针刺关元穴和三阴交穴治疗原发性痛经的疗效及其对脑功能的影响

Curative effect of acupuncture at Guanyuan acupoint and Sanyinjiao acupoint in the treatment of primary dysmenorrhea and its influence on brain function

目的探讨针刺关元穴和三阴交穴治疗原发性痛经(PDM)的中枢镇痛机制。方法收集PDM患者20例(PDM组)和健康对照者27例(对照组),PDM组于下一个经期前1周连续针刺关元穴和三阴交穴,直至月经来潮。采用视觉模拟疼痛评分(VAS)、COX痛经症状量表(CMSS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)量表进行临床症状评估。在月经期第1~3天分别进行静息态功能磁共振(rs-fMRI)扫描,运用基于Matlab平台的SPM、DPARSFA软件进行数据预处理并局部一致性(ReHo)统计参数及脑功能图像,比较针刺治疗前后ReHo值的差异。结果PDM组针刺治疗后VAS、CMSS、SAS、SDS评分均较治疗前降低(P均<0.01)。PDM组针刺后ReHo值显著增高的脑区有左侧颞极、颞上回、左侧中央前回、中央后回,而ReHo值显著减低的脑区有左侧颞中回、双侧楔前叶、左侧距状裂周围皮层。与健康对照组相比,PDM组针刺后ReHo值增高的脑区有右侧背外侧额上回、右侧岛叶、左侧颞上回、左侧中央前回,ReHo值减低的脑区有右侧丘脑、左侧颞中回、双侧前扣带和旁扣带回、内侧额上回。结论针刺关元穴和三阴交穴治疗PDM的神经作用靶点主要位于痛觉情感传导通路、边缘系统,通过调节与疼痛相关脑区的脑功能来减轻PDM疼痛。

Objective To explore the central analgesic mechanism of acupuncture at Guanyuan acupoint and Sanyinjiao acupoint in treatment of primary dysmenorrhea(PDM).Methods Twenty patients in the PDM group and 27 healthy control group were included.The resting-state functional magnetic resonance imaging(rs-fMRI)scans were performed on the 1st to 3st days of menstruation respectively.In the PDM group,acupuncture at Guanyuan acupoint and Sanyinjiao acupoint was performed continuously one week before the next menstrual period until menstruation began.Visual analogue scale(VAS)for pain,Cox menstrual symptom scale(CMSS),self-rating Anxiety Scale(SAS),and self-rating Depression Scale(SDS)were used to evaluate clinical symptoms.SPM and DPARSFA software based on Matlab platform were used for data preprocessing,regional homogeneity(ReHo)statistical parameters and brain function images,and the difference in ReHo values before and after acupuncture treatment was compared.Results The VAS,CMSS,SAS,and SDS scores decreased after acupuncture in comparison with those before treatment in patients of the PDM group(all P<0.01).After acupuncture,the ReHo values of left temporal pole and superior temporal gyrus,left precentral gyrus and postcentral gyrus increased significantly in PDM patients,while ReHo values decreased significantly in left middle temporal gyrus,bilateral precuneate lobe and left peri-talar fissure cortex.Compared with the healthy control group,ReHo increased in right dorsolateral superior frontal gyrus and right insular lobe after,left superior temporal gyrus and left precentral gyrus,while ReHo decreased in right thalamus,left middle temporal gyrus,bilateral anterior cingulate and lateral cingulate gyrus and medial superior frontal gyrus in PDM group.Conclusion Acupuncture at Guanyuan acupoint and Sanyinjiao acupoint in the treatment of PDM mainly locates in the pain and emotion conduction pathway and limbic system,and alleviates PDM pain by regulating the brain function of pain-related brain areas.