针灸治疗原发性失眠患者的神经机制研究

Neuromechanism of acupuncture therapy in primary insomnia patients

目的比较原发性失眠（PI）患者和健康对照者针灸治疗后全脑局部一致性（ReHo）的改变．探讨针刺疗法在PI脑功能损伤中的可能代偿机制。方法选择慈溪市人民医院神经内科自2014年8月至2016年1月收治的PI患者29例作为PI组，选择同期在社区招募的年龄、性别和PI组相匹配的健康志愿者22名作为对照组。选择2组受试者的百会、四神聪、神门、三阴交等穴位行针灸疗法。疗程为2周。2周后所有受试者进行静息态功能MIU扫描，采用局部一致性（ReHo）的分析方法计算2组受试者静息态下脑区的ReHo情况。结果同对照组比较，PI组患者脑区右侧枕中回、左侧枕上回、右侧楔前叶及双侧中央后回ReHo增高，左侧直回、双侧额中回及海马旁回ReHo降低，差异有统计学意义（P〈0．05）。结论静息状态下，失眠能导致感觉相关脑区受损，外部的刺激能引发相应脑区出现功能代偿，从而达到助眠的疗效。

Objective To understand the brain neural activity and possible compensation mechanism of brain function in primary insomnia （PI） patients after acupuncture therapy using regional homogeneity （ReHo） approach in resting state functional magnetic resonance imaging （fMRI）. Methods Twenty-nine PI patients, admitted to our hospital from August 2014 to January 2016, and 22 age, education, and gender-matched normal healthy subjects were chosen in our study. Every subject underwent acupuncture therapy in Baihui, Sishencongm Shenmen and Sanyinjiao for two weeks, and then, the resting state fMRI was performed to analyze the ReHo between the PI and normal control groups. Results As compared with the control group, the PI group showed significantly increased ReHo values in right middle occipital gyrus （MOG）, left superior occipital gyrus （SOG）, right cuneus and bilateral post central gyrus, and significantly decreased ReHo values in left rectus, bilateral medial frontal cortex, and bilateral para hippocampal gyrus （P〈0.05）. Conclusions The ReHo values in some brain regions of the PI patients are abnormal at the resting state; some external stimulation triggers a series of functional compensation in corresponding brain areas, and can help people fall sleep.