基于功能性磁共振成像在正常与病理状态下针刺外关穴时脑负激活的脑区定位研究

Identification of Deactivated Brain Regions by Real and Non-penetrating Sham Acupuncture Stimulation on Waiguan: An fMRI Study in Normal Versus Pathological Conditions

目的基于功能性磁共振成像(f MRI)在正常和病理状态下观察真针刺、假针刺外关穴时脑负激活的脑区定位规律。方法 2013年8—12月在南方医科大学选取正常受试者24例,2014年1—6月在南方医院、广州中医药大学第一附属医院选取缺血性脑卒中患者20例,分别施以右侧外关穴的真针刺和假针刺,同时运用血氧水平依赖(BOLD)f MRI采集负激活信号数据,所得数据运用SPM2进行处理(P≤0.001,uncorrected,活体素数目K>30)。结果正常受试者外关穴真针刺负激活的脑区定位:左侧顶上小叶(BA7)、顶下小叶(BA40)、楔前叶(BA7、19)、额上回(BA6)、中央前回(BA6、10)、中央后回(BA3、7)、枕叶(BA19),右侧中央前回(BA6)、中央后回(BA3)、楔前叶(BA19、7)、楔叶(BA19);假针刺负激活的脑区定位:左侧中央前回(BA10)、中央后回(BA3、5),右侧额上回(BA10)。缺血性脑卒中患者外关穴真针刺负激活的脑区定位:左侧额内侧回(BA6、10)、中央后回(BA3)、颞中回(BA21),右侧中央后回(BA3、5)、中央前回(BA4)、额内侧回(BA10);假针刺负激活的脑区定位:双侧楔前叶(BA7)。结论正常受试者与缺血性脑卒中患者的外关穴真针刺均使与该穴主治作用相关的脑区出现负激活,提示针刺疗效可能与脑负激活有关;在执行同样外在任务时,生理状态下和病理状态下被干扰或被打断的脑功能区不相同。

Objective To study the law of identification of deactivated brain regions by real and non- penetrating sham acupuncture stimulation on Waiguan（ Point te5） in normal versus pathological conditions based on f MRI. Methods The subjects enrolled in this study were 24 normal controls selected from Southern Medical University between August and December2013,and 20 ischemic stroke patients from Nanfang Hospital and the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January and June 2014. We conducted real and non- penetrating sham acupuncture stimulation on the right Point te5 in all the subjects,respectively and collected the signal data of brain deactivations with blood oxygenation level-dependent（ BOLD） f MRI and processed the data using SPM2（ P≤0. 001,uncorrected,number of biotin K 〉30）. Results In the normal controls,the brain regions deactivated by real acupuncture stimulation on Point te5 were as follows： left superior parietal lobule（ BA7）,left inferior parietal lobule（ BA40）,left precuneus（ BA7,19）,left superior frontal gyrus（ BA6）,left precentral gyrus（ BA6,10）, left postcentral gyrus（ BA3,7）, left occipital lobe（ BA19）, right precentral gyrus（ BA6）,right postcentral gyrus（ BA3）,right precuneus（ BA19,7）,right cuneus（ BA19）; the brain regions deactivated by non- penetrating sham acupuncture stimulation on Point te5 were left precentral gyrus（ BA10）,left postcentral gyrus（ BA3,5）,and right superior frontal gyrus（ BA10）. In the ischemic stroke patients,the brain regions deactivated by real acupuncture stimulation on Point te5 were as follows： left medial frontal gyrus（ BA6,10）, left postcentral gyrus（ BA3）, left middle temporal gyrus（ BA21）, right postcentral gyrus（ BA3,5）, right precentral gyrus（ BA4）, right medial frontal gyrus（ BA10）; the brain regions deactivated by non- penetrating sham acupuncture stimulation on Point te5 were left and right precuneuses（ BA7）. Conclusion Real acupuncture stimulation on Point te5 can deactivate the functional brain regions in both the normal controls and ischemic stroke patients,which suggests that the stimulation of Point te5 may be associated with the deactivation of brain regions; the deactivated functional brain regions in the normal controls are different from those in the ischemic stroke patients when the same kind of acupuncture stimulation given to them is disturbed or interrupted.