针刺治疗对腹泻型肠易激综合征病人rs-fMRI脑功能连接的影响

Effect of acupuncture on brain functional connectivity of resting-state fMRI in patients with diarrhea-predominant irritable bowel syndrome

目的探讨针刺治疗对腹泻型肠易激综合征(IBS-D)病人静息态功能MRI(rs-fMRI)的脑功能连接(FC)的影响。方法前瞻性纳入性别、年龄及受教育程度相匹配的IBS-D病人24例及正常对照(NC)组23例。IBSD病人接受“调神健脾”针刺法治疗6周(3次/周),分别于治疗前、后采用严重程度评分(SSS)、生活质量量表(QOL)及汉密尔顿焦虑量表(HAMA)评价病情及针刺疗效。NC组仅于纳入当日行rs-fMRI检查,IBS-D病人分别于纳入当日和针刺治疗6周结束后48 h内行rs-fMRI检查。在自动解剖标记(AAL)脑区模板上选取双侧岛叶,扣带回(前、中、后部),杏仁核及丘脑为种子点,构建其与全脑各脑区的FC。治疗前后量表评分比较采用配对t检验。NC组及治疗前后IBS-D病人的FC值比较采用单因素方差分析,组间两两比较采用事后检验。采用Pearson相关对IBS-D病人治疗前后的差异脑区FC值与临床量表评分进行分析。结果IBS-D病人经针刺治疗后较治疗前的SSS、HAMA评分下降(均P<0.05),QOL评分升高(P<0.05)。与NC组相比,治疗前IBS-D病人的左侧岛叶-右侧颞中回、左侧中扣带回-右侧颞极颞中回脑区的FC增强(均P<0.05);治疗后,上述FC均减弱(均P<0.05)。与NC组相比,治疗后右侧前扣带回-小脑蚓部3区的FC增强(P<0.05),左侧杏仁核-左侧中央后回的FC减弱(P<0.05);而治疗前上述FC差异无统计学意义(P>0.05)。治疗后IBS-D病人的右侧前扣带回-小脑蚓部3区间FC值(0.1±0.2)与HAMA评分(8.2±3.9)呈负相关(r=-0.451,P=0.027),左侧杏仁核-左侧中央后回间FC值(-0.1±0.2)与HAMA评分(8.2±3.9)呈负相关(r=-0.456,P=0.025)。结论针刺治疗可改变IBS-D病人与内脏疼痛、情绪调节相关脑区的FC,且与临床症状改善相关。

Objective To investigate the effect of acupuncture on the brain functional connection of resting-state fMRI(rs-fMRI)in patients with diarrhea-predominant irritable bowel syndrome(IBS-D).Methods We prospectively enrolled 24 IBS-D patients and 23 normal controls of age,gender,and educational level matched.All the patients underwent acupuncture treatment with“spirit-regulating and spleen-invigorating”for 6 consecutive weeks(3 times per week),and completed clinical questionnaires including symptom severity score(SSS),quality of life(QOL),Hamilton anxiety scale(HAMA)before and after acupuncture stimulation.The rs-fMRI data were collected on the day of enrollment and within 48 hours after 6 weeks of acupuncture treatment.The bilateral insula,cingulate gyrus(anterior,middle,posterior),amygdala and thalamus on the AAL atlas were selected as seeds for whole brain functional connectivity(FC)analysis.We studied the FC change before and after acupuncture stimulation compared with the normal controls.Paired-sample t test was used to analyze clinical questionnaires before and after treatment.The FC values of controls and IBS-D patients before and after treatment were compared by one-way ANOVA,post hoc test was used for pairwise comparisons.Pearson correlation analysis was conducted to investigate the relevance between FC and the clinical scale scores.Results The SSS and HAMA scores of IBS-D patients were decreased(P<0.05),QOL score increased(P<0.05)after acupuncture treatment.Compared to the control group,the FCs between the left insula and right middle temporal gyrus,the left median cingulate and the right temporal pole middle temporal gyrus were increased before treatment(P<0.05)and were decreased after treatment(P<0.05)in the IBS-D patients.The FC between right anterior cingulate and vermins-3 was increased(P<0.05),the FC between left amygdala and left postcentral gyrus was decreased(P<0.05)in the IBS-D patients after treatment,although these FCs showed no significance compared to the NC group(P>0.05).After treatment,the FC value(0.1±0.2)between right anterior cingulate and vermins-3 in the IBS-D patients negatively correlated(r=-0.451,P=0.027)with HAMA score(8.2±3.9).The FC value(-0.1±0.2)between left amygdala and left postcentral gyrus negatively correlated(r=-0.456,P=0.025)with HAMA score(8.2±3.9).Conclusion The FC of IBS-D patients involved in visceral hypersensitivity and emotion can be remodeled after acupuncture stimulation,and it is related with clinical symptom improvement.