针刺治疗膝骨性关节炎膝痛优效患者神经影像学特征研究

Research of neuroimaging characteristics of positive responses to acupuncture treatment in knee osteoarthritis knee pain patients

目的:基于静息态功能核磁共振技术,探讨针刺治疗膝骨性关节炎(KOA)膝痛优效患者的中枢神经影像学特征。方法:72例K0A患者随机分为针刺穴位组与针刺非穴组,每组36例。两组患者每天接受1次针刺治疗,每次30min,完成5次治疗后休息2d,共治疗10次。治疗前进行一次静息态血氧水平依赖功能磁共振成像扫描。治疗后以视觉评分量表(VAS)和西大略湖麦克马斯特大学骨关节炎指数(WOMAC)评分的最小临床意义重要差值(MCID)作为筛选针刺治疗KOA膝痛优效患者的临床标准。采用基于数据驱动的低频振幅比率(fALFF)和局部一致性(ReHo)分析法比较针刺优效患者相较于针刺劣效患者的脑功能活动差异。进一步将具有显著差异的fALFF和ReHo的重叠脑区作为种子点,进行基于种子点的功能连接度分析,探讨针刺优效患者脑功能网络特征。结果:针刺治疗KOA膝痛优效患者占比为50.77%。优效患者相较劣效患者具有显著差异的fALFF和ReHo的重叠脑区为双侧眶额回(OFC),表现为fALFF和ReHo值均增加,且与KOA膝痛强度变化呈正相关。与针刺劣效组比较,针刺优效组患者右侧OFC与双侧顶上小叶、缘上回,左侧直回、额中回、楔叶、梭状回、OFC、额下回,右侧梭状回以及海马旁回的功能连接增强;左侧OFC与双侧舌回、OFC、直回,左侧顶上小叶、角回、额中回、丘脑,右侧梭状回、额上回、后扣带回,以及右侧小脑、脑干的功能连接增强。结论:大脑双侧OFC的fALFF和ReHo脑功能活动高位水平,以及OFC与默认网络的静息态功能连接高位水平可能是针刺治疗KOA膝痛优效患者相较于劣效患者的部分中枢特征。

Objective:To explore the neuroimaging characteristics of central nervous system in responsive patients with chronic knee pain caused by knee osteoarthritis(KOA)treated with acupuncture based on resting state functional magnetic resonance imaging(fMRI).Methods:A total of 72 KOA patients with chronic knee pain were randomly divided into acupuncture point group(36 patients)and non-acupuncture point group(36 patients).Patients in the two groups received acupuncture treatment once a day for 30 minutes each time,and rested for 2 days after completing 5 treatments for a total of 10 treatments.Before treatment,a resting-state BOLD-fMRI scan was performed.The minimal clinically important difference(MCID)of visual score scale(VAS)and Western Ontario and McMaster Universities osteoarthritis index(WOMAC)was used as the clinical standard to screening patients with excellent effect of acupuncture treatment of KOA knee pain.The brain resting-state BOLD-fMRI data of acupuncture responsive patients compared with unresponsive patients were analyzed by data-driven fractional amplitude of low-frequency fluctuation(fALFF)and regional homogeneity(ReHo).Furthermore,the overlapping brain regions of fALFF and ReHo,which were significantly different between acupuncture responsive patients and unresponsive patients,were taken as seed points,and the seed-based functional connectivity(Seed-based FC)analysis was performed to explore the characteristics of brain functional network in acupuncture responsive patients.Results:The responsive rate of acupuncture treatment for KOA was 50.77%.The overlapping brain regions of fALFF and ReHo that were significantly different between responsive patients and unresponsive patients were the bilateral OFC.Both fALFF and ReHo values showed increased in bilateral OFC,and were positively correlated with the change of KOA knee pain intensity.Compared with unresponsive patients,the overlapping brain regions of fALFF and ReHo was bilateral orbitofrontal gyrus(OFC)in responsive patients,which was significantly different,showing that both fALFF and ReHo values increased.Compared with unresponsive patients,responsive patients showed increased FC values in the bilateral superior parietal lobules(BA7/BA19),bilateral supramarginal gyrus(BA40),left gyrus rectus(BA11),left middle frontal gyrus(BA9),left cuneus(BA19),left OFC(BA11),left inferior medial frontal gyrus(BA11),right fusiform gyrus(BA37),and parahippocampus gyrus(BA20)with the right OFC;showed increased FC values in bilateral lingual gyrus(BA30),bilateral OFC(BA11),bilateral gyrus rectus(BA11),left superior lobe(BA40),left angular gyrus(BA40),left middle frontal gyrus(BA9),left thalamus(BA27),right fusiform gyrus(BA37),right superior frontal gyrus(BA8),right posterior cingulate gyrus(BA27),right cerebellum and the brain stem with the left OFC.Conclusion:The high level of fALFF and ReHo brain functional activity in bilateral OFC and the high level of resting-state functional connectivity between OFC and default network OFC-DMN may be part of the central characteristics of responsive patients with KOA knee pain treated by acupuncture.