针刺研究

2021, v.46(04) 318-325

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基于种子点相关分析探讨调神健脾针法治疗腹泻型肠易激综合征的中枢调节机制
Mind-regulating and spleen-strengthening needling technique improves abdominal hypersensitivity and emotion by enhancing functional connectivity between hippocampus and brain regions in diarrhea-predominant irritable bowel syndrome patients

耿昊;翁晟捷;赵婷婷;陈璐;吴晓亮;周俊灵;孙建华;裴丽霞;
GENG Hao;WENG Sheng-jie;ZHAO Ting-ting;CHEN Lu;WU Xiao-liang;ZHOU Jun-ling;SUN Jian-hua;PEI Li-xia;Department of Acupuncture and Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine;

摘要(Abstract):

目的:基于种子点相关分析方法,比较腹泻型肠易激综合征(IBS-D)患者与健康志愿者中枢存在的脑区功能连接改变的差异,并探讨调神健脾针法对IBS-D的可能中枢调控机制。方法:选取25例IBS-D患者作为针刺组,另以25例健康志愿者作为健康对照组。针刺组予调神健脾针法治疗,30 min/次,3次/周,共治疗18次。分别于针刺治疗前后行静息态功能磁共振成像(rs-fMRI)检查及IBS症状严重度量表(IBS-SSS)、焦虑量表(HAMA)评价其临床综合疗效。健康志愿者不予任何处理,入组当天行rs-fMRI检查。以双侧海马区为感兴趣区,观察IBS-D患者与健康志愿者存在的脑区功能连接差异以及针刺前后IBS-D患者大脑静息态功能连接网络变化。结果:与本组治疗前比较,针刺组IBS-D患者治疗后的IBS-SSS评分、HAMA评分均降低(P<0.01)。与健康对照组比较,针刺组患者左侧海马与右侧颞下回、左侧梭状回、左侧顶上回等区域功能连接减弱,而与左侧颞上回功能连接增强;右侧海马与右侧梭状回、左侧颞下回、左侧枕下回、左侧回直肌、左侧脑岛、左侧楔前叶、右侧角回、左侧枕中回、右侧楔前叶、左侧顶上回功能连接均减弱。与本组治疗前比较,治疗后针刺组IBS-D患者左侧海马与右侧颞下回、左侧梭状回、双侧舌回、左侧杏仁核、右侧枕下回、右侧脑岛、右侧额中回、左侧额中回、左侧枕中回功能连接增强,而与左侧前扣带和旁扣带脑回、右侧中央后回功能连接减弱;右侧海马与小脑后下叶、左侧颞下回、左侧枕下回、右侧梭状回、左侧脑岛、右侧眶部额下回、左侧颞上回、左侧枕中回、右侧额中回、左侧补充运动区、右侧补充运动区功能连接增强。结论:调神健脾针法能明显改善IBS-D患者腹痛腹胀等症状和情绪状态,其机制可能为改变海马区与情绪、内脏感觉相关脑区的功能连接。基于rs-fMRI技术的种子点方法可为探索调神健脾针法治疗IBS的中枢机制提供可视化神经影像学依据。
Objective To compare the difference of brain functional connectivity between diarrhea-predominant irritable bowel syndrome(IBS-D) patients and healthy volunteers and changes after acupuncture intervention, so as to investigate the underlying mechanism of acupuncture in regulating functional activities of IBS-D patients by using seed point correlation analysis. Methods A total of 25 IBS-D patients and 25 healthy volunteers were recruited in the present study and respectively attributed to acupuncture group and control group. The IBS-D patients received manual acupuncture stimulation of Baihui(GV20), Yintang(EX-HN3), and bilateral Tianshu(ST25), Zusanli(ST36), Shangjuxu(ST37), Sanyinjiao(SP6) and Taichong(LR3) with mind-regulating and spleen-strengthening technique for 30 min, once a day, 3 days a week for 6 weeks. Before and after the intervention, the IBS symptom severity scale(IBS-SSS) was used to assess the patients' state of abdominal pain, distention and defecation, and Hamilton Anxiety Rating Scale(HAMA) employed to evaluate the patients' anxiety severity. The resting state functional magnetic resonance imaging(rs-fMRI) data were acquired and preprocessed by using SPM8 and DPARSE soft-wares. Seeds(bilate-ral hippocampus regions) to whole-brain analysis was performed to obtain the mean time series of the left and right seed regions, followed by making Pearson correlation analysis to obtain the correlation coefficient(time series from each seed region with the rest of the voxels in the brain), and making a multivariate comparative correction to get data of functional connectivity(FC) of bilateral hippocampus regions and to find the related difference in the brain regions. Then, the differences of the FC of brain regions between IBS-D patients and healthy volunteers were compared. Results Following acupuncture treatment, both the HAMA and IBS-SSS scores were significantly reduced in the acupuncture group compared with its pre-treatment(P<0.01). Compared with the healthy volunteers, there were a reduction in the functional connectivity between the left hippocampus seed region and the right inferior temporal gyrus, left fusiform gyrus and left superior gyrus, and between the right hippocampus region and the right fusiform gyrus, left inferior temporal gyrus, left inferior occipital gyrus, left rectus gyrus, left insula, left precuneus, right angular gyrus, left middle occipital gyrus, right precuneus, and the left superior temporal gyrus, and an increase in the FC between the left hippocampus and left superior temporal gyrus was increased in ISB-D patients. Self-comparison showed that after the treatment, the FC was increased between the left hippocampus seed region and the right inferior temporal gyrus, left fusiform gyrus, bilateral lingual gyrus, left amygdala, right inferior occipital gyrus, right insula, right middle frontal gyrus, left middle frontal gyrus and the left middle occipital gyrus; and between the right hippocampus seed region and the posterior inferior cerebellar lobe, left inferior temporal gyrus, left suboccipital gyrus, right fusiform gyrus, left insula, right inferior frontal gyrus, left superior temporal gyrus, left middle occipital gyrus, right middle frontal gyrus, left supplementary motor area and right supplementary motor area, and decreased between the left hippocampus region and the left anterior cingulate, paracingulate gyrus and the right posterior central gyrus in IBS-D patients. Conclusion Mind-regulating and spleen-strengthening acupuncture intervention may improve the abdominal pain and distension and emotional state in IBS-D patients, which is possibly associated with its effect in enhancing FC between the hippocampus and brain regions.

关键词(KeyWords): 针刺;肠易激综合征;功能连接;调神健脾针法;静息态功能磁共振成像
Acupuncture;Diarrhea-predominant irritable bowel syndrome;Functional connectivity;Mind-regulating and spleen-strengthening needling;Resting state functional magnetic resonance imaging

Abstract:

Keywords:

基金项目(Foundation): 国家中医药管理局项目(No.c2019XZZX-ZJ008);; 江苏省中医药管理局领军人才项目(No.SLJ0206);; 国家自然科学基金项目(No.81804193);; 江苏省中医院高峰人才项目(No.y2018rc05)

作者(Author): 耿昊;翁晟捷;赵婷婷;陈璐;吴晓亮;周俊灵;孙建华;裴丽霞;
GENG Hao;WENG Sheng-jie;ZHAO Ting-ting;CHEN Lu;WU Xiao-liang;ZHOU Jun-ling;SUN Jian-hua;PEI Li-xia;Department of Acupuncture and Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine;

Email:

DOI: 10.13702/j.1000-0607.200569

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