基于fMRI低频振幅比率分析调神法针刺治疗早醒型失眠的中枢机制研究  

A Study on Central Mechanism of Tiaoshen Acupuncture Treatment for Early Awakening Insomnia Based on fMRI Low-Frequency Amplitude Ratio Analysis

作　　者：宋章筱 姜同菲 尹雪娇 朱丽颖[1,2] 郭静 SONG Zhangxiao;JIANG Tongfei;YIN Xuejiao;ZHU Liying;GUO Jing(Beijing University of Chinese Medicine,Beijing 100029,China;Acupuncture Center of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing Key Laboratory of Acupuncture Neuroregulation,Beijing 100010,China)

机构地区：[1]北京中医药大学,北京100029 [2]首都医科大学附属北京中医医院针灸中心针灸神经调控北京市重点实验室,北京100010

出　　处：《针灸临床杂志》2024年第8期10-16,共7页Journal of Clinical Acupuncture and Moxibustion

基　　金：国家自然科学基金面上项目,编号:81774391;北京自然科学基金面上项目,编号:7212170。

摘　　要：目的:基于静息态功能磁共振成像(rs-fMRI)研究调神法针刺治疗早醒型失眠的潜在中枢机制。方法:将48例早醒型失眠患者随机分为调神法针刺组(24例,脱落1例)和非穴位浅刺组(24例,脱落1例,剔除1例)。调神法针刺组予针刺百会、神庭、四神聪、本神、神门、内关和三阴交;非穴位浅刺组予非效穴旁开1寸浅刺治疗,非效穴取臂臑、手三里、阳池、外关、风市、伏兔和梁丘;两组均治疗4周,每周3次,比较两组患者针刺前后匹兹堡睡眠质量指数(PSQI)及早醒评分、汉密尔顿抑郁量表(HAMD-17)评分及早醒评分和汉密尔顿焦虑量表(HAMA)评分,治疗前后进行rs-fMRI数据采集。观察两组患者针刺前后低频振幅比率(fALFF)的变化,fALFF值与量表进行相关性分析。结果:治疗后,调神法针刺组PSQI评分、PSQI早醒评分、HAMD评分、HAMD早醒评分和HAMA评分均较治疗前显著降低,差异具有统计学意义(P<0.01),且量表评分均显著低于非穴位浅刺组,差异具有统计学意义(P<0.05)。非穴位浅刺组HAMA评分较治疗前显著降低,差异具有统计学意义(P<0.01)。治疗后调神法针刺组较非穴位浅刺组fALFF值在左侧背外侧额上回(SFGd)升高、左侧小脑4_5区(CER4_5)降低,差异具有统计学意义(均GRF校正,体素水平P<0.01,团块水平P<0.01,双尾),左SFGd的fALFF值与PSQI评分(r=0.386)、PSQI早醒评分(r=0.330)和HAMD评分(r=0.358)呈显著正相关,差异具有统计学意义(P<0.05),左CER4_5的fALFF值与PSQI评分(r=0.374)、HAMD评分(r=0.483)呈显著负相关,差异具有统计学意义(P<0.05)。结论:调神法针刺可能通过调节早醒型失眠患者的局部脑功能强度,从而有效改善睡眠质量和早醒症状,缓解焦虑、抑郁情绪。Objective:To explore the potential central mechanisms of Tiaoshen acupuncture in treating early awakening insomnia based on resting-state functional magnetic resonance imaging(rs-fMRI).Methods:48 patients with early awakening insomnia were randomly assigned to the study group(n=24,1 case dropped off)and the control group(n=24,1 case dropped off,1 case was removed).The study group was treated with Tiaoshen needling Baihui(DU20),Shenting(DU24),Sishencong(EX-HN1),Benshen(GB47),Shenmen(HT7),Neiguan(PC6)and Sanyinjiao(SP6);the control group was treated with needling 1-inch next to non-effective points of Binao(LI14),Shousanli(LI10),Yangchi(TE4),Waiguan(TE5),Fengshi(GB31),Futu(ST32)and Liangqiu(ST34).Both groups were treated 3 times a week for 4 weeks.The Pittsburgh Sleep Quality Index(PSQI)score,PSQI early awakening score,Hamilton Depression Scale(HMAD-17)score and Hamilton Anxiety scale(HAMA)score were compared between before and after the treatment in the two groups.rs-fMRI scan was performed before and after the treatment.The change of fractional amplitude of low frequency fluctuations(fALFF)was observed in the two groups,and the correlations between the fALFF value and the scales of PSQI,HAMA and HAMD were analyzed.Results:The PSQI score,PSQI early awakening score,HAMD score,HAMD early awakening score and HAMA score were significantly lower after the treatment than those before the treatment in the study group(P<0.01),and the scale scores were significantly lower in the study group than those in the control group after the treatment(P<0.05).The HAMA score was significantly lower after the treatment than that before the treatment in the control group(P<0.01).The fALFF value was increased in the left dorsolateral superior frontal gyrus(SFGd)and it was decreased in the left cerebellar 4_5 area(CER4_5)after the treatment in the study group compared to those in the control group(GRF correction,P-voxel<0.01,P-cluster<0.01,double-tail).The fALFF value of left SFGd was significantly positively correlated with the PSQI sco

关 键 词：早醒型失眠 针刺 静息态功能磁共振成像 低频振幅比率 

分 类 号：R246.6[医药卫生—针灸推拿学]