太极拳辅助治疗对轻中度慢性阻塞性肺疾病患者疼痛、认知功能及大脑静息态脑功能的影响  

Effect of Adjuvant Tai Chi on Pain,Cognitive Function and Resting-state Brain Function in Patients with Mild and Modertae Chronic Obstructive Pulmonary Disease

作　　者：沈浩冉 魏高峡[1,2] 陈丽珍 胡卓尔 姚晓燕 李光熙[5] SHEN Haoran;Wei Gaoxia;CHEN Lizhen;HU Zhuoer;YAO Xiaoyan;LI Guangxi(Institute of Psychology,Chinese Academy of Sciences,Beijing,100101;Department of Psychology,University of Chinese Academy of Sciences;Sino-Danish College,University of Chinese Academy of Sciences;Sino-Danish Centre for Education and Research,Chinese Academy of Science;Guang’anmen Hospital,China Academy of Chinese Medical Sciences)

机构地区：[1]中国科学院心理研究所,北京市100101 [2]中国科学院大学心理学系 [3]中国科学院大学中丹学院 [4]中国科学院中丹科教中心 [5]中国中医科学院广安门医院

出　　处：《中医杂志》2022年第11期1051-1057,共7页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(31671163);北京市中医药科技发展资金项目(JJ2018-90);中国中医科学院科技创新工程(CI2021A01110)。

摘　　要：目的观察太极拳辅助治疗对轻中度慢性阻塞性肺疾病(COPD)患者的疗效和相关神经机制。方法选取20例轻中度COPD患者,在西医常规治疗基础上辅助太极拳康复训练,每周3次,每次90 min,共计8周。干预前后采用慢性阻塞性肺疾病症状评估量表(CAT)及改良后的呼吸困难量表(mMRC)评估患者临床症状和呼吸困难程度;使用E-prime 2.0软件编制疼痛共情程序及注意网络测试,记录疼痛强度、疼痛不愉悦度评分,警觉、定向和执行控制评分;使用静息态功能性磁共振成像(fMRI)扫描,计算反映局部大脑功能的低频振幅(ALFF)和局部功能一致性(ReHo)指标、反映大脑功能网络连接属性的度中心性(DC)指标以及反映半球偏侧化程度的体素-镜像同伦连接(VMHC)指标。结果研究期间,有3例患者未能坚持训练而脱落,最终干预后纳入统计分析患者17例。与干预前比较,干预后患者CAT评分、疼痛强度评分和疼痛不愉悦度评分均显著降低,警觉功能评分显著提高(P<0.05或P<0.01),但mMRC评分、定向和执行控制功能评分差异无统计学意义(P>0.05)。影像学分析发现,额叶、扣带回和楔前叶在DC、ReHo、VMHC的局部功能指标出现稳定下降。相关分析发现,右侧额下回DC值降低与疼痛强度评分降低(r=0.68,P<0.05)、疼痛不愉悦度评分降低(r=0.79,P<0.05)呈显著正相关,与执行控制提升也呈显著正相关(r=0.82,P<0.05)。结论太极拳辅助治疗能改善轻中度COPD患者的临床症状、缓解疼痛、提升认知功能,额下回功能改变可能是患者疼痛和认知功能改善的潜在神经机制。ObjectiveTo explore the effect of adjuvant Tai Chi in the treatment of mild to moderate chronic obstructive pulmonary disease(COPD)as well as the related neural mechanism.Methods COPD patients were recruited for 8-week Tai Chi rehabilitation,90 minutes each time,three times weekly,in addition to regular treatment.Before and after the treatment,the clinical symptoms and dyspnea degree were measured using the COPD assessment test(CAT)and the modified medical research council dyspnea scale(mMRC).E-prime2.0 software was used to execute the empathy for pain paradigm and the attentional network test,recording pain intensity and unpleasantness,alertness,orientation and executive function.Resting-state functional magnetic resonance imaging(fMRI)was performed to obtain the amplitude of low-frequency fluctuation(ALFF)and regional homogeneity(ReHo)reflecting the local brain function,degree centrality(DC)reflecting the brain functional network connectivity,and Voxel-Mirrored homotopic connectivity(VMHC)reflecting the degree of hemispheric lateralization.Results Three patients dropped out due to failure of adherence to the Tai Chi training,and 17 patients were included in the final analysis.After 8-week treatment,the CAT score,pain intensity and unpleasantness score significantly decreased,while the alertness score significantly increased(P<0.05 or P<0.01);there were no significant differences in mMRC score,orientation and executive function score(P>0.05).Resting-state fMRI showed steady decline of local function indicators DC,ReHo and VMHC in the frontal lobe,cingulate gyrus and precuneus.Correlation analysis showed that decreased DC values of the right inferior frontal gyrus was positively correlated with the decrease of pain intensity score(r=0.68,P<0.05),the decrease of pain unpleasantness score(r=0.79,P<0.05)and increase of executive function score(r=0.82,P<0.05).ConclusionAdjuvant Tai Chi rehabilitation can improve the clinical symptoms,relieve pain,and increase cognitive function in mild to moderate COPD.The changes of

关 键 词：慢性阻塞性肺疾病 太极拳 呼吸困难 疼痛 认知功能 脑功能 额叶 

分 类 号：R259[医药卫生—中西医结合]