基于动脉自旋标记技术观察针刺对不同敏感度体质人群压痛阈影响的中枢效应  

ASL-based Observation of Central Nervous System Responses to Acupuncture Analgesia for People with Different Sensitivities

作　　者：马琳[1,2] 李学智 付妮妮[1] 杨晓光 席小芳[1] 刘菲 任毅[4] MA Lin1,2,LI Xue-zhi1,2,FU Ni-ni1,YANG Xiao-guang3,XI Xiao-fang1,LIU Fei1,REN Yi4(1 Department of Traditional Chinese Medicine of Chongqing Medical University, 2Key Laboratory of Metabolic Disease Prevention and Treatment by Traditional Chinese Medicine, Chongqing 400016, China ; 3 Department of Rehabilitation, Xiangyang Central Hospital, Xiangyang 441000, Hubei Province ;4 Department of Rehabilitation, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi Province)

机构地区：[1]重庆医科大学中医药学院,重庆400016 [2]重庆市中医药防治代谢性疾病重点实验室,重庆400016 [3]湖北省襄阳市中心医院康复科,湖北襄阳441000 [4]陕西省汉中市中心医院康复科,陕西汉中723000

出　　处：《针刺研究》2018年第5期319-325,共7页Acupuncture Research

基　　金：国家自然科学基金项目(No.81303036)

摘　　要：目的:观察不同敏感度体质对针刺镇痛效应的影响,运用脑功能磁共振动脉自旋标记(fMRIASL)技术,观察不同体质影响针刺镇痛效应的脑区激活变化特征,探讨体质因素影响针刺效果的中枢响应机制。方法:按标准筛选对针刺不同敏感度受试者,分为不敏感组20例和敏感组20例。针刺受试者左侧足三里穴,测定针刺前后两组受试者的体表压痛阈(PPT),比较两组针刺后的镇痛效应和PPT变化率;行脑功能磁共振ASL扫描,应用SPM 8、ASLtbx等软件对结果进行预处理,Pearson相关分析法分析局部脑血流(rCBF)与针感视觉模拟量尺(VAS)评分的相关性。结果:敏感组受试者的针感VAS评分显著高于不敏感组(P<0.05);针刺后敏感组的PPT变化率大于不敏感组(P<0.05)。不敏感组激活脑区包括右侧海马旁回、左侧海马、胼胝体、左侧扣带回中部、右侧扣带回中部、额叶、右侧扣带回前部等,敏感组激活脑区包括双侧扣带回中部、双侧扣带回后部、颞叶、右侧海马、丘脑、额中回、双侧扣带回前部、内侧额上回、左侧扣带回前部等。相关分析结果显示,不敏感组右侧扣带回前部和敏感组内侧额上回rCBF与VAS评分存在负相关(r>0.3,P<0.05)。结论:不同针刺敏感度体质是影响针刺镇痛效应的重要因素,敏感组针刺镇痛的疗效优于不敏感组,针刺可能使不同大脑功能区负激活而产生镇痛效应,内侧额上回、双侧前扣带回的负激活对敏感体质人群的针刺镇痛效应起到积极作用,这可能是针刺敏感体质人群针刺镇痛的中枢效应脑区之一。Objective To examine the effects of different sensitivities on the effectiveness of acupuncture analgesia by observing activation change characteristics of cerebral areas resulting from the influences of constitutions on analgesia effects and to discuss the response mechanism of central nervous system（CNS）to determine the factor of constitutions on acupuncture efficacy using cerebral functional magnetic resonance imaging arterial spin labeling（fMRI-ASL）.Methods Participants with different sensitivities were assessed according to standard screening and grouped into two groups：insensitivity group（n=24）and sensitivity group（n=22）.All participants were given acupuncture at the left-sided Zusanli point.Pressure pain threshold（PPT）of their body surface was determined before and after the acupuncture,and the two groups were subsequently compared in terms of analgesic effects and PPT rate of change;cerebral fMRI-ASL was performed;software such as SPM 8 and ASLtbx were utilized to preprocess the results,and correlation between regional cerebral blood flow（rCBF）and visual analog scale（VAS）score was determined using Pearson＇s correlational analysis.Results VAS score in the sensitivity group was significantly higher than that in the insensitivity group（P〈0.05）;after acupuncture,PPT rate of change in the sensitivity group was higher than that in the insensitivity group（P〈0.05）.The analyses revealed that there was a negative correlation between rCBF and VAS score for the right-sided anterior cingulate cortex in the insensitivity group and superior frontal gyrus in the sensitivity group（ ｜r｜〉 0.3 and P〈0.05）.Conclusion Different sensitivity to acupuncture is one of the crucial factors influencing analgesia effects.The sensitivity group had superior analgesia effect than the insensitivity group.Acupuncture might deactivate cerebral functional areas to generate analgesic effects.The superior frontal gyrus and bilateral anterior cingulate cortex,because of deactivation,play a

关 键 词：针刺镇痛 体质 脑功能磁共振 动脉自旋标记技术 

分 类 号：R245[医药卫生—针灸推拿学]