基于静息态功能磁共振成像技术针刺十七椎穴治疗原发性痛经的机制

The mechanism of Shiqizhui acupoint in treating primary dysmenorrhea by using resting-state functional magnetic resonance imaging technology

目的应用静息态功能磁共振成像(rs-fMRI)技术探讨针刺十七椎治疗原发性痛经的机制。方法将40例原发性痛经患者(PDM)随机分为针刺组和假针刺组,针刺干预前后对患者分别进行rs-fMRI检查。采用低频振幅(ALFF)和局部一致性(ReHo)评价脑自发活动。分析中脑导水管周围灰质(PAG)与其他脑区的功能连接(FC)。结果PDM患者经针刺治疗后,月经疼痛明显缓解,治疗前后ALFF和ReHo差异无统计学意义(P>0.05);但VA组针刺治疗有效患者左侧PAG与双侧背外侧前额叶皮质(DLPFC)、右侧中央后回、右侧后眶额叶皮质(OFC)、左侧内侧前额叶皮质(mPFC)、左侧缘上回、左侧角回和左小脑半球crus I小叶FC增强(P<0.05)。结论针刺十七椎穴治疗PDM的中枢机制与PAG疼痛网络、下行疼痛调节系统、默认模式网络、情绪等脑区之间的FC增强有关。

Objective To explore the possible central mechanism of Shiqizhui acupoint in treating primary dysmenorrhea(PDM)by using resting-state functional magnetic resonance imaging(rs-fMRI)technology.Methods Total 40 patients with PDM were recruited and devided randomly into verum(VA)and sham(SA)acupuncture treatment groups.FMRI was conducted before and after the intervention.The amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(ReHo)were assessed to measure the spontaneous activity in brain.Functional connectivity(FC)analysis was performed to investigate the FC between the periaqueductal gray(PAG)and other brain regions.Results PDM patients showed significantly menstrual pain relieved after verum acupuncture treatment but not in sham acupuncture.There were no statistical differences in ALFF and ReHo changes between pre-and post-treatment(P>0.05).Patients with effective acupuncture treatment in the VA group showed increased FC between left PAG and several regions,including bilateral dorsolateral prefrontal cortex,right postcentral gyrus,right posterior orbitofrontal cortex,left medial prefrontal cortex,left supramarginal gyrus,left angular gyrus and left crus I of cerebellar hemisphere(P<0.05).Conclusion Acupuncture at the Shiqizhui acupoint can effectively relieve menstrual pain.The underlying mechanism is related to the enhanced FC between PAG and various brain regions involved in pain matrix,descending pain modulation systems,default mode network,and emotion etc.