“补肾安神”针刺法治疗围绝经期失眠fNIRS初步研究  

Preliminary fNIRS Study of“Tonifying the Kidney and Tranquilizing the Mind”Acupuncture in the Treatment of Perimenopausal Insomnia

作　　者：代轶楠 穆敬平 郑苏 王熙 廖恒 彭力[4] DAI Yinan;MU Jingping;ZHENG Su;WANG Xi;LIAO Heng;PENG Li(Shiyan Taihe Hospital,Affiliated Hospital of Hubei Medical College,Shiyan 442000,Hubei,China;Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China;Shiyan Integrated Traditional and Western Medicine Hospital,Shiyan 442000,Hubei,China;Shiyan Hospital of Chinese Medicine Affiliated to Hubei University of Chinese Medicine,Shiyan 442000,Hubei,China)

机构地区：[1]十堰市太和医院,湖北医药学院附属医院,湖北十堰442000 [2]湖北中医药大学,湖北武汉430061 [3]十堰市中西医结合医院,湖北十堰442000 [4]湖北中医药大学附属十堰市中医医院,湖北十堰442000

出　　处：《辽宁中医药大学学报》2024年第9期91-95,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(2021YFC2501500);湖北省中医药科研立项项目(ZY2021M006,ZY2021Q015)。

摘　　要：目的探索补肾安神针刺法对围绝经期失眠(perimenopausal insomnia,PMI)患者前额叶功能活动的调节作用。方法将40例PMI患者随机分为两组,针刺组和药物组,针刺组穴取百会、照海、申脉、肾俞、三阴交、安眠、太溪,每日1次,每次30 min,治疗2周;药物组口服佐匹克隆片,每次7.5 mg,每晚1次,治疗2周。同时招募与之相匹配的健康人20名设为健康组,采集患者治疗前后及健康人基线的匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)评分和功能性近红外光谱技术(functional near-infraredspectroscopy,fNIRS)数据,分析针刺对PMI患者前额叶功能活动的影响。结果治疗前,PMI患者额叶的前运动皮层区(BA6)的氧合血红蛋白(HbO)浓度明显高于健康组(P<0.05);背外侧前额叶区(BA9)、双侧额极区(BA10)的HbO浓度明显低于健康组(P<0.05)。治疗后,两组PMI患者额叶的前运动皮层区(BA6)的HbO浓度较前明显降低(P<0.05);双侧前额叶额极区(BA10)、左侧背外侧前额叶区(BA9)、腹外侧前额叶区(BA44、BA45)的HbO浓度明显升高(P<0.05)。治疗后组间比较,针刺组在左侧背外侧前额叶区(BA9)激活显著(P<0.05)。结论该研究为围绝经期失眠的过度觉醒假说提供了影像学依据,证明了前额叶在睡眠觉醒过程的重要作用,进一步揭示了补肾安神针刺治疗围绝经期失眠的脑功能机制,为治疗靶点的选择提供了新思路。Objective To explore the modulating effect of tonifying the kidney and tranquilizing the mind acupuncture on prefrontal functional activity in perimenopausal insomnia patients.Methods 40 patients were randomly divided into acupuncture group,drug group.The acupuncture group received conventional acupuncture treatment,the drug group received zopiclone tablets.At the same time,20 matched healthy people were recruited as the health group.The Pittsburgh sleep quality index(PSQI)scores and functional near infrared imaging spectroscopy(fNIRS)of patients and healthy people were collected before and after treatment,which analyze the effects of acupuncture on the prefrontal functional activities of PMI patients.Results Before treatment,the concentration of HbO in the frontal motor cortex region(BA6)of PMI patients was significantly higher than that of the healthy group(P<0.05);The concentration of HbO in dorsolateral prefrontal lobe region(BA9)and bilateral frontal region(BA10)pole were significantly lower than that in healthy group(P<0.05).After treatment,the concentration of HbO in the frontal motor cortex region(BA6)of the two groups of patients were significantly lower than pre-treatment concentrations(P<0.05);The concentration of HbO in bilateral frontal polar region(BA10),left dorsolateral prefrontal lobe region(BA9)and ventrolateral prefrontal lobe region(BA44,BA45)were significantly increased than pre-treatment concentrations(P<0.05).After treatment,there was significant activation in left dorsolateral prefrontal lobe(BA9)in acupuncture group(P<0.05).Conclusion This study provided the imaging basis for the hypothesis of excessive wakefulness in perimenopausal insomnia,proved the important role of the frontal lobe in the process of sleep and wakefulness,further revealed the brain function mechanism of invigorating kidney and anchoring acupuncture in the treatment of perimenopausal insomnia,and provided a new idea for the selection of therapeutic targets.

关 键 词：针灸 围绝经期失眠 近红外脑功能成像 氧合血红蛋白 机制 

分 类 号：R256.23[医药卫生—中医内科学]