针刺健康受试者廉泉穴的针感与脑效应相关性分析  

Correlation between Needling Sensation and Brain Effect when Stimulated at Lianquan(RN 23) in Healthy Subjects

作　　者：慕容志苗 樊小农[2,3] 葛文逸 刘巍 李礼 秦毅[2] 刘迈兰 李思琦[2] 王辉[2] 丁露 常颖慧 王舒 余亮 MURONG Zhimiao;FAN Xiaonong;GE Wenyi;LIU Wei;LI Li;QIN Yi;LIU Mailan;LI Siqi;WANG Hui;DING Lu;CHANG Yinghui;WANG Shu;YU Liang(School of Acupuncture,Moxibustion&Tuina and Rehabilitation,Hunan University of Chinese Medicine,Changsha,410208;First Teaching Hospital of Tianjin University of Traditional Chinese Medicine;National Clinical Research Center for Chinese Medicine Acupuneture and Moxibustion;Tianjin Academy of Traditional Chinese Medicine Afiliated Hospital)

机构地区：[1]湖南中医药大学针灸推拿与康复学院,湖南省长沙市410208 [2]天津中医药大学第一附属医院 [3]国家中医针灸临床医学研究中心 [4]天津市中医药研究院附属医院

出　　处：《中医杂志》2023年第1期49-54,共6页Journal of Traditional Chinese Medicine

基　　金：国家重点研发计划(2018YFC1705004);国家自然科学基金(82205298);天津市科技计划(18PTLCSY00040);天津市教委科研计划(2021ZD011)。

摘　　要：目的基于功能性磁共振成像(f MRI)探索针刺廉泉穴过程中针感与脑效应的相关性。方法纳入18~35岁右利手健康受试者20例,采用随机交叉设计法将其随机分为两部分各10例,一部分受试者先接受真针刺,间隔7天洗脱期后再接受假针刺;另一部分受试者先接受假针刺,间隔7天洗脱期后再接受真针刺。将最终获得的40例次数据中接受真针刺时收集的数据归为试验组,接受假针刺时收集的数据归为对照组。真针刺为针刺廉泉穴,行手法1 min,留针8 min,再重复1次,共干预18 min;假针刺为针刺类廉泉穴,针灸师手拿针柄但不行手法持续1min,留针8 min,再重复1次,共干预18 min。针刺过程中采用马萨诸塞州总医院针感量表对针感进行评分,对受试者全脑进行f MRI扫描,以低频振幅分析(ALFF)指标评估受试者针刺后脑区功能活动的变化;对试验组针感评分与差异脑区的ALFF指标进行相关性分析,以探索脑功能活动变化与针感之间的关系。结果试验组针感中酸痛、深压痛、沉重感、胀痛、刺痛、如鲠在喉评分及总分均高于对照组(P<0.05或P<0.01);疼痛、麻木感评分两组比较差异无统计学意义(P>0.05)。针刺后试验组ALFF指标显著变化的脑区包括左侧枕上回、右侧颞中回,对照组ALFF指标显著变化的脑区包括右侧梭状回、右侧岛盖部额下回、右侧脑岛(P<0.05)。试验组与对照组比较ALFF指标显著变化的脑区包括左侧颞下回、左侧小脑6区、左侧楔前叶(P<0.05)。相关性分析结果显示,酸痛、疼痛、深压痛、刺痛、麻木感、如鲠在喉评分及总分与左侧颞下回有相关性(P<0.05);针感各项评分及总分与左侧小脑6区、左侧楔前叶无相关性(P>0.05)。结论廉泉穴针刺过程中的针感可能与左侧颞下回脑区功能活动密切相关,深压痛感、如鲠在喉感等复合针感可能是针刺引起的特异性脑中枢效应的针感。Objective To explore the correlation between needling sensation and brain effect when stimulated at Lianquan(RN 23) based on functional magnetic resonance imaging(f MRI).Methods In a crossover trial,20 right-handed healthy subjects aged 18-35 were randomly divided into two groups,each with 10 cases.Subjects in one group received acupuncture first,and then sham-acupuncture after a wash-out period of 7 days,while those in the oth-er group received treatments in reverse order.Finally,40 cases of data were obtained,and were analyzed as interven-tion group with cases receiving acupuncture and control group with cases receiving sham acupuncture.In the acupunc-ture group,Lianquan(RN 23) was needled with manipulation for 1 minute and needle retention for 8 minutes,repeat-ed once more,for a total of 18 minutes.For sham acupuncture,the sham acupoints of Lianquan(RN 23) was used,with superficial skin puncture and no manipulation for 1 minute and needle retention for 8 minutes,repeated once more,for a total of 18 minutes.The Massachusetts General Hospital Acupuncture Sensation Scale(MASS) was used to measure the needling sensation,while f MRI scan of whole brain was performed,and the amplitude of low-frequency fluctuation(ALFF) was used to evaluate the changes in the functional activity of the brain regions.Correlation be-tween the scores of needling sensation and the ALFF index of differentiated brain regions in bothe groups was ana-lyzed,so as to explore the relationship between brain functional activity changes and needling sensation.Results The scores of aching pain,deep tenderness,heavy pain,distending pain,stabbing pain,and like a fishbone getting stuck in the throat,and the total score of the needling sensation in the intervention group were higher than those in the control group(P<0.05 or P<0.01);there was no difference in the scores of pain and numbness between groups(P>0.05).The ALFF index significantly changed after treatment in the brain regions of left superior occipital gyrus and right middle temporal gyrus in

关 键 词：针感 脑效应 低频振幅分析 功能性磁共振成像 廉泉 

分 类 号：R246[医药卫生—针灸推拿学]