针刺对不同敏感度正常人大脑局部一致性影响差异的功能性磁共振研究

摘要

目的:探求不同敏感度体质因素对针刺镇痛效应的影响及其中枢神经调控机制.方法:筛选3种典型体质的健康受试者,分为不敏感组、正常组、敏感组各15例,测定针刺足三里穴前后的实验压痛阈值,比较针刺对不同组别受试者的镇痛效应.采用磁共振扫描仪采集针刺前后受试者脑内静息态BOLD成像数据,运用局部一致性(regional homogeneity,ReHo)方法观察局部脑区自发神经元活动的同步性.结果:1.针刺前后压痛阈比较,敏感组、正常组压痛阈改变均有统计学意义(P＜0.05),不敏感组无统计学意义(P＞0.05).2.针刺后与针刺前ReHo值比较,获取差异有统计学意义的脑区(校正前P＜0.005):①不敏感组未见ReHo值增高脑区,ReHo值减低脑区有:左梭状回、左颞下回、双侧中央后回、左中央前回；②正常组ReHo值增高脑区有:左脑干、右小脑后叶、右海马旁回、右梭状回、左角回、颞叶、左额叶等,ReHo值减低的脑区有:双侧枕叶、右颞上回等；③敏感组ReHo值增高的脑区有:左脑干、双侧小脑后叶、左颞下回、基底节、左岛叶、前扣带回、额叶、顶下小叶、右辅助运动区,ReHo值减低的脑区有:双侧枕叶、梭状回、中央后回、右后扣带回、左颞叶、左旁中央小叶等.结论:①针感是影响针刺镇痛效应的重要因素,与不同敏感度体质密切相关.②相关脑区ReHo值变化可能是体质影响针刺效应的中枢调控机制.%Objective To observe the synchronism difference of brain region activities in response to acupuncture stimulation of Zusanli (ST 36) in healthy volunteer subjects with different acupuncture analgesia sensitivity,so as to study the central factors influencing acupuncture intervention outcomes.Methods Forty-five healthy volunteer subjects with different constitutions (different sensitivities in response to needling stimulation) were divided into insensitive group,normal group and sensitive group (n =15).The pressure pain threshold (PPT) of the Zusanli (ST 36) region before and after acupuncture stimulation of ST 36 was assessed using visual analog scale (VAS).Two weeks later after acupuncture stimulation of ST 36,resting-state fMRI images were acquired by using a nuclear magnetic resonance imaging system and analyzed by using DPARSFV 2.1 software package,software SPM 8 and REST 1.7.The cerebral regional homogeneity (ReHo) of the subjects was then calculated by Resting-State fMRI Data Analysis Toolkit (REST).Results Compared with pre-acupuncture,PPT levels of the normal and sensitive groups were significantly increased after acupuncture of ST 36 (P＜0.05),and that of the insensitive group had no significant change (P＞0.05).Following acupuncture stimulation of ST 36,the insensitive group only showed a significant decreased ReHo in the left fusiform gyrus,left inferior temporal gyrus,bilateral postcentral gyrus,and left anterior central gyrus.In the normal group,a significantly increased ReHo was found in left brainstem,the right cerebellum posterior lobe,right parahippocampa gyrus,right fusiform gyrus,left angular gyrus,temporal lobe and the left frontal lobe; and a significantly decreased ReHo in the occipital lobes and the right superior temporal gyrus after acupuncture stimulation of ST 36.In the sensitive group,a markedly increased ReHo was found in the left brainstem,bilateral cerebellum posterior lobes,left inferior temporal gyrus,basal ganglia,the left insular lobe,anterior cingutate,frontal lobe,inferior parietal Iobule,and the right supplementary motor area,and an obviously decreased ReHo found in the bilateral occipital lobes,fusiform gyrus,posterior central gyrus,the right posterior cingutate,the left temporal lobe and the left paracentral Iobule,etc.after acupuncture of ST 36.Conclusion Constitution-associated needling sensation may be an important influential factor for acupuncture analgesia in normal subjects.The change of ReHo in different cerebral areas is probably responsible for the difference of acupuncture analgesia in different constitution people.