平衡针镇痛效应观察及脑功能局部一致性分析
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摘要
目的:观察平衡针针刺头痛穴对无先兆偏头痛患者的镇痛效应,探讨其与脑区功能改变的关系。方法:将40例无先兆偏头痛患者随机分为头痛穴组和非穴组,每组20例。头痛穴组针刺头痛穴,患者有放电感、麻胀感时立即出针,非穴组针刺非穴,均每天1次,治疗4周。采用视觉模拟量尺(VAS)评分评估针刺镇痛效应,采用静息态功能磁共振成像(fMRI)的局部一致性(ReHo)分析脑区功能改变。结果:干预期(针刺结束时)和随访期(针刺结束后4周)头痛穴组镇痛效应优于非穴组(P<0.05),头痛穴组干预期的镇痛效果优于随访期(P<0.05);非穴组干预期与随访期镇痛效果的差异无统计学意义(P>0.05)。与干预前对比,头痛穴组针刺干预4周后ReHo值增高的脑区有前扣带回、中央前回、眶额上回、腹外侧核、脑岛、腹后内侧核、顶下小叶、左前扣带回、脑桥、小脑扁桃体、眶额下回(P<0.05);ReHo值降低的脑区有右脑桥、中央后回、腹后外侧核、后扣带回,左中央前回、海马(P<0.05)。非穴组针刺干预4周后ReHo值增高的脑区有右舌回、左楔前叶、前扣带回、枕下回(P<0.05);ReHo值减低的脑区有左腹后外侧核(P<0.05)。结论:平衡针针刺头痛穴的镇痛效应可能与以边缘系统为主的多个脑功能区互相作用有关。
Objective To observe the relationship between the analgesic effect of balance acupuncture and functional changes in brain in patients with migraine without aura.Methods A total of 40 cases of migraine without aura were equally randomized into a headache-acupoint group and a sham-acupoint group.When acupuncture given,a filiform needle was inserted into the headache-acupoint(the midpoint of the depression region anterior to the juncture of the first and second metatarsal bones on the dorsum of the foot)or the sham point(the midpoint of the depression region anterior to the juncture site between the 3 rd and4 th metatarsal joints of the dorsum of the foot)about 25—40 mm deep and manipulated for a while till the patient experienced feelings of electric shock and numbness,then withdrawn immediately.The treatment was conducted once daily for 4 weeks.The visual analogue scale(VAS)was used to evaluate the severity of pain,and the regional homogeneity(ReHo)analysis of resting state functional magnetic resonance imaging(fMRI)was used to assess changes of the spontaneous brain activity.Results After acupuncture,the analgesic effect of headache-acupoint was better than that of the sham-acupoint in both intervention stage and the follow-up stage(P<0.05),and was also stronger in the intervention stage than in the follow-up stage(P<0.05).There was no significant difference in the analgesic effect between the intervention stage and the follow-up stage in the sham-acupoint group(P>0.05).Compared with pre-intervention,4-weeks' intervention at the headache-acupoint showed an increase of ReHo values in the anterior cingulate gyrus,anterior central gyrus,superior orbital frontal gyrus,insula,inferior lobule,left anterior cingulate gyrus,ventral lateral nucleus and ventral posteromedial nucleus of the thalamus,pontine nucleus,cerebellar tonsils and orbital frontal inferior gyrus of the brain(P<0.05),and a decrease of ReHo values in the right brain bridge,central posterior gyrus,posterior cingulate gyrus,left central anterior gyrus,posterolateral nucleus of thalamus,and hippocampus(P<0.05),separately.In the sham-acupoint group,the ReHo value was increased in the right tongue gyrus,the left anterior lobe,the anterior cingulate gyrus and the lower occipital gyrus of the brain(P<0.05),and reduced in the left ventral posterolateral nucleus of the thalamus,separately(P<0.05).Conclusion Balance acupuncture stimulation of headache acupoint has an analgesic effect in migraine patients without aura,which may be related to its effect in regulating resting state brain function of the limbic-system-dominated multiple brain regions.
Objective To observe the relationship between the analgesic effect of balance acupuncture and functional changes in brain in patients with migraine without aura.Methods A total of 40 cases of migraine without aura were equally randomized into a headache-acupoint group and a sham-acupoint group.When acupuncture given,a filiform needle was inserted into the headache-acupoint(the midpoint of the depression region anterior to the juncture of the first and second metatarsal bones on the dorsum of the foot)or the sham point(the midpoint of the depression region anterior to the juncture site between the 3 rd and4 th metatarsal joints of the dorsum of the foot)about 25—40 mm deep and manipulated for a while till the patient experienced feelings of electric shock and numbness,then withdrawn immediately.The treatment was conducted once daily for 4 weeks.The visual analogue scale(VAS)was used to evaluate the severity of pain,and the regional homogeneity(ReHo)analysis of resting state functional magnetic resonance imaging(fMRI)was used to assess changes of the spontaneous brain activity.Results After acupuncture,the analgesic effect of headache-acupoint was better than that of the sham-acupoint in both intervention stage and the follow-up stage(P<0.05),and was also stronger in the intervention stage than in the follow-up stage(P<0.05).There was no significant difference in the analgesic effect between the intervention stage and the follow-up stage in the sham-acupoint group(P>0.05).Compared with pre-intervention,4-weeks' intervention at the headache-acupoint showed an increase of ReHo values in the anterior cingulate gyrus,anterior central gyrus,superior orbital frontal gyrus,insula,inferior lobule,left anterior cingulate gyrus,ventral lateral nucleus and ventral posteromedial nucleus of the thalamus,pontine nucleus,cerebellar tonsils and orbital frontal inferior gyrus of the brain(P<0.05),and a decrease of ReHo values in the right brain bridge,central posterior gyrus,posterior cingulate gyrus,left central anterior gyrus,posterolateral nucleus of thalamus,and hippocampus(P<0.05),separately.In the sham-acupoint group,the ReHo value was increased in the right tongue gyrus,the left anterior lobe,the anterior cingulate gyrus and the lower occipital gyrus of the brain(P<0.05),and reduced in the left ventral posterolateral nucleus of the thalamus,separately(P<0.05).Conclusion Balance acupuncture stimulation of headache acupoint has an analgesic effect in migraine patients without aura,which may be related to its effect in regulating resting state brain function of the limbic-system-dominated multiple brain regions.
引文
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[14]方剑乔.针刺镇痛-全景式的多维度疼痛调控方案[J].针刺研究,2018,43(8):459-466.
[15]于洪丽,徐桂芝,杨硕,等.磁刺激穴位镇痛诱发的脑电信号特征成分及源定位[J].中国组织工程研究与临床康复,2011,15(9):1639-1642.
[16]杨一玲,黄键澎,蒋丽,等.针刺干预慢性疼痛突触可塑性变化:“疼痛记忆”的机制探讨[J].针刺研究,2017,42(6):547-551.
[17]陈静,卢明,彭立辉,等.边缘系统脑胶质瘤的临床特点及显微手术方法探讨[J].临床军医杂志,2010,38(1):47-49.
[18]MORGANE P J,GALLER J R,MOKLER D J.A review of systems and networks of the limbic forebrain/limbic midbrain[J].Prog Neurobiol,2005,75(2):143-160.
[19]HUI K,LIU J,MARINA O,et al.The integrated response of the human cerebro cerebellar and limbic systems to acupucture stimulation at ST 36as evidenced by fMRI[J].Neuroimage,2005,27:479-496.
[20]李媛,吴凡,程珂,等.针刺对炎性疼痛的镇痛机制[J].针刺研究,2018,43(8):467-475.
[2]于生元.从宏观到微观认识头痛[J].中国疼痛医学杂志,2014,20(1):2-4.
[3]林燕,张文,武陈涛.偏头痛患者脑血管病一级预防证据评价[J].中国现代神经疾病杂志,2015,15(1):33-38.
[4]LINDE K,ALLAIS G,BRINKHAUS B,et al.Acupuncture for the prevention of episodic migraine[J].Cochrane Database Syst Rev,2016(6):CD001218
[5]王文远.中国平衡针灸[M].北京:北京科学技术出版社,1998:3.
[6]董峰,方朝义.平衡针疗法治疗偏头痛50例[J].世界中西医结合杂志,2010,5(1):62-63.
[7]HEADACHE CLASSIFICATION COMMITTEE OF THEINTERNATIONAL HEADACHE SOCIETY(HIS).The international classification of headache disorders:3rd edition(beta version)[J].Cephalalgia,2013,33(9):629-808.
[8]贾文宵,陈敏.磁共振功能成像临床应用[M].北京:人民军医出版社,2012:156.
[9]方继良,王小玲.脑功能磁共振成像技术简介及针刺研究应用(一)[J].中国中西医结合影像学杂志,2012,10(1):94-96.
[10]HUANG W,PACH D,NAPADOW V,et al.Characterizing acupuncture stimuli using brain imaging with FMRI-a systematic review and meta-analysis of the literature[J].PLoSOne,2012,7(4):e32960.
[11]LIU B,CHEN J,WANG J,et al.Altered small-world efficiency of brain functional networks in acupuncture at ST36:a functional MRI study[J].PLoS One,2012,7(6):e39342.
[12]吴文锋,黄凡.平衡针治疗偏头痛56例[J].中国中医急症,2011,20(6):1000-1002.
[13]WILLIAMS A C,CRAIG K D.Updating the definition of pain[J].Pain,2016,157(11):2420-2423.
[14]方剑乔.针刺镇痛-全景式的多维度疼痛调控方案[J].针刺研究,2018,43(8):459-466.
[15]于洪丽,徐桂芝,杨硕,等.磁刺激穴位镇痛诱发的脑电信号特征成分及源定位[J].中国组织工程研究与临床康复,2011,15(9):1639-1642.
[16]杨一玲,黄键澎,蒋丽,等.针刺干预慢性疼痛突触可塑性变化:“疼痛记忆”的机制探讨[J].针刺研究,2017,42(6):547-551.
[17]陈静,卢明,彭立辉,等.边缘系统脑胶质瘤的临床特点及显微手术方法探讨[J].临床军医杂志,2010,38(1):47-49.
[18]MORGANE P J,GALLER J R,MOKLER D J.A review of systems and networks of the limbic forebrain/limbic midbrain[J].Prog Neurobiol,2005,75(2):143-160.
[19]HUI K,LIU J,MARINA O,et al.The integrated response of the human cerebro cerebellar and limbic systems to acupucture stimulation at ST 36as evidenced by fMRI[J].Neuroimage,2005,27:479-496.
[20]李媛,吴凡,程珂,等.针刺对炎性疼痛的镇痛机制[J].针刺研究,2018,43(8):467-475.