基于分数低频振幅的针刺对吸烟渴求的即刻效应与中枢机制:fMRI脑功能研究

Immediate effects and central mechanism of acupuncture for craving of smoking based on f ALFF: An f MRI study

目的:基于分数低频振幅(fALFF),利用功能性磁共振成像(fMRI)技术观察针刺对烟草渴求的即刻效应,探讨其中枢作用机制。方法:选择受试者40名并根据是否吸烟分为吸烟组(20名)和非吸烟组(20名);吸烟受试者要求fMRI扫描前烟草戒断24h,并由CO检测仪验证。fMRI设计类型为静息态,流程为"扫描-针刺-扫描"。针刺穴位选择列缺、合谷、百会、足三里、三阴交和太冲,留针时间30min,同时使用电针治疗仪在双侧列缺、足三里上进行连续波(15Hz)治疗30min,强度以受试者最大耐受为限。分别在针刺前静息状态、取针后静息态收集fMRI脑功能数据,并记录自拟吸烟渴求程度量表、明尼苏达尼古丁戒断症状量(MNWS)和吸烟渴求简短量表(QSU)。使用DPARSF软件包对fMRI数据进行预处理;使用SPM 12和REST软件计算每个个体的fALFF图像并进行比较。结果:1针刺后吸烟组自拟吸烟渴求量表、MNWS量表得分和QSU量表得分均较治疗前明显降低(P<0.05)。2针刺前与非吸烟组相比,吸烟组受试者左侧回直肌神经活动抑制,左侧枕中回、小脑、左侧中央前后、右侧中央后回、右侧补充运动区神经活动激活;针刺前后比较,非吸烟受试者左侧颞中回神经活动抑制,右侧楔前叶、右侧角回、右侧额中回、左侧背外侧额上回、右侧中央后回神经活动激活;针刺后,吸烟组受试者左侧颞下回、左侧三角部额下回、右侧脑岛、右侧枕上回、右侧小脑、左侧楔叶、左侧小脑神经活动抑制,左侧眶部额上回、右侧额中回、左侧背外侧额上回、右侧中央前回、左侧中央前回、左侧前扣带回神经活动激活。3相关分析表明自拟吸烟渴求程度与背外侧额上回和额中回、前扣带回具有相关性,MNWS量表得分与枕上回、背外侧额上回和小脑具有相关性,每日吸烟数与额中回具有相关性,尼古丁依赖程度与前扣带回具有相关性。结论:针刺治疗可以缓解吸烟者因戒烟产生的吸烟渴求,其作用机制可能是通过"脑岛-前扣带回"通路以调整前额叶皮质小脑和视觉皮层的神经活动,最终达到缓解吸烟渴求、抑制吸烟冲动的目的。

Objective： Based on fractional amplitude of low-frequency fluctuation（f ALFF）, the functional magnetic resonance imaging（f MRI） was adopted to explore the immediate effects and central mechanism of acupuncture on craving for smoking. Methods： A total of 40 subjects were recruited and divided into smoking group（20 cases） and non-smoking group（20 cases） according to smoking background. Subjects in the smoking group were requested to cease smoking 24 hours prior to f MRI scan and verified by carbon monoxide detector. The f MRI type was rest state ‘scan-acupuncture-scan＇. Lieque（LU7）, Hegu（LI4）, Baihui（GV20）, Zusanli（ST36）, Sanyinjiao（SP6） and Taichong（LR3） were selected and the needles were retained for 30 min. Furthermore, electro-acupuncture was applied at Lieque（LU7） and Zusanli（ST36） with continuous wave（15Hz） for 30 min. The intensity was under the maximum tolerance of subjects. The f MRI data was acquired before and after acupuncture, the self-made scale of craving for smoking, Minnesota Nicotine Withdrawal Scale（MNWS） and ten-item Questionnaire of Smoking Urges（QSUBrief） were recorded. DPARSF software, SPM 12 and REST software were used to calculate and measure the f ALFF pictures. Results： 1After acupuncture, the results of self-made craving for smoking, MNWS and QSU-Brief were all reduced（P0.05）. 2Before acupuncture, the nervous activity of left inferior temporal gyrus and left rectus in the smoking group was reduced than that in the non-smoking group, and that of middle occipital gyrus, cerebellum, left precentral gyrus, right precentral gyrus and right supplementary motor area were higher than that in the non-smoking group. Compared before and after acupuncture, in the nonsmoking group the nervous activity of left middle temporal gyrus was reduced, and the nervous activity of right precuneus, right angular gyrus, right middle frontal gyrus, left dorsolateral superior frontal gyrus and right postcentral gyrus was increased. After acupuncture, the activity of left inferior temporal gyrus, left triangle inferior frontal gyrus, right insula, right superior occipital gyrus, right cerebellum, left precuneus and left cerebellar was reduced, while that of left orbital frontal gyrus, right middle frontal back, left dorsolateral frontal gyrus, right precentral gyrus, left precentral gyrus and left anterior cingulate gyrus was increased. 3Correlation analysis showed that the outcome of self-made craving for smoking was related to the nervous activity of dorsolateral superior frontal gyrus and anterior cingulate, the outcome of MNWS was related to the nervous activity of superior occipital gyrus, dorsolateral superior frontal gyrus and cerebellum, the amount of daily cigarette consumption was related to the nervous activity of middle frontal gyrus, the outcome of FTND was related to the nervous activity of anterior cingulate. Conclusion： Acupuncture could reduce the cravings for smoking, which was likely to be related with regulating ‘prefrontal cortex-anterior cingulate＇ circuit and improving the activity of cerebellum and visual cortex, achieving the aim of smoking abstinence.