针刺对无先兆偏头痛患者疼痛调控脑区影响的文献研究

Literature Analysis of Acupuncture on Pain-regulating Brain Region in Migraine Patients without Aura

目的 分析针刺对无先兆偏头痛患者脑功能活动的影响,探讨针刺治疗无先兆偏头痛的机制。方法检索PubMed、中国知网、万方数据库和维普期刊资源整合服务平台中收录的从2012年1月1日至2022年1月1日与针灸治疗无先兆偏头痛及功能磁共振(fMRI)相关的临床研究文献。对纳入文献的研究类型、干预方式、腧穴选择、观察指标以及针刺治疗无先兆偏头痛影响的高频脑区进行总结与分析。结果 共纳入24篇文献,19篇为中文文献,5篇为英文文献;9项研究比较真针刺与安慰针刺对无先兆偏头痛患者脑功能的影响;11项研究采用了健康受试者作为对照。文献中涉及腧穴共有29个,其中使用频次>5的高频腧穴共5个,分别为外关、阳陵泉、丘墟、足临泣和风池穴。与健康受试者相比,无先兆偏头痛患者脑功能升高的脑区为额叶、扣带回,脑功能降低的脑区为楔前叶。真针刺治疗无先兆偏头痛影响的脑区为中央前回、中央后回、海马、后扣带回及前额叶皮层;安慰针刺治疗后患者脑功能未见明显变化。真针刺治疗脑功能升高的脑区为前扣带回、中央前回和小脑,脑功能降低的脑区为中央后回、后扣带回和楔前叶。结论 针刺可改善无先兆偏头痛患者疼痛相关脑区功能异常,主要脑功能升高的脑区为前扣带回、中央前回和小脑,脑功能降低的脑区为中央后回、后扣带回和楔前叶,这可能是其发挥针刺镇痛的作用机制之一。

Objective To analy ze the effect of acupuncture on brain functional activities in patients with migraine without aura and to the study the mechanism of acupuncture in treatment of migraine without aura.Methods The clinical studies on acupuncture in the treatment of migraine without aura based on fMRI were searched using PubMed,CNKI,Wanfang and VIP databases from January 1 st 2012 to January 1 st 2022.The types of studies,interventions,selection of acupoints,indicators and high-frequency brain regions affected by acupuncture in treatment of migraine without aura were summarized and analyzed.Results A total of 24 papers were included,of which 19 were in Chinese and 5 were in English.Sham acupuncture for treatment of migraine without aura was set as control group in 9 studies.Eleven trials recruited healthy people as control.There were 29 acupoints involved,of which five were high-frequency acupoints(more than five times),namely Waiguan(SJ 5),Yanglingquan(GB 34),Qiuxu(GB 40),Zulinqi(GB 41) and Fengchi(GB 20).Compared to those in healthy subjects,the brain function of frontal lobe and cingulate gyrus increased in patients with mwithout aura,while the precuneus function decreased.The brain regions affected by acupuncture in treatment of migraine without aura were precentral gyrus,postcentral gyrus,hippocampus,posterior cingulate gyrus and prefrontal cortex.There was no obvious change in brain function after the treatment of sham acupuncture.Acupuncture increased the function of anterior cingulate gyrus,precentral gyrus,and cerebellum in migraine without aura,and decreased the function of retrocentral gyrus,posterior cingulate gyrus and precuneus.Conclusion Acupuncture can improve the abnormal brain function of pain-related brain regions in migraine patients without aura,by mainly increasing the function of anterior cingulate gyrus,precentral gyrus and cerebellum and reducing the function of posterior cingulate gyrus,posterior cingulate gyrus and precuneus,which may be one explanation for its analgesic effect.