针刺影响颈椎病颈痛病人默认网络的功能磁共振研究  

The functional magnetic resonance imaging study of acupuncture's impact on the default mode network in patients with cervical spondylosis neck pain

作　　者：高珍 崔梦洁 王海军 张静 冀来喜 GAO Zhen;CUI Meng-jie;WANG Hai-jun;ZHANG Jing;JI Lai-xi(Shanxi University of Traditional Chinese Medicine,Jinzhong 030619,China;Department of Acupuncture,Shanxi University of Chinese Medicine Affiliated Acupuncture and Massage Hospital(Shanxi Acupuncture Hospital),Taiyuan 030006,China;Department Acupuncture II,Affiliated Hospital of Shanxi University of Chinese Medicine,Taiyuan 030024 China)

机构地区：[1]山西中医药大学,晋中030619 [2]山西中医药大学附属针灸推拿医院(山西省针灸医院)针灸科,太原030006 [3]山西中医药大学附属医院针灸二科,太原030024

出　　处：《中国疼痛医学杂志》2025年第3期181-188,共8页Chinese Journal of Pain Medicine

基　　金：国家自然科学基金(82074549);山西省基础研究计划(202203021221195);山西中医药大学博士科研启动基金(2023BK17);优秀博士毕业生来晋工作奖励经费科研启动基金(2023BKS12)。

摘　　要：目的:基于功能磁共振成像技术探讨针刺治疗颈椎病(cervical spondylosis,CS)颈痛的部分中枢起效机制。方法:2023年3月至2024年5月于山西中医药大学、山西中医药大学附属针灸推拿医院招募40例CS病人(治疗组和对照组各20例)进行2周共6次治疗,同时招募健康受试者40名进行3.0T功能磁共振扫描。采用视觉模拟评分法(visual analogue scale,VAS)评分在治疗前后进行疗效评价,采用分数低频振幅(fractional amplitude of low frequency fluctuations,fALFF)和功能连接(functional connectivity,FC)分析方法表征健康受试者和CS颈痛病人的中枢病理特征,以及两组病人针刺治疗前及治疗结束后的中枢响应特征。结果:与健康受试者相比,CS病人右侧额中回(middle frontal gyrus,MFG)fALFF值增高,且与VAS评分呈正相关。与治疗前相比,针刺后治疗组VAS评分显著降低,右侧MFG到左侧楔前叶、枕中回等FC增高;对照组VAS评分改善不明显,右侧MFG到左侧MFG、眶部额下回等FC降低。结论:针刺可能通过调节默认网络的异常功能连接缓解疼痛,而假针刺的镇痛作用则可能与针刺所引发的安慰剂效应相关联。Objective:To explor the central efficacy mechanisms of acupuncture treatment for cervical spondylosis(CS)neck pain with functional magnetic resonance imaging.Methods:From March 2023 to May 2024,40 patients with CS were recruited at Shanxi University of Traditional Chinese Medicine and Shanxi Acupuncture Hospital(20 cases of the treatment group and 20 cases of the control group)for 6 treatments over 2 weeks.Additionally,40 healthy subjects were recruited for 3.0T functional magnetic resonance imaging scans.The visual analogue scale(VAS)was used to evaluate the efficacy before and after treatment.The fractional amplitude of low frequency fluctuations(fALFF)and functional connectivity(FC)analysis were used to characterize the central pathological features of healthy subjects and patients with neck pain,as well as the central response characteristics before and after acupuncture treatment in both groups.Results:Compared with healthy subjects,CS patients showed increased low-frequency amplitude in the right middle frontal gyrus(MFG),which was positively correlated with VAS scores.Following acupuncture treatment,the true acupuncture group exhibited a significant decrease in VAS scores,along with increased FC from the right MFG to the left precuneus and posterior cingulate cortex.In contrast,the sham acupuncture group showed less improvement in VAS scores and decreased FC from the right MFG to the left MFG and orbital inferior frontal gyrus.Conclusion:True acupuncture may alleviate pain by modulating abnormal functional connectivity in the default mode network,while sham acupuncture may be associated with the placebo analgesic effect induced by acupuncture.

关 键 词：针刺 颈椎病 功能连接 默认网络 

分 类 号：R24[医药卫生—中医临床基础]