艾灸热敏态关元穴对原发性痛经患者脑功能连接网络影响的研究

Study on Effects of the Moxibustion at Heat-sensitized Guanyuan( RN 4) on Brain Functional Connective Network in Patients with Primary Dysmenorrhea

目的:运用静息态功能磁共振技术(Rs-fMRI),观察原发性痛经患者经艾灸热敏态关元穴后脑功能连接网络的变化,为探索艾灸热敏化腧穴的中枢机制提供潜在的影像学证据。方法:选取2016年12月至2018年2月江西中医药大学附属医院收治的原发性痛经患者60例作为研究对象。按照热敏腧穴灸感法进行检测,根据施灸过程中关元穴是否发生热敏现象分为热敏态腧穴组(n=30)和非热敏态腧穴组(n=30)。2组患者分别在艾灸前及艾灸结束后进行Rs-fMRI数据采集。采用DPARSFA软件和以前额叶(PFC)为种子点的脑功能连接分析方法对数据进行后处理。结果:与艾灸前比较:热敏态腧穴组艾灸后与PFC脑功能连接增强的脑区有右大脑、脑白质区、壳核、豆状核、顶叶、楔前叶。非热敏态腧穴组艾灸后与PFC脑功能连接增强的脑区有右大脑、壳核、豆状核,与PFC脑功能连接减弱的脑区有额叶、中央前回、脑灰质区。与非热敏态腧穴组比较:艾灸前,热敏态腧穴组与PFC脑功能连接减弱的脑区有左大脑、额叶、额下回、顶叶、顶下小叶。艾灸后,热敏态腧穴组与PFC脑功能连接增强的脑区有左侧脑干、左侧小脑,与PFC脑功能连接减弱的脑区有左大脑、脑白质区、岛叶、额叶。结论:艾灸热敏态关元穴能使原发性痛经患者脑功能连接网络发生变化,热敏灸感的出现可能与增强左侧脑干-左侧小脑的联系,同时抑制左大脑-脑白质区-岛叶-额叶的功能连接,间接影响其他边缘系统相关脑区的功能有关。

Objective: To observe the change of brain functional connective network in patients with primary dysmenorrhea by the moxibustion at heat-sensitized Guanyuan(RN 4),based on the resting state functional magnetic resonance imaging(Rs-fMRI),so as to provide potential imageological evidence for exploring the central mechanism of the moxibustion at heat-sensitized acupoints. Methods: A total of 60 patients with primary dysmenorrhea admitted in the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from December 2016 to Febuary 2018 were selected as research objects.According to the test method of moxibustion sensation for heat-sensitized acupoints,and whether the heat-sensitive phenomenon occurred at Guangyuan(RN 4),they were divided into heat-sensitized acupoint group(HA group, n =30)and non heat-sensitized acupoint group(NHA group, n =30).Rs-fMRI data collection was performed before and after the moxibustion in the 2 groups.DPARSFA software and an analysis method of brain functional connection(taking prefrontal cortex(PFC)as the seed point)were applied for data post-processing. Results: Compared with before the moxibustion:After the moxibustion in the HA group,regions related to enhanced PFC brain functional connection were the right brain,cerebral white matter area,putamen,lenticular nucleus,parietal lobe and precuneus.After the moxibustion in the NHA group,regions related to the enhanced PFC brain functional connection were the right brain,putamen and lenticular nucleus.And regions related to weakened PFC brain functional connection were the frontal lobe,anterior central gyrus and cerebral gray matter area.Compared with the NHA group:Before the moxibustion in the HA group,regions related to the weakened PFC brain functional connection were the left brain,frontal lobe,inferior frontal gyrus,left parietal lobe and inferior parietal lobe.After the moxibustion in the HA group,regions related to the enhanced PFC brain functional connection were the left brain stem and the left cerebellum.Regions related to weakened PFC brain functional connection were the left brain,cerebral white matter area,insula lobe and frontal lobe. Conclusion: The moxibustion at heat-sensitized Guanyuan(RN 4)can make the patients with primary dysmenorrhea change the brain functional connective network.The emergence of the sense of heat-sensitive moxibustion may be related to functions like enhancing the contact between the left brain stem and the left cerebellum,inhibiting the functional connection of the left brain-cerebral white matter area-insular lobe-frontal lobe,and indirectly affecting other limbic system related brain areas.