针刺治疗膝骨性关节炎膝痛优效患者神经影像学特征研究  

Research of neuroimaging characteristics of positive responses to acupuncture treatment in knee osteoarthritis knee pain patients

作　　者：周俊 李政杰[1,2] 程施瑞 董晓慧[1,2] 曾芳 梁繁荣 ZHOU Jun;LI Zheng-jie;CHENG Shi-rui;DONG Xiao-hui;ZENG Fang;LIANG Fan-rong(College of Acupuncture-Moxibustion and Tuina,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Acupuncture&Brain Research Center,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China)

机构地区：[1]成都中医药大学针灸推拿学院,成都610075 [2]成都中医药大学针灸脑科学研究中心,成都610075

出　　处：《中华中医药杂志》2022年第12期7313-7320,共8页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家中医药管理局中医药创新团队及人才支持计划项目(No.ZYYCXTD-D-202003);国家自然科学基金项目(No.81774400,No.81973958);中国博士后科学基金(No.2017M610593,No.2018T110954,No.20190037)。

摘　　要：目的:基于静息态功能核磁共振技术,探讨针刺治疗膝骨性关节炎(KOA)膝痛优效患者的中枢神经影像学特征。方法:72例K0A患者随机分为针刺穴位组与针刺非穴组,每组36例。两组患者每天接受1次针刺治疗,每次30min,完成5次治疗后休息2d,共治疗10次。治疗前进行一次静息态血氧水平依赖功能磁共振成像扫描。治疗后以视觉评分量表(VAS)和西大略湖麦克马斯特大学骨关节炎指数(WOMAC)评分的最小临床意义重要差值(MCID)作为筛选针刺治疗KOA膝痛优效患者的临床标准。采用基于数据驱动的低频振幅比率(fALFF)和局部一致性(ReHo)分析法比较针刺优效患者相较于针刺劣效患者的脑功能活动差异。进一步将具有显著差异的fALFF和ReHo的重叠脑区作为种子点,进行基于种子点的功能连接度分析,探讨针刺优效患者脑功能网络特征。结果:针刺治疗KOA膝痛优效患者占比为50.77%。优效患者相较劣效患者具有显著差异的fALFF和ReHo的重叠脑区为双侧眶额回(OFC),表现为fALFF和ReHo值均增加,且与KOA膝痛强度变化呈正相关。与针刺劣效组比较,针刺优效组患者右侧OFC与双侧顶上小叶、缘上回,左侧直回、额中回、楔叶、梭状回、OFC、额下回,右侧梭状回以及海马旁回的功能连接增强;左侧OFC与双侧舌回、OFC、直回,左侧顶上小叶、角回、额中回、丘脑,右侧梭状回、额上回、后扣带回,以及右侧小脑、脑干的功能连接增强。结论:大脑双侧OFC的fALFF和ReHo脑功能活动高位水平,以及OFC与默认网络的静息态功能连接高位水平可能是针刺治疗KOA膝痛优效患者相较于劣效患者的部分中枢特征。Objective:To explore the neuroimaging characteristics of central nervous system in responsive patients with chronic knee pain caused by knee osteoarthritis(KOA)treated with acupuncture based on resting state functional magnetic resonance imaging(fMRI).Methods:A total of 72 KOA patients with chronic knee pain were randomly divided into acupuncture point group(36 patients)and non-acupuncture point group(36 patients).Patients in the two groups received acupuncture treatment once a day for 30 minutes each time,and rested for 2 days after completing 5 treatments for a total of 10 treatments.Before treatment,a resting-state BOLD-fMRI scan was performed.The minimal clinically important difference(MCID)of visual score scale(VAS)and Western Ontario and McMaster Universities osteoarthritis index(WOMAC)was used as the clinical standard to screening patients with excellent effect of acupuncture treatment of KOA knee pain.The brain resting-state BOLD-fMRI data of acupuncture responsive patients compared with unresponsive patients were analyzed by data-driven fractional amplitude of low-frequency fluctuation(fALFF)and regional homogeneity(ReHo).Furthermore,the overlapping brain regions of fALFF and ReHo,which were significantly different between acupuncture responsive patients and unresponsive patients,were taken as seed points,and the seed-based functional connectivity(Seed-based FC)analysis was performed to explore the characteristics of brain functional network in acupuncture responsive patients.Results:The responsive rate of acupuncture treatment for KOA was 50.77%.The overlapping brain regions of fALFF and ReHo that were significantly different between responsive patients and unresponsive patients were the bilateral OFC.Both fALFF and ReHo values showed increased in bilateral OFC,and were positively correlated with the change of KOA knee pain intensity.Compared with unresponsive patients,the overlapping brain regions of fALFF and ReHo was bilateral orbitofrontal gyrus(OFC)in responsive patients,which was significantly dif

关 键 词：针刺 膝骨性关节炎 慢性膝痛 静息态功能磁共振 疗效预测 

分 类 号：R246.9[医药卫生—针灸推拿学]