针刺治疗可改变膝骨性关节炎患者的脑灰质结构:基于MRI数据

MRI study of brain structures in patients with osteoarthritis of the knee treated with acupuncture

目的基于体素的形态学测量探讨膝骨性关节炎(KOA)患者在针刺治疗前后的脑灰质体积改变,进而分析其针刺疗效机制。方法前瞻性纳入25例KOA患者,对KOA患者行针刺治疗,并在针刺治疗前后进行视觉模拟评分法、焦虑自评量表、抑郁自评量表、蒙特利尔认知评估量表相关评分量表评估及高分辨率T1WI扫描。采用基于体素的形态学测量方法分析针刺治疗前后KOA患者脑灰质结构差异,分析其与评估量表结果间的相关性。结果针刺治疗后KOA患者对疼痛、焦虑、抑郁均有缓解(P<0.001),认知功能有所提高(P<0.001)。治疗后灰质体积增加的脑区包括右侧舌回、左侧脑岛;灰质体积减少的脑区包括左侧枕中回、中央旁小叶(体素水平P<0.001,团块水平P<0.05)。结论针刺可以明显缓解KOA患者的临床症状,同时发现针刺后KOA患者多个脑区结构改变,因此推测针刺疗效可能是通过大脑多个脑区相互作用而实现。

Objective To investigate the changes in gray matter volume of the brain before and after acupuncture treatment in patients with knee osteoarthritis(KOA)based on voxel-based morphometry,and then to analyze the efficacy mechanism of acupuncture.Methods We prospectively included 25 patients with KOA,and acupuncture treatment was performed on patients with KOA,who were evaluated using visual analogue scale,self-rating anxiety scale,self-rating depression scale and Montreal cognitive assessment rating scales before and after acupuncture treatment,and scanned high-resolution T1WI.The voxel-based morphometry method was used to analyze the differences in the gray matter structure of the brain in KOA patients before and after acupuncture treatment.The correlation with the results of the rating scales was analyzed.Results KOA patients showed relief of pain,anxiety,and depression after acupuncture treatment(P<0.001),and cognitive function was improved(P<0.001).After treatment brain regions with increased gray matter volume included the right lingual gyrus and left insula;brain regions with decreased gray matter volume included the left middle occipital gyrus and paracentral lobule.(P<0.001 at the level of the somatosensory image,P<0.05 at the level of the clump).Conclusion The clinical symptoms of KOA patients could be significantly relieved by acupuncture.The structural changes of multiple brain regions in KOA patients are also found after acupuncture.It is speculated that the efficacy of acupuncture may be achieved through the interaction of multiple brain regions.