基于丘脑动态功能连接预测针刺治疗无先兆偏头痛疗效的研究  

Prediction of Therapeutic Effect of Acupuncture on Migraine Without Aura Based on Dynamic Functional Connection of Thalamus

作　　者：侯逸轩 詹松华[1] 谭文莉[1] 徐春阳 王立 龚志刚[1] 王辉[1] 魏翔宇 张晶 杨玉婵[1] HOU Yixuan;ZHAN Songhua;TAN Wenli(Department of Imaging Medical,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,P.R.China)

机构地区：[1]上海中医药大学附属曙光医院影像医学科,201203 [2]上海中医药大学附属曙光医院针灸科,201203 [3]复旦大学附属肿瘤医院综合治疗科

出　　处：《临床放射学杂志》2025年第1期14-20,共7页Journal of Clinical Radiology

基　　金：上海市2022年度“科技创新行动计划”医学创新研究专项项目(编号:22Y11910600)。

摘　　要：目的以丘脑为种子点观察无先兆偏头痛(MwoA)患者接受针刺前后丘脑动态功能连接(dFC)变化,并以治疗前dFC差异脑区为特征构建机器学习(ML)模型以预测MwoA患者对针刺治疗的反应。方法搜集50例确诊为MwoA的患者,根据治疗前后临床指标变化分为针刺应答组(AR)30例与非应答组(NR)20例。使用3.0 T MRI采集其T 1WI和BOLD-fMRI图像,通过梯度提升(GBM)、支持向量机(SVM)及随机森林(RF)机器学习算法对其dFC进行分析。结果AR组针刺前丘脑与枕中回、眶内额上回、颞下回动态功能连接较NR组强,中央沟盖、颞中回、距状裂周围皮层、梭状回动态功能连接较NR组弱;与治疗前相比,治疗后丘脑与岛盖部额下回、颞横回、额中回动态功能连接增强;丘脑与背外侧额上回、颞中回、中央前回动态功能连接减弱;训练集中GBM表现较好,权重绝对值排名前三的脑区为眶内额上回、颞中回、左侧距状裂周围皮层。结论调节丘脑与默认模式网络(DMN)、感觉运动环路的dFC是针刺治疗MwoA的可能作用机制;基线状态丘脑与DMN、视觉通路的功能连接强度可能是针刺效果的关键,是针刺疗效的潜在预测因子。Objective To observe the changes of thalamic Dynamic Functional Connectivity(dFC)before and after acupuncture in patients with Migraine without Aura(MwoA),using the thalamus as the seed point.Moreover,a Machine Learning(ML)model was constructed to predict the response of MwoA patients to acupuncture therapy by using the brain regions with dFC differences before treatment.Methods Fifty patients diagnosed with MwoA were collected and categorized into 30 acupuncture responders(AR)and 20 non-responders(NR)according to the changes in clinical indicators before and after treatment.T 1WI and BOLD-fMRI images were acquired using 3.0T MRI and analyzed by Gradient Boosting Model(GBM),Logistic Regression(LR),Support Vector Machine(SVM),and Random Forest(RF)machine learning algorithms for its dFC.Results The dynamic functional connectivity of the thalamus with the middle occipital gyrus,supraorbital frontal gyrus,and inferior temporal gyrus was stronger in the AR group than in the NR group,and the dynamic functional connectivity of the central sulcus,insula,middle temporal gyrus,perisylvian fissure cortex,and fusiform gyrus was weaker in the NR group than in the AR group.Dynamic functional connectivity of the thalamus with the insula inferior frontal gyrus,transverse temporal gyrus,and middle frontal gyrus was enhanced after treatment compared with before treatment;dynamic functional connectivity of the thalamus with the dorsolateral superior frontal gyrus,middle temporal gyrus,and precentral gyrus were weakened.The top three brain regions with the best GBM performance in the training set were the intra-frame superior frontal gyrus,middle temporal gyrus,and left pericalar cleft cortex.Conclusion Modulation of the dFC of the thalamus with the DMN and sensorimotor circuits is a possible mechanism of action of acupuncture in the treatment of MwoA;The strength of functional connectivity of the baseline state thalamus to the DMN and visual pathways may be critical to the effectiveness of acupuncture and is a potential predictor o

关 键 词：无先兆偏头痛 机器学习 丘脑 功能连接 针刺 

分 类 号：R246.6[医药卫生—针灸推拿学]