针刺法治疗慢性膝骨关节炎的临床疗效评价及中枢机制研究

Clinical efficacy evaluation and central mechanism study of acupuncture in treating chronic knee osteoarthritis

目的研究针刺法治疗慢性膝骨关节炎(KOA)的临床疗效及中枢作用机制。方法选取2019年2月-2020年7月黑龙江中医药大学附属第一医院CT磁共振科收治的慢性KOA患者80例为研究组,另选取年龄、性别匹配的健康受试者80例为对照组。研究组予以针刺治疗,对照组不采取治疗措施。研究组分别于治疗前、疗程结束后1周进行功能性磁共振成像(fMRI)扫描及超声检查,对照组仅于研究组治疗前同时间fMRI扫描及超声检查1次。比较研究组治疗前后的疼痛、关节功能变化及超声检查结果,比较研究组与对照组及研究组治疗前后大脑网络功能活动情况。结果与治疗前比较,研究组治疗后简明疼痛评定量表(BPI)评分下降、Lysholm膝关节功能评分升高,关节软骨蜕变分期、关节间隙无回声区厚度、关节腔滑膜厚度及滑膜周围动脉网阻力指数(RI)降低(P<0.05)。研究组治疗前与对照组在不同脑区的ALFF信号均存在差异,其中增高区域包括双侧额中回,右侧额下回、梭状回、脑岛,左侧楔前叶、缘上回、颞中回、颞下回,降低区域包括右侧额上回、左侧枕中回/枕上回与海马/丘脑/杏仁核,差异有统计学意义(P<0.05);研究组治疗前后在不同脑区的ALFF信号均存在差异,其中增高区域包括顶叶中央前回、中扣带回,右侧颞中回、枕中回,降低区域为额前叶,差异有统计学意义(P<0.05)。结论慢性KOA患者存在脑功能活动异常,针刺可改善脑功能活动变化,降低疼痛、改善关节功能,减轻膝关节病理变化。

Objective To explore the clinical efficacy and central mechanism of acupuncture in the treatment of chronic knee osteoarthritis(KOA).Methods Eighty patients with chronic KOA with the treatment of acupuncture as the study group and another healthy 80 people as control group matched with the sex and age of the study group were selected from the CT and MRI department of the First Affiliated Hospital of Heilongjiang University of Traditional Medicine from February 2019 to July 2020.The study group was given acupuncture treatment,while the control group did not take treatment measures.The study group underwent fMRI scanning and ultrasound examination before the treatment and one week after the end of the treatment.The control group only had fMRI scanning and ultrasound examination at the same time before treatment in the study group.The pain,joint function changes and ultrasonic examination results of the study group before and after treatment were compared.The brain network function of the study group was compared with that of the control group and the study group before and after treatment.Results Compared with before treatment,the score of BPI of the study group decreased,Lysholm knee function score increased,the stage of articular cartilage degeneration,the thickness of anechoic zone in the joint space,the thickness of articular cavity synovial membrane and the resistance index(RI)of perisynovial arterial network decreased(P<0.05).Before treatment with the control group,the amplitude of low frequency(ALFF)of the bilateral frontal gyrus,tright inferior frontal gyrus,fusiform gyrus and insular lobe,left anterior cuneiform lobe,superior marginal gyrus,middle temporal gyrus and inferior temporal gyrus of the study group increased before the treatment,while the ALFF values of right superior frontal gyrus,left middle occipital gyrus/superior occipital gyrus and hippocampus/thalamus/amygdala decreased(P<0.05).Compared with those before the treatment,the ALFF value of the tissue area of the central anterior gyrus and the cingulate gyrus,the right temporal gyrus and the occipital gyrus increased in the study group after treatment,and the ALFF value in the prefrontal cortex was decreased(P<0.05).Conclusion Patients with chronic knee osteoarthritis have abnormal brain function.Acupuncture could improve the changes of brain function,reduce pain,improve joint function,and reduce the pathological changes of the knee joint.