针刺足三里穴对胃黏膜保护及损伤因子影响与脑功能变化的相关性

Central mechanism of electric-acupuncture at Zusanli （ST36） for gastric mucous membrane protection with fMRI

目的 联合分析电针刺激足三里穴后外周血胃黏膜保护及损伤因子相关指标和功能磁共振（fMRI）信号的变化,探索针刺调节胃黏膜的中枢机制.方法 实验分为真穴组和假穴组;16名健康成人志愿者（均为同济大学在校学生）于2008年9-11月期间参加了两组实验,同一名受试者进行两次实验间隔2周以上.真穴组针刺受试者右侧足三里穴.实验前5 min及电针刺激停止后的5、15、25、30 min分别5次采集受试者外周血检测胃黏膜相关指标;针刺时进行fMRI扫描.用SPM2分析fMRI数据,检验P值〈0.00l.结果 真穴组电针针刺停止后的5、15、25、30 min外周血中降钙素基因相关肽（CGRP）、前列腺素E2（PGE2）含量较针刺前均有明显升高（P〈0.01）,同时内皮素（ET）、胃泌素（GAS）的含量均较针刺前明显下降（P〈0.01）,各项指标于电针针刺后25 min达峰值.假穴组外周血中各时间点CGRP、PGE2、ET、GAS的含量针刺前后差异无统计学意义.电针刺激足三里穴主要激活双侧额中回、尾状核,扣带回,左侧中央前回、中央后回、额下回、下丘脑,右侧岛叶、海马、小脑半球.假穴组电针刺激后只激活了右侧旁中央小叶及小脑半球.结论 针刺足三里穴对胃黏膜的影响作用可能需要通过中枢特定脑区的介导作用于靶器官而实现.

Objective To explore the central mechanism of acupuncture in protecting gastric mucous membrane by a composite analysis of gastric mucous membrane related indices in peripheral blood and functional MRI （fMRI） signal changes after electric-acupuncturing Zusanli （ST36） acupoint. Methods Sixteen healthy adult volunteers were divided into true acupoint group （ A ） and sham acupoint group （ B）. Zusanli acupoint was used for Group A. Peripheral blood was drawn 5 min before and 5, 15, 25, 30 min after needle-removal for the detection of gastric mucous membrane related indices. fMRI was performed during acupuncture and the acquired fMRI data were analyzed by SPM2 （P 〈0. 001）. Results The levels of calcitonin gene related peptide （CGRP） and prostaglandin E2 （ PGE2 ） increased while those of endothelin （ET） and gastrin （GAS） decreased significantly after acupuncture in Group A （P〈0. 01）. And there was no significant change in Group B （P 〉 0. 05）. Acupuncturing Zusanli activated the bilateral middle frontal gyrus, caudate, left precentral and postcentral gyri, hypothalamus, anterior cingulate cortex, right hippocampus, insula and cerebellar hemisphere. But acupunturing the sham acupoint only activated the paracentral lobule and cerebellar hemisphere. Conclusion Acupuncturing Zusanli acupoint activates certain cortex areas and multiple systems to stimulate the release of neurotransmitters and regulate the peripheral humoral factors to achieve the protection of gastric mucous membrane.