用,能改变脑静息默认功能模式,产生即时针刺后脑效应,但也存在较小的差异,显示了穴位脑效应的相对特异性。本实验中针刺诱导产生的脑功能网络模式与以往研究的情绪认知功能调节环路有相似的特点。我们推论,针灸镇静、抗焦虑、抗抑郁症的治疗效应可能需要通过这-边缘叶-旁边缘叶-新皮层网络所介导。
The specific brain effects of acupoint are an important scientific concern in the research of acupuncture neuromechanism. However, most fMRI acupuncture studies focused on acupoints on the limb, employed simple design and data analyzing method, and some interpreted the results without convincible evidence. Therefore, researches on acupoints of different properties, using new experiment designs and new data analyzing methods are warranted. In this study, brain effects of acupuncture on trunk at acupoints Guanyuan (CV4) and Zhongwan (CV12) were tested using fMRI scan on 21 healthy volunteers at resting state, during needle retention, electroacupuncture (EA), and post-EA resting state. According anatomic knowledge, Guanyuan (CV4) and Zhongwan (CV12) have different nerve innervations, but share the same meridian category and same tissue type (connective tissue). Brain areas activated by EA at these two acupoints were analyzed with SPM2. The local and remote connectivity maps were calculated with whole brain correlation analysis. We thus compared brain functional activity and connectivity between CV4 and CV12. It revealed that EA at CV4 and CV12 induced apparent deactivation effects in the limbic-paralimbic-neocortical network (LPNN); default mode of the brain at rest was modified by needle retention and EA, respectively; functional brain network changed significantly after EA, and instant post-acupuncture effects were found mainly in the ventral medial prefrontal cortex and anteroinferior portion of the anterior cingulate cortex. The results showed that relatively small differences of brain activity and functional connectivity were found between these two acupoints. It indicates that relative specificity of acupoint effect in the brain exists. The results demonstrated similarity between functional brain network mode of acupuncture effects and functional circuits of emotional and cognitive regulation. Therefore, we hypothesize that therapeutic effects of acupuncture analgesia、acupuncture on anxiety. depression may be mediated by the limbic-paralimbic-neocortical network (LPNN)
引文
[1]NIH. NIH Consensus Conference. JAMA,1998,280:1518-1524.
[2]Pomeranz B. Scientific Basis of Acupuncture. New York:Springer-Verlag. 1995.
[3]朱兵.针灸的科学基础.青岛：青岛出版社.1997.
[4]韩济生.神经科学原理.北京：北京医科大学出版社.1999.p365-378.
[5]Hui KKS, Liu J, Kwong KK. Functional mapping of the human brain during acupuncture with magnetic resonance imaging somatosensory cortex activation. World J Acupuncture-Moxibustion,1997,7:44-49.
[6]Hui KKS, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI, Kennedy DN, Rosen BR, Kwong KK. Acupuncture modulates the limbic system and subcortical gray structures of the human brain:evidence from fMRI studies in normal subjects. Hum Brain Mapp,2000,9:13-25.
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[8]Hui KKS, Marina O, Claunch JD, Nixon EE, Fang JL, Liu J, Li M, Napadow V, Vangel M, Makris N, Chan ST, Kwong KK, Rosen BR. Acupuncture mobilizes the brain's default mode and its anti-correlated etwork in healthy subjects. Brain research,2009,1287:84-103.
[9]Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, Wong EK, Min BI. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci USA,1998,95:2670-2673.
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[33]Cho ZH, Hwang SC, Wong EK, Son YD, Kang CK, Park TS, Bai SJ, Kim YB, Lee YB, Sung KK, Lee BH, Shepp LA, Min KT. Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurol Scand,2006,113:370-377.
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[36]Mayberg HS, Liotti M, Brannan SK, McGinnis S, Mahurin RK, Jerabek PA, Silva JA, Tekell JL, Martin CC, Lancaster JL, Fox PT. Reciprocal limbic-cortical function and negative mood:converging PET findings in depression and normal sadness. Am J Psychiatry May,1999,156(5):675-82.
[37]Anand A, Li Y, Wang Y, Gardner K, Lowe MJ. Reciprocal effects of antidepressant treatment on activity and connectivity of the mood regulating circuit:an FMRI study. J Neuropsychiatry Clin Neurosci.,2007,19(3):274-82.
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[39]Buckner RL, Andrews-Hanna JR, Schacter DL. The brain's default network:anatomy, function, and relevance to disease. Ann N Y Acad Sci., 2008,1124:1-38.
[1]NIH. NIH Consensus Conference. JAMA,1998,280:1518-1524.
[2]Pomeranz B. Scientific Basis of Acupuncture. New York: Springer-Verlag.1995.
[3]朱兵.针灸的科学基础.青岛：青岛出版社.1997.
[4]韩济生.神经科学原理.北京：北京医科大学出版社.1999.p365-378.
[5]Hui KKS, Liu J, Kwong KK. Functional mapping of the human brain during acupuncture with magnetic resonance imaging somatosensory cortex activation. World J Acupuncture-Moxibustion,1997,7:44-49.
[6]Hui KKS, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI, Kennedy DN, Rosen BR, Kwong KK. Acupuncture modulates the limbic sys-tem and subcortical gray structures of the human brain:evidence from fMRI studies in normal subjects. Hum Brain Mapp,2000,9:13-25.
[7]Hui KKS, Liu J, Marina 0, Napadow V, Haselgrove C, Kwong KK, Kennedy, DN, Makris N. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST36 as evidenced by fMRI. Neuroimage,2005,27:479-496.
[8]Hui KKS, Marina 0, Claunch JD, Nixon EE, Fang JL, Liu J, Li M, Napadow V, Vangel M, Makris N, Chan ST, Kwong KK, Rosen BR. Acupuncture mobilizes the brain's default mode and its anti-correlated etwork in healthy subjects. Brain research,2009,1287:84-103.
[9]Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, Wong EK, Min BI. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci USA,1998,95: 2670-2673.
[10]Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC, Tsai G, Rosen BR, Kwong KK. Central Nervous Pathway for Acupuncture Stimulation: Localization of Processing with functional MR imaging of the Brain-Preliminary Experience. Radiology,1999,212:133-141.
[11]Wu MT, Sheen JM, Chuang KH, Yang P, Chin SL, Tsai CY, Chen CJ, Liao JR, Lai PH, Chu KA, Pan HB, Yang CF. Neuronal Specificity of Acupuncture Response:A fMRI Study with Electroacupuncture. Neuroimage,2002,16: 1028-1037.
[12]Kong J, Ma L, Gollub RL, Wei J, Yang X, Li D, Weng X, Jia F, Wang C, Li F, Li R, Zhuang D. A pilot study of functional magnetic resonance imaging of the brain during manual and electroacupuncture stimulation of acupuncture point (LI-4 Hegu) in normal subjects reveals differential brain activation between methods. J Altern Complement Med,2002,8: 411-419.
[13]Kong J, Kaptchuk TJ, Webb JM, Kong JT, Sasaki Y, Polich GR, Vangel MG, Kwong K, Rosen B, Gollub RL. Functional neuroanatomical investigation of vision-related acupuncture point specificity--a multisession fMRI study. Hum Brain Mapp.,2009,30(1):38-46.
[14]Li G, Cheung RT, Ma QY, Yang ES. Visual cortical activations on fMRI upon stimulation of the vision-implicated acupoints. Neuroreport,2003, 14:669-673.
[15]Li G, Liu HL, Cheung RT, Hung YC, Wong KK, Shen GG, Ma QY, Yang ES. An fMRI study comparing brain activation between word generation and electrical stimulation of language-implicated acupoints. Hum Brain Mapp. 2003,18:233-238.
[16]Zhang WT, Jin Z, Cui GH, Zhang KL, Zhang L, Zeng YW, Luo F, Chen AC, Han JS. Relations between brain network activation and analgesic effect induced by low vs. high frequency electrical acupoint stimulation in different subjects:a functional magnetic resonance imaging study. Brain Res.,2003,982:168-178.
[17]Fang JL, Krings T, Weidemann J, Meister IG and Thron A. Functional MRI in Healthy Subjects during Acupuncture:Different Effects of Needle Rotation in Real and False Acupoints. Neuroradiology,2004,46:359-362.
[18]方继良,金真,王寅,李科,曾亚伟,佟海滨,任燕双,高波,王映辉,程谟库.针刺太冲及其临近穴脑反应区功能磁共振成像比较.中国医学影像技术,2005,21(9)：1332-1336.
[19]Fang JL, Nixon E, Liu J, Hui KKS. The limbic-cortical system and pain neuromatrix:deactivation by acupuncture, activation by pain-an fMRI study at LV3 Abstract. Society for Neuroscience 2007 Annual meeting in San Diego.
[20]Fang J, Jin Z, Wang Y, Li K, Kong J, Nixon EE, Zeng Y, Ren Y, Tong H, Wang Y, Wang P, Hui KK. The salient characteristics of the central effects of acupuncture needling:limbic-paralimbic-neocortical network modulation. Hum Brain Mapp.,2009,30(4):1196-206.
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[23]Parrish TB, Schaeffer A, Catanese M, Rogel MJ. Functional magnetic resonance imaging of real and sham acupuncture:Noninvasively measuring cortical activation from acupuncture. IEEE Eng Med Biol Mag,2005,24: 35-40.
[24]Yan B, Li K, Xu J, Wang W, Li K, Liu H, Shan B, Tang X. Acupoint-specific fMRI patterns in human brain. Neurosci Lett,2005,383: 236-240.
[25]Fang SH, Zhang SZ, Liu H, Shou YQ, Zhang QW, Cui HW, Hu XY. Study on Brain Response to acupuncture by functional magnetic resounce imaging-Observation on 14 healthy subjects. Chinese Journal of Integrative Medicine,2006,26:965-968.
[26]Wang W, Liu L, Zhi X, Huang JB, Liu DX, Wang H, Kong XQ, Xu HB. Study on the regulatory effect of electro-acupuncture on hegu point (LI4) in cerebral response with functional magnetic resonance imaging. Chin J Integr Med.,2007,13:10-16.
[27]Biella G, Sotgiu ML, Pellegata G, Paulesu E, Castiglioni I, Fazio F. Acupuncture produces central activations in pain regions. Neuroimage, 2001,14:60-66.
[28]Cho ZH, Na C, Wong EK, Lee S, Hong I. Investigation of acupuncture using brain fMRI. In:Litscher G, Cho Z Editors. Computer Controlled Acupuncture. Berlin:Pabst Science Publishers,2000. p45-64. [29] Gareus IK, Lacour M, Schulte AC, Hennig J. Is there a BOLD response of the visual cortex on stimulation of the vision-related acupoint GB 37? J Magn Reson Imaging,2002,15:227-232.
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[31]Cho ZH, Hwang SC, Wong EK, Son YD, Kang CK, Park TS, Bai SJ, Kim YB, Lee YB, Sung KK, Lee BH, Shepp LA, Min KT. Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurol Scand,2006,113:370-377.
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