基于脑功能连接网络的针刺敏化穴治疗慢性颈痛的中枢机制研究

Study on the central mechanism of acupuncture at sensitive points for chronic neck pain based on brain function connection

目的:通过研究针刺敏化穴对慢性颈痛患者脑功能连接网络特征的影响,以揭示针刺敏化穴治疗慢性颈痛的中枢影像机制。方法:本研究共纳入符合纳入标准的慢性颈痛患者73例和健康受试者27名,将慢性颈痛患者随机分配到针刺敏化穴组(39例)和常规护理组(34例)。针刺敏化穴组以患者颈项部区域压痛阈值变化最大的5个穴位/敏感点作为针刺选穴,治疗2周后再次进行测量,并根据测量的压痛阈值结果调整针刺穴位;前2周治疗3次/周,后2周2次/周,4周共行10次针刺治疗。常规护理组自行通过颈椎保健操进行锻炼,观察期为4周。在治疗前后分别进行大脑静息态磁共振成像(fMRI)检测,并从颈痛发作频率、颈痛程度和颈部功能3个方面进行临床评价;健康受试者只进行1次fMRI检测。采用基于体素的形态学测量方法(VBM)和功能连接(FC)的方法进行影像数据分析。结果:治疗4周后,针刺敏化穴组患者的4周平均每周颈痛发作天数、4周平均每日颈痛发作时长、颈痛VAS评分、颈椎功能障碍指数(NDI)评分和简式McGill疼痛问卷(SF-MPQ)评分较治疗前比较差异有统计学意义(P<0.01,P<0.05)。常规护理组观察前后组内比较差异无统计学意义。治疗4周后,针刺敏化穴组和常规护理组在4周平均每周颈痛发作天数、4周平均每日颈痛发作时长和MPQ评分方面比较均有显著性差异(P<0.05)。慢性颈痛患者与健康受试者相比,左侧前扣带回、右侧顶上回灰质体积显著减少(P<0.05);以其作为种子点进行FC分析,发现针刺敏化穴组在治疗后左侧前扣带回与左侧楔前叶、右侧内侧额上回及右侧眶内额上回功能连接增强,前扣带回-楔前叶的功能连接变化率与MPQ评分变化率(r=0.460,P=0.014)呈正相关。结论:针刺敏化穴对慢性颈痛的发作频率,疼痛程度和对颈部功能都有明显的改善作用。左侧前扣带回和右侧顶上回是慢性颈痛患者大脑结构异常的关键部位。前扣带回-楔前叶、内侧额上回及眶内额是针刺敏化穴特异性影响的脑功能网络;前扣带回-楔前叶的功能连接的变化可能是针刺敏化穴改善颈痛程度的关键中枢机制。

Objective:To study the influence of acupuncturing at sensitive points in patients with chronic neck pain on the network characteristics of the brain function connection and revealing the central imaging mechanism of acupuncture at the sensitizing point in the treatment of chronic neck pain with resting state magnetic resonance imaging technology.Methods:A total of 73 participants with chronic neck pain and 27 healthy participants who met the inclusion criteria were included in this study.All chronic neck pain participants were randomly assigned to the acupuncture sensitization point group(39 cases)and the routine care group(34 cases).In the acupuncture sensitization group,the 5 acupoints/sensitive points with the largest changes in the tenderness threshold were selected as acupuncture points,and the acupuncture points were measured again after 2 weeks of treatment.And the acupuncture points would be adjusted according to the testing results;The participants were treated 3 times a week in the first two weeks and 2 times a week for the next two weeks,totally 10 times.The routine nursing group did not perform acupuncture intervention,and the participants were instructed to exercise by themselves through cervical health exercises,with 4 weeks’observation period.Before and after treatment/observation,clinical evaluations were made from three aspects:frequency of neck pain,degree of neck pain and function of neck.Image data analysis were performed by the voxel-based morphometry(VBM)and functional connectivity(FC)methods.Results:After 4 weeks of acupuncture treatment,there were significant differences in the average number of days of neck pain per week in the past 4 weeks,the average daily duration of neck pain in the past 4 weeks,VAS score,NDI score and MPQ score in the acupuncture sensitization point group compared to the data before treatment(P<0.01,P<0.05).There was no statistical difference in the routine nursing group before and after the observation.After 4 weeks of acupuncture treatment/observation,there was significant difference in the average number of days of neck pain per week in the past 4 weeks,average daily duration of neck pain in the past 4 weeks and MPQ score between acupuncture sensitive points group and the routine care group(P<0.05).Compared with healthy participants,the volume of gray matter in the left anterior cingulate gyrus and right apical gyrus of patients with chronic neck pain was significantly reduced(P<0.05).Setting the left anterior cingulate gyrus and the right superior gyrus as seed points for FC analysis,it was found that the functional connection of the left anterior cingulate gyrus,the left precuneus,right medial superior frontal the gyrus and the superior frontal gyrus in the right orbit in the participants of the acupuncture sensitive points group was enhanced.Conclusion:Acupuncture at the sensitive points can significantly improve the frequency of chronic neck pain,pain degree and neck function.The left anterior cingulate gyrus and the right superior gyrus may be the key parts of abnormal brain structure in patients with chronic neck pain.Anterior cingulate gyrus-anterior cuneiform lobe,anterior cingulate gyrus-medial superior frontal gyrus and anterior cingulate gyrus-orbitofrontal superior are the brain function networks that are specifically affected by acupuncture sensitization points;the change of functional connection of anterior cingulate gyrus-precuneus may be the key central mechanism for acupuncture at the sensitive point to improve the degree of neck pain.