针刺治疗对原发性痛经患者中枢奖赏网络的影响  

Effects of acupuncture treatment on central reward network in patients with primary dysmenorrhea

作　　者：朱豪 粟孟华 魏微 余思奕 郭小丽 申治富 王亚楠[1,3] 杨洁 ZHU Hao;SU Menghua;WEI Wei;YU Siyi;GUO Xiaoli;SHEN Zhifu;WANG Yanan;YANG Jie(School of Acupuncture-Moxibustion and Tuina,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Clinical School of Integrated Traditional Chinese and Western Medicine,North Sichuan Medical College,Nanchong 637100,China;Department of Pain,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400011,China;Sichuan Clinical Research Center of Acupuncture and Moxibustion,Chengdu 610072,China)

机构地区：[1]成都中医药大学针灸推拿学院,成都610075 [2]川北医学院中西医结合临床医学院,南充637100 [3]重庆市中医院疼痛科,重庆400011 [4]四川省针灸临床医学研究中心,成都610072

出　　处：《中华中医药杂志》2025年第2期969-975,共7页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.81574089,No.81973966)。

摘　　要：目的:基于功能磁共振成像(fMRI)技术,探讨针刺治疗对原发性痛经(PDM)患者奖赏网络的中枢调控机制。方法:共纳入PDM患者46例,随机分为等待治疗组和针刺组,每组23例。等待治疗组在试验期间不接受任何治疗,针刺组接受3个月经周期的针刺治疗。两组患者治疗前后分别进行视觉模拟量表(VAS)评分、Cox痛经症状量表(CMSS)评分、疼痛灾难化量表(PCS)评分、血清前列腺素F_(2α)(PGF_(2α))评估以及fMRI扫描。以双侧腹侧被盖区(VTA)为种子点进行功能连接(FC)分析。结果:与治疗前比较,针刺组在治疗后VTA与右侧眶额回(OFC)、双侧背外侧前额叶皮层(DLPFC)、左侧前脑岛(AI)、左侧背侧前扣带回(dACC)以及左侧蓝斑的FC值增高,而VTA与左侧伏隔核(NAc)、双侧尾状核的FC降低;等待治疗组在试验后VTA与右侧中央前回、右侧顶上小叶FC增高;而VTA与右侧舌回、右侧腹外侧前额叶皮层(VLPFC)、右侧海马(HIP)等脑区的FC降低。与等待治疗组比较,针刺组在治疗后VTA与双侧VLPFC、双侧前AI、右侧HIP、右侧舌回、左侧dACC等脑区的FC增高;而VTA与右侧中央前回、右侧尾状核等脑区的FC降低。针刺组患者在针刺治疗后,VTA-dACC的FC变化与PCS改善值呈正相关(P<0.05),VTA-NAc的FC变化与CMSS以及PGF2α的改善值呈正相关(P<0.05,P<0.01)。结论:针刺可能通过靶向调控以中脑边缘系统(VTA-NAc)为核心的奖赏网络,进而起到治疗PDM的作用。Objective:Based on functional magnetic resonance imaging(fMRI)technology,to explore the central mechanism of acupuncture treatment on the reward network of patients with primary dysmenorrhea(PDM).Methods:A total of 46 PDM patients were included and randomly divided into waiting treatment group and acupuncture treatment group,with 23 patients in each group.Waiting treatment group received no treatment during the trial period,while acupuncture treatment group received acupuncture for 3 menstrual cycles.The two groups of patients underwent visual analogue scale(VAS),Cox menstrual symptom scale(CMSS),pain catastrophizing scale(PCS),protaglandin F_(2α)(PGF_(2α))detection and fMRI scan before and after the experiment.Perform functional connectivity(FC)analysis using the bilateral ventral tegmental area(VTA)as the seed point.Results:Compared to pre-treatment,the acupuncture group exhibited increased FC values between the VTA and the right orbitofrontal cortex(OFC),bilateral dorsolateral prefrontal cortex(DLPFC),left anterior insula(AI),left dorsal anterior cingulate cortex(dACC),and left locus coeruleus after treatment;whereas FC decreased between the VTA and the left nucleus accumbens(NAC),bilateral caudate nuclei.In the waiting treatment group,FC increased between the VTA and the right precentral gyrus,and right superior parietal lobule after the trial;whereas FC decreased between the VTA and regions such as the right lingual gyrus,right ventrolateral prefrontal cortex(VLPFC),and right hippocampus(HIP).Compared to the waiting treatment group,the acupuncture group showed increased FC between the VTA and bilateral ventrollateral prefrontal cortex(VLPFC),bilateral anterior AI,right HIP,right lingual gyrus,and left dACC after treatment;whereas FC decreased between the VTA and regions such as the right precentral gyrus and right caudate nucleus.In patients from the acupuncture group,changes in FC between VTAdACC positively correlated with improvements in PCS(P<0.05),and changes in FC between VTA-NAc positively correlated

关 键 词：奖赏网络 原发性痛经 针刺 腹侧被盖区 功能磁共振成像 

分 类 号：R24[医药卫生—中医临床基础]