针刺治疗对原发性痛经患者脑镜像同伦连接的影响  

Effect of acupuncture on brain voxel-mirrored homotopic connectivity in patients with primary dysmenorrhea

作　　者：魏伟 樊丽华 马萧童 贾颖斐 王咪 燕洋洋 张聪 郑运松 WEI Wei;FAN Lihua;MA Xiaotong;JIA Yingfei;WANG Mi;YAN Yangyang;ZHANG Cong;ZHENG Yunsong(Department of Medical Imaging,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,China;School of Medical Technology,Shaanxi University of Traditional Chinese Medicine,Xianyang 712046,China)

机构地区：[1]陕西中医药大学附属医院医学影像科,陕西咸阳712000 [2]陕西中医药大学医学技术学院,陕西咸阳712046

出　　处：《分子影像学杂志》2024年第5期484-490,共7页Journal of Molecular Imaging

基　　金：陕西省科学技术厅2024年度陕西省重点研发计划项目(2024SF-YBXM-524)。

摘　　要：目的基于静息态功能磁共振成像探讨原发性痛经(PDM)患者双侧大脑半球间体素-镜像同伦连接(VMHC)以及针刺治疗前后VMHC的变化,分析PDM针刺治疗前后VMHC值的改变与临床量表评分的相关性。方法纳入2021年9月~2022年9月陕西中医药大学58例PDM患者为PDM组,同期50例健康者作为健康对照组,在经期第1~3天进行静息态功能磁共振成像扫描,并填写疼痛视觉模拟量表(VAS)、COX痛经症状量表(CMSS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)。PDM组在下一个经期前1周进行连续针刺三阴交和关元穴组穴治疗,参与完整针刺的PDM组有30例。采用基于VMHC方法、Matlab平台的DPABI软件进行双样本t检验及配对t检验,观察两组受试者之间及PDM组在针刺治疗前后VMHC值有差异的脑区;采用Spearman相关性分析PDM组针刺治疗前后VMHC值的改变与临床量表评分改变之间的相关性。结果PDM组与健康对照组在VAS、CMSS、SAS、SDS量表评分的差异均有统计学意义(P<0.001)。PDM组针刺治疗前后,在VAS、CMSS、SAS、SDS量表评分的差异均有统计学意义(P<0.01)。与健康对照组相比,PDM组VMHC值升高的脑区主要包括双侧后扣带皮层、梭状回、颞上回/颞中回、壳核,VMHC值减低的脑区包括双侧前额叶皮层(体素水平P<0.001,组水平P<0.05)。PDM组针刺后在双侧中扣带皮层、枕下回VMHC值减低;相关性分析结果显示,PDM组针刺后双侧枕下回VMHC值的减低与CMSS总发作时间量表评分改变呈正相关(r=0.398,P<0.05)。结论基于静息态功能磁共振成像及VMHC方法,PDM患者双侧大脑半球间对称脑区存在一定的同伦功能连接障碍。针刺治疗对PDM患者具有良好的临床疗效,并且减低了双侧中扣带皮层、枕下回VMHC值,这些异常脑区主要位于痛觉传导通路,可能参与了针刺治疗原发性痛经的中枢镇痛。Objective To investigate the changes in voxel-mirrored homotopic connectivity(VMHC)in bilateral cerebral hemispheres of patients with primary dysmenorrhea(PDM),as well as the changes in VMHC before and after acupuncture treatment,and the changes of VMHC before and after acupuncture treatment,using resting-state functional magnetic resonance imaging,and to analyze the correlation between VMHC value and clinical scale scores before and after acupuncture treatment in PDM group.Methods Fifty-eight patients with PDM in Shaanxi University of Chinese Medicine from September 2021 to September 2022 were prospectively included as the PDM group,and 50 healthy subjects from the same period were selected as the healthy control group.Resting-state functional magnetic resonance imaging scan was performed on the 1st to 3rd day of menstruation.The visual analogue scale(VAS),COX dysmenorrhea symptom scale(CMSS),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were completed.The PDM group received continuous acupuncture therapy at Sanyinjiao and Guanyuan point one week before the next menstrual period.There were 30 cases in PDM group participating in complete acupuncture.Independent samples t-test and paired t-test were performed using VMHC method and DPABI software based on Matlab platform to observe the brain regions with differences in VMHC values between the two groups of subjects and PDM group before and after acupuncture treatment.Spearman correlation analysis was finally applied.The correlation between VMHC value and clinical scale score before and after acupuncture treatment in PDM group was observed.Results There were substantial variances in VAS,CMSS,SAS and SDS scores between PDM group and healthy control group(P<0.001).Substantial variations were also observed in VAS,CMSS,SAS,and SDS scores before and after acupuncture therapy in the PDM group(P<0.01).Compared to the healthy control group,the brain regions with increased VMHC value in PDM group mainly included bilateral posterior cingulate cortex,fusoi

关 键 词：原发性痛经 静息态功能磁共振成像 体素-镜像同伦连接 

分 类 号：R246.3[医药卫生—针灸推拿学] R445.2[医药卫生—中医临床基础]