基于静息态功能磁共振成像观察推桥弓干预Ⅰ级原发性高血压的即时脑效应

Immediate brain effect of pushing Qiaogong point intervention on stage Ⅰ essential hypertension based on rs-fMRI

目的 采用静息态功能磁共振成像(resting-state functional magnetic resonance imaging, rs-fMRI)技术观察推桥弓干预Ⅰ级原发性高血压(essential hypertension, EH)患者的即时脑效应。材料与方法 前瞻性纳入15例EH患者和15例性别、年龄、身高、体质量等基线情况与EH组相匹配的健康对照(healthy controls, HC)。入组前分别填写两组人口统计学数据,试验开始后,先采集两组患者基线期rs-fMRI数据、收缩压和舒张压,随后对EH组进行10 min推桥弓干预,再行第二次MRI扫描,最后测量收缩压和舒张压。采用低频振幅(amplitude of low frequency fluctuation, ALFF)分析方法,比较EH组与HC组的ALFF值,再选择Pearson相关分析ALFF值差异脑区与血压的相关性;以及干预前后ALFF值的变化。结果 与HC组相比,EH组患者仅左侧额中回(left middle frontal gyrus, MFG.L)ALFF值显著降低(高斯随机场校正,voxel P<0.005,cluster P<0.05)。MFG.L ALFF值与收缩压呈负相关(r=-0.627,P=0.012);与舒张压无相关性(P>0.05)。EH组干预后,收缩压(t=3.61,P=0.003)、舒张压(t=3.80,P=0.002)均显著低于治疗前;双侧额中回(middle frontal gyrus, MFG)的ALFF值显著升高(高斯随机场校正,voxel P<0.005,cluster P<0.05)。结论 EH患者存在MFG.L大脑活动降低,可能提示EH发病伴随着脑功能的损害;推桥弓能即时调控EH患者MFG的ALFF值,可能是推拿刺激信号传递,激活大脑调节功能,从而改善血压。

Objective: To observe the immediate brain effect of pushing Qiaogong point intervention in patients with grade Ⅰ essential hypertension(EH) by resting-state functional magnetic resonance imaging(rs-fMRI). Materials and Methods: Fifteen EH patients and 15 healthy controls(HC) with no statistical difference in sex, age, height, weight and other baseline conditions were prospectively enrolled. Demographic data of the two groups were filled in before enrollment. Baseline rs-fMRI data, systolic and diastolic blood pressures were collected for both groups at the start of the experiment, followed by a 10 minute Qiaogong point intervention for the EH group, followed by a second MRI scan and final measurement of systolic and diastolic blood pressures. Amplitude of low frequency fluctuation(ALFF) was used to compare the ALFF values of EH group and HC group, and the changes of ALFF values before and after intervention. Pearson correlation analysis was used to analyze the correlation between the difference of ALFF value in brain region and blood pressure between two groups. Results: Compared with HC group, ALFF value of left middle frontal gyrus(MFG. L) was significantly lower in EH group(Gaussian random field correction, voxel P<0.005, cluster P<0.05). ALFF value of left middle frontal gyrus was negatively correlated with systolic blood pressure(r=-0.627, P=0.012). There was no significant correlation with diastolic blood pressure(P>0.05). After intervention, the systolic blood pressure and diastolic blood pressure of hypertension group were significantly lower than those before treatment(t=3.61, P=0.003);(t=3.80, P=0.002). ALFF values were significantly increased in bilateral middle frontal gyrus(Gaussian random field correction, voxel P<0.005, cluster P<0.05). Conclusions: Decreased brain activity in left middle frontal gyrus in hypertensive patients Qiaogong point that the onset of EH is accompanied by brain function damage. Pushing bridge arch can immediately regulate the ALFF value of MFG in EH patients, which may communicate with massage stimulation signal, activate the brain regulatory function, and thus improve blood pressure.