针刺干预原发性失眠患者脑血氧饱和度即刻效应对照观察

Controlled Observation of Instant Effect of Concentration of Brain Oxyhemoglobin in Patients with Primary Insomnia by Acupuncture

目的观察针刺治疗原发性失眠患者的即刻效应,并与健康组对比,探讨针刺对两组人群在表情识别过程中大脑皮层血氧饱和度及额、顶叶脑区功能的影响。方法选取30例原发性失眠患者和30例年龄、性别相匹配的健康人,两组均用近红外脑功能成像(fNIRS)检测针刺前表情识别任务下额叶及顶叶氧合血红蛋白(HBO)浓度变化,随后进行针刺治疗,针刺后复测fNIRS。结果组内比较针刺后识别正性和负性表情时,健康组额叶的前运动皮层(Brodmann 6区)、初级运动皮层(Brodmann 4区)及顶叶缘上回(Brodmann 40区)的HBO浓度均较针刺前升高(P<0.05),失眠组额叶的前运动皮层(Brodmann 6区)及顶叶的体感联合皮层(Brodmann 7区)HBO浓度均较针刺前降低(P<0.05),识别中性表情时健康组针刺前后无变化(P>0.05),失眠组顶叶的体感联合皮层(Brodmann 5区)的HBO浓度较针刺前升高(P<0.05);组间比较,针刺前识别正性和负性表情时原发性失眠患者双侧额叶前运动皮层(Brodmann 6区)、左侧前额叶区域额极区(Brodmann 10区)、左侧顶叶体感联合皮层(Brodmann 5区)HBO浓度较健康组升高(P<0.05),识别中性表情时,左侧顶叶体感联合皮层(Brodmann 5区)HBO浓度较健康组升高,左侧额叶动眼区(Brodmann 8区)HBO浓度较健康组降低(P<0.05),针刺后识别正性、中性及负性表情时失眠组左侧额叶初级运动皮层(Brodmann 4区)、左侧前额叶眶额区(Brodmann 11区)、右侧顶叶体感联合皮层(Brodmann 7区)、右侧前额叶后外侧区(Brodmann 9区)、右侧前运动皮层(Brodmann 6区)HBO浓度均较健康组降低(P<0.05)。结论针灸治疗原发性失眠能通过针刺特定穴位,调节大脑皮层氧合血红蛋白浓度,从而改善额叶、眶额皮层及顶叶相关脑区功能,增强个体对无关刺激非自主激活的控制,调节过度觉醒活动以改善失眠。

Objective To observe instant effect of acupuncture in treating primary insomnia patients,and to compare with the health group,to explore the effects of acupuncture on oxyhemoglobin(HBO)and loubus fromatis and lobus parietalis function of the two groups during expression recognition.Methods 30 primary insomnia patients and 30 healthy people who matched with age and sex were selected by using functional near infrared imaging spectroscopy(fNIRS)to detect changes in the concentration of oxyhemoglobin(HBO)levels in the loubus fromatis and lobus parietalis of the epithelial during the expression recognition task,then followed by acupuncture therapy,and retested fNIRS after the treatment.Results For comparison within the group,after the treatment,when identifying positive and negative expressions,the concentration of HBO in the the pre-motor and supplementary motor cortex(Brodmann 6),the primary motor cortex(Brodmann 4)and the supramarginal gyrus(Brodmann 40)were identified higher than that in the pre-treatment(P<0.05),the pre-motor and supplementary motor cortex(Brodmann 6)and the somatosensory association cortex(Brodmann 7)of the insomnia group were both lower than pre-treatment concentrations(P<0.05),no change in health group before and after recognition of neutral expressions(P>0.05),the HPO concentration in the left somatosensory association cortex(Brodmann 5)of the top lobe of the insomnia group increased compared to the pre-treatment level(P<0.05).In group comparisons,the concentration of HBO in the pre-motor and supplementary motor cortex(Brodmann 6),the left frontopolar area(Brodmann 10),and the concentration of HBO in the somatosensory association cortex(Brodmann 5)significant statistically increased compared to the healthy group when identifying positive and negative expressions before the treatment(P<0.05),when neutral expressions were identified,the concentration of HBO in the left somatosensory association cortex(Brodmann 5)was higher than that of the healthy group,and the concentration of HBO in the left includes frontal eye field(Brodmann 8)was lower than that of the healthy group(P<0.05),after the treatment,when identifying positive,neutral,and negative expressions,the concentration of HBO in the primary motor cortex(Brodmann 4),orbitofrontal area(Brodmann 11),and the somatosensory association cortex(Brodmann 7),the dorsolateral prefrontal cortex(Brodmann 9),and the pre-motor and supplementary motor cortex(Brodmann 6)were significant statistically lower than the healthy group(P<0.05).Conclusion The treatment of acupuncture for primary insomnia can regulate the concentration of oxyhemoglobin in the cerebral cortex by manipulating at specific acupoints,which can improve the function of loubus fromatis,orbitofrontal cortex and and lobus parietalis related brain areas,enhance individual control of involuntary activation of extraneous stimuli,and regulate excessive arousal activity to improve insomnia.