基于“按之快然”点按力敏舒快态委中穴对腰椎间盘突出症患者的即刻功能脑网络研究  

Immediate Functional Brain Networks in Patients with Lumbar Disc Herniation Using"Press-Emergence Sensation"at Pressure Pleasantly-Sensitive Weizhong Point(BL 40)

作　　者：周星辰 吕智桢[1,2,3] 吴双 田雨 胡会杰[1,2] 王凯正 吕立江 ZHOU Xing-chen;LV Zhi-zhen;WU Shuang;TIAN Yu;HU Hui-jie;WANG Kai-zheng;LV Li-jiang(Department of Tuina,The Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou,310053;Research Institute of Spinal Manipulation,Zhejiang Chinese Medicine University,Hangzhou,310053;The Third Clinical Medical College of Zhejiang University of Traditional Chinese Medicine,Hangzhou,310053)

机构地区：[1]浙江中医药大学附属第三医院推拿科,杭州310053 [2]浙江中医药大学推拿脊柱病研究所,杭州310053 [3]浙江中医药大学第三临床医学院,杭州310053

出　　处：《中国中西医结合杂志》2024年第7期814-820,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：浙江省“尖兵”“领雁”重大研发攻关项目(No.2022C03123);国家自然科学基金资助项目(No.82274672,No.81774442);吕立江名老中医专家传承工作室(No.GZS2021026)。

摘　　要：目的 运用静息态功能磁共振成像(rs-fMRI)技术,分析点按力敏舒快态委中穴对腰椎间盘突出症(LDH)患者的即刻功能脑网络,以“穴位敏化—中枢敏化”为切入点剖析“按之快然”的理论内涵。方法 符合纳入标准的30例LDH患者为LDH组及31名健康者为健康组,所有患者均在委中穴探查出力敏舒快感。LDH组采用点按力敏舒快态委中穴15 min,并于治疗前后行rs-fMRI扫描,健康组仅纳入时行rs-fMRI扫描。分析基线期LDH组与健康组在除均值标准化低频振幅(mALFF)差异有统计学意义的脑区,并以差异有统计学意义脑区为感兴趣区(ROI)分析LDH组即刻治疗前后的功能连接(FC)变化。结果 LDH组治疗前较健康组在右侧岛盖部额下回、左侧眶部额中回、左侧眶部额下回和左侧额中回的mALFF显著增强;在右侧豆状壳核的mALFF值显著降低(P<0.005)。不同脑区,mALFF值最大且峰值最大的是左侧额中回。LDH组治疗前较健康组在左侧中央前回的FC值特异性显著降低(P<0.005)。与本组治疗前比较,治疗后LDH组在双侧丘脑和左侧顶下缘角回的FC增强(P<0.005)。结论 LDH患者的长期慢性疼痛存在“前额叶—额顶网络—感觉运动网络”神经环路的显著激活。“带状盖网络—默认模式网络”可能是点按LDH患者力敏舒快态委中穴,腧穴力敏舒快态激发和即刻镇痛起效的关键神经环路。(Clinical Trials.gov,No.NCT05613179)。Objective To dissect the theoretical connotations of"press-emergence sensation"from the perspective of"acupoint sensitization-central sensitization"by utilizing resting-state functional magnetic resonance imaging(rs-fMRI)to investigate the immediate functional brain networks of lumbar disc herniation(LDH)patients undergoing press stimulation at the pressure pleasantly-sensitive Weizhong point(BL 40).Methods Thirty LDH patients meeting inclusion criteria were classified as LDH group and thirty-one healthy subjects as healthy group,all of whom experienced pleasant sensations at the Weizhong point(BL 40).LDH group underwent 15 minutes of press stimulation at the Weizhong point(BL 40),and rs-fMRI scan was performed before and after treatment,while healthy group underwent rs-fMRI scans only at inclusion.The brain regions with statistically significant differences in the baseline period between the LDH group and the healthy group were analyzed,focusing on the regions of interest(ROI)with statistically significant differences for analyzing changes in functional connectivity(FC)before and after immediate treatment in the LDH group.Results Compared with the healthy group,mALFF in the right insular cortex,left orbital medial frontal gyrus,left orbital inferior frontal gyrus,and left medial frontal gyrus before treatment increased in the LDH group;and mALFF in the right lentiform nucleus decreased(P<0.005).The left medial frontal gyrus exhibited the largest mALFF value and peak value among different brain regions.The LDH group showed a specific significant decrease in FC in the left precentral gyrus before treatment compared with the healthy group(P<0.005).And the LDH group showed enhanced FC in the bilateral thalamus and left inferior parietal lobule after treatment compared with before treatment(P<0.005).Conclusions Significant activation of the"prefrontal cortex-frontoparietal network-sensorimotor net work"neural circuit is present in LDH patients with chronic long-term pain.The"cingulo-opercular network-default mode net

关 键 词：力敏舒快态腧穴 点按法 腰椎间盘突出症 功能磁共振 即刻脑效应 委中穴 

分 类 号：R246.9[医药卫生—针灸推拿学]