推拿治疗慢性下腰痛的即时脑效应研究

Brain Immediate Analgesia Mechanism of Tuina in Low Back Pain

目的:通过静息态血氧水平依赖功能磁共振成像(BOLD fMRI)探讨推拿缓解慢性下腰痛的即时镇痛效应。方法:前瞻性收集20例慢性下腰痛受试者接受推拿治疗,在治疗前后即刻分别进行静息态BOLD fMRI检查。同时募集20例性别年龄匹配健康志愿者,比较慢性下腰痛受试者治疗前后与健康志愿者低频振幅值(ALFF)的差异,并将ALFF值与各项临床评分进行相关性分析。结果:慢性下腰痛受试者治疗前疼痛视觉模拟评分(VAS)及改良Oswestry功能障碍指数(ODI)分别为(53.25±14.26)分,(30.10±12.73)分,治疗后分别为(31.00±10.71)分,(21.45±9.85)分,差异有统计学意义(P<0.05)。慢性下腰痛受试者与健康志愿者比较出现右侧后扣带回、额上回ALFF值的升高及左侧辅助运动区ALFF值的降低。治疗后与健康志愿者比较,右侧楔前叶脑功能活动减低。推拿治疗后与之前比较,慢性下腰痛受试者小脑后叶ALFF值升高,两侧额中回、右侧扣带回、右侧角回ALFF值减低。在慢性下腰痛受试者治疗前后的配对t检验中,右侧额中回的ALFF值与VAS和ODI变化率负相关。结论:推拿的即时镇痛效应体现在纠正疼痛矩阵相关脑区的异常改变,同时又引起认知相关区域的变化。

Objective:To explore the immediate analgesia mechanism of Tuina in low back pain through the rest blood-oxygen-level dependent functional magnetic resonance imaging(BOLD fMRI).Methods:Twenty patients with low back pain were recruited for Tuina therapy and the rest BOLD fMRI were performed before and right after the therapy.Meanwhile twenty volunteers who were age-and gender-matched with the patients were recruited and the rest BOLD fMRI were performed once.The difference of amplitude of low frequency fluctuation(ALFF)was calculated between the patients before therapy and volunteers,between the patients after therapy and volunteers,and between the patients before and after Tuina.The correlation analysis of ALFF value and clinical indexes was calculated.Results:The visual analogue scale(VAS)and modified Oswestry disability index(ODI)of patients were(53.25 ± 14.26)and(30.10±12.73).After the therapy,they were changed into(31.00±10.71),(21.45±9.85).There was significant statistical difference.Compared to volunteers,the patients showed higher ALFF value in the right posterior cingulate,superior frontal gyrus and lower ALFF value in the left supplementary motor area.After the Tuina,the patients showed lower brain activity in the right precuneus.The left and right middle frontal gyrus,right cingulate gyrus,right angular gyrus showed lower ALFF value,and the posterior lobe of cerebellum showed higher ALFF value in the patients after Tuina,compared to them without Tuina.In the paired t-test of patients,the ALFF value of the right middle frontal gyrus was negatively correlated with the changes of VAS and modified ODI.Conclusion:The immediate analgesia effect of Tuina is embodied in rectifying the abnormal changes in the pain matrix and bringing the changes of brain cognitive area.