摘要
目的:利用fMRI脑功能成像技术观察针刺对颈型颈椎病患者针刺后镇痛效应的脑功能连接改变。方法:16例颈型颈椎病患者手法捻针针刺治疗,比较颈疼患者与正常人对照者及针刺前后静息态脑功能成像特点。观察针刺后效应对疼痛相关矩阵中前扣带回(ACC)的功能连接的调节作用。结果:对比颈疼患者与正常人静息态脑功能成像的功能连接改变发现l-ACC功能连接增高的区域有背外侧前额叶、脑岛和丘脑,功能连接下降的区域有颞中回;与r-ACC功能连接升高的区域有PAG、颞中回。双侧ACC种子点均无显著脑功能连接下降的区域。颈痛患者疼痛的程度与l_ACC-dlpfc脑功能连接改变相关(r=0.508,P<0.001)。针刺后,患者l_ACC功能连接升高的区域有左侧腹侧前额叶、右侧颞中回,功能连接降低的区域有左侧丘脑;与r_ACC功能连接升高的区域有左侧颞中回、右侧枕下回,降低的脑区有右侧丘脑。治疗前后疼痛的降低程度与l_ACC-vmpfc脑功能连接相关(r=0.619,P<0.001)。结论:颈疼患者的功能连接疼痛上行传导通路中中脑导水管周围灰质、丘脑、脑岛、背外侧前额叶与前扣带回的功能连接活动增强,背外侧前额叶与前扣带回的功能连接反映了疼痛的严重程度。而针刺不仅有即时效果还有后效应,后效应能维持降低丘脑到前扣带回信号输入,并且增强腹内侧前额叶和扣带回的功能连接产生镇痛作用。负责疼痛信号编码ACC是针刺干预的重要节点,针刺镇痛的主要机制可能为通过腹内侧前额叶下行抑制疼痛的传导,从ACC下调其与丘脑疼痛信号的兴奋性传递。
Objective:To observe the effect of acupuncture on the function of brain connection in patients with cervical spondylosis by functional magnetic resonance imaging(fMRI).Methods:16 patients with cervical spondylosis were treated with manual twisting acupuncture manipulation,and the resting state brain functional imaging characteristics was compared between the patients and the normal person,as well as between before and after the treatment.The effect of acupuncture on the functional connectivity of anterior cingulate cortex(ACC)in pain related matrix were observed after acupuncture.Results:By comparing the functional connectivity changes of resting state brain functional imaging between patients with neck pain and normal controls,it found that the areas with increased l-ACC functional connectivity included dorsolateral prefrontal lobe,insula and thalamus,and the areas with decreased functional connectivity included middle temporal cortex.The areas with increased r-ACC functional connectivity were PAG and middle temporal cortex.There was no significant decrease of brain functional connectivity in bilateral ACC seed points.The degree of pain in patients with neck pain and the change of brain functional connectivity between l_ACC-dlpfc was correlated(r=0.508,P<0.001).After acupuncture,the areas with increased 1-ACC functional connectivity were left ventral prefrontal lobe and right middle temporal cortex,and the area with decreased functional connectivity was left thalamus.The areas with increased r-ACC functional connectivity were the left middle temporal cortex and the right suboccipital cortex,and the right thalamus was the area with decreased functional connectivity.The degree of pain reduction before and after the treatment was related to brain functional connectivity of l_ACC-vmpfc(r=0.619,P<0.001).Conclusion:The activity of functional connection between the midbrain periaqueductal grey(PAG),thalamus,insula,dorsolateral prefrontal lobe and ACC is enhanced in patients with neck pain,and the functional connection between dorsolateral prefrontal lobe and ACC reflects the degree of pain.Acupuncture not only has immediate effect,but also has after effect,which can maintain and reduce the signal input from thalamus to ACC,and enhance the functional connection between ventromedial prefrontal cortex and cingulate cortex to produce analgesic effect.ACC,which is responsible for pain signal coding,is an important node of acupuncture intervention.The main mechanism of acupuncture analgesia may be related to down-regulating the excitatory transmission from the thalamus to ACC,and inhibiting the conduction of pain through the ventromedial prefrontal lobe.
作者
沈巍
李健强
王乙翔
邹蓓蕾
李丹丹
王小龙
孙曌
SHEN Wei;LI Jianqiang;WANG Yixiang;ZOU Beilei;LI Dandan;WANG Xiaolong;SUN Zhao(The First Affiliated Hospital of Hainan Medical University, Haikou 570000, China)
出处
《针灸临床杂志》
2021年第8期10-15,共6页
Journal of Clinical Acupuncture and Moxibustion
基金
国家地区科学基金,编号:81560797、81861503。
关键词
针刺后效应
功能性磁共振成像
颈型颈椎病
脑功能连接
前扣带回
After effect of acupuncture
fMRI
Cervical spondylosis
Brain functional connectivity
Anterior cingulate cortex
