原发性痛经机制及针灸疗效

Pathogenesis of primary dysmenorrhea and therapeutic effect of acupuncture

目的观察原发性痛经(PDM)发病机制及针灸疗效。方法前瞻性纳入20例PDM患者(PDM组)及27名健康女性[健康对照(HC)组],于经期行痛经相关评分量表评估,采集头颅低频振幅(ALFF)及度中心性(DC)静息态功能MRI(rs-fMRI);之后对PDM组行针灸治疗,于其后行第二次量表评估并采集rs-fMRI,比较治疗前、后组间及组内脑区ALFF值及DC值差异。结果PDM组针灸治疗前痛经评分显著高于HC组及该组针灸后(P均<0.05)。PDM组右侧背外侧额上回(SFGdor)ALFF值及左侧颞中回(MTG)、左侧SFGdor、左侧后扣带回DC值均高于HC组(P均<0.05),而左侧脑岛ALFF值低于HC组(P=0.043)。PDM组内针灸后双侧脑岛ALFF值及左侧中央后回、左侧中央旁小叶DC值均高于针灸前(P均<0.05),而左侧颞下回、右侧MTG、左侧枕中回、右侧楔前叶ALFF值及左侧壳核/尾状核、右侧壳核DC值均低于针灸前(P均<0.05)。结论PDM患者经期多个脑区功能异常,针灸治疗有助于改善。

Objective To explore the pathogenesis of primary dysmenorrhea(PDM),and to observe the therapeutic effect of acupuncture.Methods Twenty PDM patients(PDM group)and 27 healthy young women(healthy control[HC]group)were prospectively enrolled,and dysmenorrhea related score scale evaluation,amplitude of low frequency fluctuation(ALFF)and degree centrality(DC)resting-state functional MRI(rs-fMRI)of brain were performed during menstruation.Then PDM patients underwent acupuncture,and scale evaluation and brain rs-fMRI were performed again during menstruation after acupuncture.ALFF and DC values of brain regions were compared between groups and within PDM group before and after acupuncture.Results The scores of dysmenorrhea of PDM group before acupuncture were significantly higher than after acupuncture and of HC group(all P<0.05).ALFF value of right dorsolateral superior frontal gyrus(SFGdor),DC values of left middle temporal gyrus(MTG),left SFGdor and left posterior cingulate gyrus in PDM group were all higher than those in HC group(all P<0.05),while ALFF value of left insula was lower in PDM group than that in HC group(P=0.043).In PDM group,ALFF values of bilateral insula,DC values of left postcentral gyrus and left paracentral lobule after acupuncture were higher all than those before acupuncture(all P<0.05),while ALFF values of left inferior temporal gyrus,right MTG,left middle occipital gyrus and right precuneus,as well as DC values of left putamen/caudate and right putamen were all lower than those before acupuncture(all P<0.05).Conclusion Abnormal brain regions existed in PDM patients,and acupuncture was helpful for treatment.