温振运气方对慢性疲劳综合征气虚证患者脑功能和脑代谢的影响  

Effect of Wenzhen Yunqi Formula(温振运气方)on Brain Function and Cerebral Metabolism in Patients with Chronic Fatigue Syndrome of Qi Deficiency Pattern

作　　者：黄瑶[1] 张振贤[1] 李冠武[1] 陈畅[1] 史佳宁[1] 陈敏[1] 张维佳[1] HUANG Yao;ZHANG Zhenxian;LI Guanwu;CHEN Chang;SHI Jianing;CHEN Min;ZHANG Weijia(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200437)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海市200437

出　　处：《中医杂志》2022年第10期943-950,共8页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81373624);上海市中医药事业发展三年行动计划[ZY(2018-2020)-ZWB-1001]。

摘　　要：目的观察温振运气方干预慢性疲劳综合征气虚证患者疲劳及负性情绪的临床疗效并探索其中枢作用机制。方法60例慢性疲劳综合征气虚证患者随机分为治疗组与对照组各30例,对照组给予基础治疗,治疗组给予基础治疗联合温振运气方口服,疗程12周。于治疗前及治疗6周、12周时测定中医证候量表评分并判定中医证候疗效,治疗前后进行疲劳量表(FS-14)评分并判定疲劳疗效,治疗前后采用汉密顿抑郁量表(HAMD)与汉密顿焦虑量表(HAMA)评分判定负性情绪情况,运用血氧水平依赖功能磁共振(BOLD-fMRI)、氢质子磁共振波谱成像(1H-MRS)检测治疗前后患者脑功能、脑代谢变化。结果治疗组中医证候疗效总有效率为90.00%,FS-14疗效总有效率86.67%,对照组分别为66.67%、60.00%,治疗组均优于对照组(P<0.05)。与本组治疗前比较,治疗组治疗6、12周时中医证候总积分及神疲、气短、乏力症状评分降低,治疗后FS-14总分、躯体疲劳评分与脑力疲劳评分均较治疗前降低,且均显著优于对照组(P<0.05或P<0.01)。治疗后治疗组HAMD总分、焦虑/躯体化、日夜变化、睡眠障碍、绝望感、认知障碍及HAMA总分、躯体性焦虑、精神性焦虑评分均较治疗前显著降低(P<0.05或P<0.01)。治疗组治疗后在双侧额中回、右侧三角部额下回、左侧背外侧额上回均出现低频振幅(ALFF)与局部一致性方法(ReHo)增高,在右侧梭状回、右侧楔前叶出现ALFF降低(P<0.001);治疗组双侧额中回N-乙酰天门冬氨酸(NAA)/肌酸(Cr)较治疗前升高(P<0.05),且较对照组升高更显著(P<0.05)。结论温振运气方可有效改善慢性疲劳综合征患者的中医临床症状,缓解疲劳,改善抑郁、焦虑状态,其机制可能与提高前额叶部分脑区神经活动及调节双侧额中回NAA脑代谢相关。Objective To observe the clinical effect of Wenzhen Yunqi Formula(温振运气方,WYF)on fatigue and negative emotions in patients with chronic fatigue syndrome(CFS)and qi deficiency pattern,and to explore its central mechanism.Methods In a randomized controlled trial,60 CFS patients with qi deficiency pattern were divided into the treatment group(30 cases)and the control group(30 cases).The control group was given basic treatment,while the treatment group additionally received oral WYF,both for 12 weeks.The scores of traditional Chinese medicine(TCM)syndrome scale were assessed before,after 6 w-and 12 w-treatment.The fatigue scale-14(FS-14),Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were assessed before and after treatment.The changes of brain function and brain metabolism were detected by blood oxygen level dependent functional magnetic resonance imaging(BOLD-fMRI)and hydrogen proton magnetic resonance spectroscopy(~1 H-MRS).Results The total effective rate regarding TCM syndrome and FS-14 in the treatment group was 90.00%and 86.67%,respectively,while that in the control group was 66.67%and 60.00%,respectively(P<0.05).The total score of TCM syndrome and the scores of mental fatigue,shortness of breath,and fatigue significantly decreased after 6 w-and 12 wtreatment,and FS-14 total score and physical and mental fatigue scores also decreased after 12 w-treatment in the treatment group,with more remarkable decreases than the control group(P<0.05 or P<0.01).The total score of HAMD,scores of anxiety/sormatization,day and night change,sleep disorder,sense of despair,cognitive impairment,as well as total score of HAMA,somatic and mental anxiety scores in the treatment group were significantly reduced after treatment(P<0.05 or P<0.01).The amplitude of low-frequency fluctuation(ALFF)and regional homogeneity(ReHo)increased in bilateral middle frontal gyrus,right trigonal inferior frontal gyrus and left dorsalateral superior frontal gyrus in the treatment group,while ALFF decreased in right fougate gyru

关 键 词：慢性疲劳综合征 气虚证 温振运气方 血氧水平依赖功能磁共振 氢质子磁共振波谱 

分 类 号：R259[医药卫生—中西医结合]