基于fMRI探究针刺对无先兆偏头痛患者脑功能活动的影响  

Exploring the effect of acupuncture on brain functional activity in migraine without aura based on fMRI technology

作　　者：高小雨 田甜 王潇 倪夕秀 欧阳旭 赵凌[1] 董凌琳[2] GAO Xiaoyu;TIAN Tian;WANG Xiao;NI Xixiu;OUYANG Xu;ZHAO Ling;DONG Linglin(College of Acupuncture,Moxibustion and Tuina,Chengdu University of Traditional Chinese Medicine,Chengdu 611137,China;Department of Neurology,Sichuan Provincial People’s Hospital,Chengdu 610072,China)

机构地区：[1]成都中医药大学针灸推拿学院,四川成都611137 [2]四川省人民医院神经内科,四川成都610072

出　　处：《中国中西医结合影像学杂志》2025年第2期185-190,207,共7页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：国家重点研发计划项目(2019YFC1709700);四川省自然科学基金项目(2022NSFCS1493)。

摘　　要：目的:应用fMRI的局部一致性(ReHo)方法探讨经穴针刺与安慰针刺2种干预方式对无先兆偏头痛(MWoA)患者局部脑功能的影响及其差异。方法:纳入MWoA患者36例,随机分为经穴针刺组与安慰针刺组各18例。于治疗前后分别行fMRI扫描,并记录患者头痛发作次数、持续时间、无法工作/学习时间,以及视觉模拟量表(VAS)、头痛影响测试问卷(HIT-6)、偏头痛患者生活品质问卷(MSQ)评分。采用ReHo方法分析影像数据,提取2组治疗前后差异有统计学意义脑区(差异脑区)的ReHo值,并与临床指标行相关性分析。结果:经穴针刺组治疗前后,VAS、HIT-6、MSQ(功能受限领域、功能障碍领域、情感领域)评分及头痛无法工作/学习时间差异均有统计学意义(均P<0.05)。安慰针刺组在针刺前后VAS、HIT-6、MSQ(功能受限领域)评分差异均有统计学意义(均P<0.05)。2组治疗后各临床疗效评价指标比较,差异均无统计学意义(均P>0.05)。经穴针刺组针刺后,右侧颞上回、右侧中央前回ReHo值升高,右侧额中回、右侧前扣带回、左侧中扣带回、右侧角回ReHo值降低;安慰针刺组针刺后,左侧顶下回的ReHo值降低,其余脑区无显著变化。相关性分析发现,经穴针刺组右侧前扣带回针刺前后ReHo值变化与VAS评分改善值呈负相关(r=-0.57,P=0.02),安慰针刺组ReHo值变化与各临床疗效指标均无相关性(均P>0.05)。经穴针刺组针刺后与安慰针刺组针刺后相比,左侧中央后回、右侧枕中回、左侧枕上回、左侧额上回、左侧中央前回、右侧中央前回、左侧中央旁小叶ReHo值升高,右侧颞下回、右侧顶上回、右侧额下回ReHo值降低。结论:经穴针刺与安慰针刺均可改善MWoA患者的VAS、HIT-6、MSQ(功能受限领域)评分,但经穴针刺还可改善MWoA因头痛无法工作/学习时间及MSQ(功能障碍和情感领域)评分。额中回、前扣带回及颞上回脑功能的变化可能为针刺调节MWoA�Objective:To use fMRI and regional homogeneity(ReHo)analysis method to explore the effects and differences of true and sham acupuncture on brain function in patients with migraine without aura(MWoA).Methods:A total of 36 patients with MWoA were included in this study,randomly assigned to either true acupuncture(18 cases)or sham acupuncture(18 cases).All patients underwent fMRI scans before and after acupuncture,and the number of headache attacks,duration,work/learning incapacity duration,visual analogue scale(VAS),headache impact test-6(HIT-6)and migraine-specific questionnaire(MSQ)scores were recorded.Using ReHo’s method for image data analysis,and extracting the differences in brain area values before and after acupuncture between the two groups for correlation analysis with clinical indicators.Results:In the true acupuncture group,the VAS,HIT-6,MSQ(Role Function-Restrictive,Role Function-Preventive,Emotional Function)scores,work/learning incapacity duration showed statistical differences before and after acupuncture(all P<0.05).In the sham acupuncture group,VAS,HIT-6 and MSQ(Role Function-Restrictive)scores showed statistical differences before and after acupuncture(all P<0.05).There were no statistically significant differences in clinical efficacy evaluation indicators between the two groups after acupuncture(all P>0.05).The true acupuncture group induced ReHo increases in right superior temporal gyrus,right precentral gyrus,and ReHo decreases in right middle frontal gyrus,right anterior cingulate cortex,left mid-cingulate cortex,right angular gyrus after acupuncture,while the sham acupuncture group reduced ReHo decrease in left parietal inferior gyrus.Correlation analysis showed that the ReHo changes of right anterior cingulate gyrus in the true acupuncture group before and after treatment were negatively correlated with VAS score changes(r=-0.57,P=0.02),while the ReHo changes in the sham acupuncture group were not correlated with clinical efficacy indicators(all P>0.05).Compared with the sham acupuncture

关 键 词：针刺 磁共振成像 无先兆偏头痛 局部一致性 

分 类 号：R24[医药卫生—中医临床基础]