电针上肢穴位对运动皮层躯干脑区皮质脊髓兴奋性的影响  

Effect of electroacupuncture at upper limb points on corticospinal excitability in the motor cortex of brain region of trunk

作　　者：程伟丽 周彤 黄键澎 谢萌萌 许能贵 刘健华[1] CHENG Weili;ZHOU Tong;HUANG Jianpeng;XIE Mengmeng;XU Nenggui;LIU Jianhua(The Second Clinical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Clinical Medical College of Acupuncture-moxibustion and Rehabilitation,Guangzhou University of Chinese Medicine,Guangzhou 510000,China)

机构地区：[1]广州中医药大学第二临床医学院,广州510405 [2]广州中医药大学针灸康复临床医学院,广州510000

出　　处：《上海针灸杂志》2024年第6期701-708,共8页Shanghai Journal of Acupuncture and Moxibustion

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(ZYYCXTD-C-202004);国家自然科学基金面上项目(81873381);广东省岭南中医药重点研发项目(2020B1111100008)。

摘　　要：目的观察电针上肢穴位对健康受试者初级运动皮层(primary motor cortex,M1)躯干脑区皮质脊髓兴奋性的影响。方法纳入15名健康受试者,采用交叉设计。试验一观察电针上肢穴位对竖脊肌(erector spinae,ES)皮质脊髓兴奋性的影响,受试者随机先后进入3组试验,A组电针合谷穴,B组电针孔最穴,C组假针合谷穴。运用经颅磁刺激,检测干预前后对侧M1第一骨间背侧肌、桡侧腕屈肌及ES的运动诱发电位(motor evoked potentials,MEPs)的波幅和潜伏期,ES的MEPs波幅升高者进入试验二。试验二为抑制背侧前运动皮层(premotor cortex,PMd)后电针上肢穴位对ES的皮质脊髓兴奋性的作用研究,受试者随机先后进入两组试验,D组采用抑制PMd配合电针合谷穴干预,E组采用抑制PMd配合电针孔最穴干预。观察并比较两组对侧M1上肢脑区和躯干脑区MEPs的波幅和潜伏期。结果A组和B组干预后上肢脑区及躯干脑区MEPs总波幅均较同组干预前显著增加(P<0.001,P<0.01)。A组干预后上肢脑区及躯干脑区MEPs总波幅均明显高于C组,B组干预后仅躯干脑区MEPs总波幅明显高于C组,差异均具有统计学意义(P<0.001)。D组干预后上肢脑区最佳刺激点MEPs平均波幅及总波幅较同组干预前均显著增加(P<0.05)。D组和E组干预前后躯干脑区最佳刺激点的MEPs平均波幅及总波幅比较,差异也均无统计学意义(P>0.05)。结论生理状况下,电针合谷、孔最穴均可增强ES的皮质脊髓兴奋性,二者之间无明显差异,PMd可能参与其过程。Objective To observe the effect of electroacupuncture at upper limb points on corticospinal excitability in the primary motor cortex(M1)of the brain region of the trunk in healthy subjects.Method Fifteen healthy subjects were recruited to conduct a cross-over design trial.Trial part 1 observed the effect of electroacupuncture at upper limb points on corticospinal excitability of the erector spinae(ES).The subjects randomly joined three test groups:group A received electroacupuncture at Hegu(LI4),group B at Kongzui(LU6),and group C at the sham Hegu point.Before and after the intervention,transcranial magnetic stimulation(TMS)was used to detect the contralateral M1 of the first dorsal interosseus,flexor carpi radialis,and ES for the amplitude and latency of motor evoked potentials(MEPs).Those with increased amplitude of ES MEPs were selected for test part 2.Test part 2 studied the influence of EA at upper limb points on the corticospinal excitability of ES after inhibiting the dorsal premotor cortex(PMd).The subjects randomly joined two test groups:group D received electroacupuncture at Hegu plus inhibiting PMd,and group E received electroacupuncture at Kongzui plus inhibiting PMd.The contralateral M1 in brain regions of the upper limbs and trunk was observed for the amplitude and latency of MEPs.Result After the intervention,the total amplitude of MEPs in brain regions of the upper limbs and trunk increased significantly in groups A and B(P<0.001,P<0.01).After the intervention,Group A surpassed group C in comparing the total amplitude of MEPs in brain regions of the upper limbs and trunk,while group B only showed an advantage in comparing the total amplitude of MEPs in the brain region of the trunk compared with group C,all showing statistical significance(P<0.001).The mean and total amplitudes of MEPs increased markedly at the optimal stimulation spot in the brain region of upper limbs in group D after the intervention(P<0.05).Neither group D nor group E showed significant changes in the mean and total amplitudes

关 键 词：针刺疗法 电针 脑可塑性 运动诱发电位 皮质脊髓兴奋性 经颅磁刺激 穴 合谷 穴 孔最 

分 类 号：R245.2[医药卫生—针灸推拿学]