健脑安神法针刺治疗失眠及对磁共振脑功能成像的影响  

Effect of Jiannao Anshen acupuncture on insomnia: a functional magnetic resonance imaging study

作　　者：赵婷 徐辉[2] 赵腾 焦军阳 李刚 雷正权[6] 安军明 袁海光[6] 张容超 ZHAO Ting;XU Hui;ZHAO Teng;JIAO Jun-yang;LI Gang;LEI Zheng-quan;AN Jun-ming;YUAN Hai-guang;ZHANG Rong-chao(Xi'an Hospital of TCM,Xi'an 710000,Shaanxi Province,China;Xi'an Jiaotong University;Xi'an High-Tech Hospital,Xi'an 710000,Shaanxi Province;Affiliated Hospital of Shaanxi University of CM;Xixiang County Hospital of TCM;Shaanxi University of CM,Xianyang 712000)

机构地区：[1]西安市中医医院,陕西西安710000 [2]西安交通大学 [3]西安市高新医院,陕西西安710000 [4]陕西中医药大学附属医院 [5]西乡县中医医院 [6]陕西中医药大学,咸阳712000

出　　处：《中国针灸》2021年第7期767-773,共7页Chinese Acupuncture & Moxibustion

基　　金：陕西省教育厅科研项目:18JK0209;西安市市级中医药科研项目:SZJ201905;陕西省中医学术流派传承工作室。

摘　　要：目的:观察健脑安神法针刺治疗失眠的疗效及针刺前后磁共振成像的动态变化,为针刺治疗失眠提供神经影像学依据。方法:受试者58例,其中29例失眠患者为观察组,29例健康受试者为对照组。观察组采用健脑安神法针刺治疗,穴取百会、左右神聪、风府、风池、强间、枕上旁线、安眠、翳明、大椎。每天治疗1次,10d为一疗程,共治疗2个疗程。观察组在治疗前后采集静息态功能磁共振数据;对照组不进行治疗,仅采集1次静息态功能磁共振数据。比较观察组治疗前与对照组、观察组治疗前后脑静息态功能性磁共振数据。记录观察组治疗前后匹兹堡睡眠质量指数量表(PSQI)、失眠严重程度指数(ISI)、日间失眠症状反应量表(DISS)、过度觉醒量表(HAS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(Mo CA)和数字符号测试评分及连线测试A、B时间,并评定观察组临床疗效。结果:观察组总有效率为89.7%(26/29)。观察组治疗后PSQI、ISI、DISS评分降低、连线测试B时间缩短(P<0.01,P<0.05)。观察组治疗前较对照组功能连接强度降低的脑区有腹背叶前额叶皮质、前扣带回皮层背侧、顶叶下叶、背外侧前额叶皮质、前扣带回皮层背侧、左侧腹侧前扣带回、右侧腹侧前扣带回。观察组治疗后较治疗前功能连接强度增加的脑区有舌回、小脑六区、额叶、岛叶和前扣带回、运动前回、后扣带回。针刺治疗后,观察组左侧腹侧尾状核与岛叶的功能连接强度与HAMD评分呈负相关(r=-0.55,P<0.05),观察组左侧腹侧尾状核与前扣带回的功能连接强度与HAMA评分呈负相关(r=-0.47,P<0.05)。结论:健脑安神法针刺可以有效改善失眠患者的睡眠质量,针刺治疗可增强左侧背侧、右侧腹侧、左侧腹侧尾状核与脑区的连接强度。Objective To observe the efficacy of Jiannao Anshen acupuncture(acupuncture for brain-invigorating and mind-calming) on insomnia, and the dynamic changes of functional magnetic resonance imaging(f MRI) before and after acupuncture, to provide neuroimaging basis of acupuncture for insomnia. Methods A total of 58 participants were included. Of them, 29 patients with insomnia were included into an observation group, and 29 healthy participants were included into a control group. The patients in the observation group were treated with Jiannao Anshen acupuncture at Baihui(GV 20), bilateral Sishencong(EX-HN 1), Fengfu(GV 16), Fengchi(GB 20), Qiangjian(GV 18), occipital sideline, Anmian(Extra), Yiming(EX-HN 14) and Dazhui(GV 14);treatment was given once a day, 10 days as a course of treatment, and a total of 2 courses of treatment was given. The resting-state f MRI data was collected in the observation group before and after treatment. The participants in the control group received no treatment, and the resting-state f MRI data was collected only once. The resting-state f MRI data in the observation group before treatment and in the control group, also the observation group before and after treatment were compared. The Pittsburgh sleep quality index(PSQI), insomnia severity index(ISI), daytime insomnia symptom scale(DISS), hyperarousal scale(HAS), Hamilton anxiety scale(HAMA), Hamilton depression scale (HAMD), digit symbol test, mini-mental state examination(MMSE), Montreal cognitive assessment(Mo CA) and the A, B speed of trail making test(NCT) were observed in the observation group before and after treatment. The clinical efficacy of the observation group was evaluated. Results The total effective rate was 89.7%(26/29) in the observation group. In the observation group, the scores of PSQI, ISI and DISS, the A, B speed of NCT were all decreased after treatment(P<0.01, P<0.05). Before treatment, compared with the control group, functional connectivity in ventral dorsal prefrontal cortex, dorsal anterior cingulate cortex

关 键 词：失眠 针刺 健脑安神 尾状核 神经影像学 

分 类 号：R246.1[医药卫生—针灸推拿学]