电针刺激视觉相关穴位光明穴的脑BOLD-fMRI研究

时间：2020-09-01 08:42:03 临床医学毕业论文我要投稿

【摘要】　　目的利用磁共振成像(MRI)平面回波序列(EPI)的血氧水平依赖(BOLD)技术分别对足少阳胆经光明穴和假穴进行电针刺激的脑功能成像研究，观察大脑功能区反应的异同，探寻针刺治疗眼病的中枢机制。方法选择国人健康志愿者12例，分别接受电针刺激真穴(光明穴)和假穴的两步脑功能磁共振成像实验。实验采用组块设计，静息相(R)与刺激相(S)交替进行，重复5次,即“RSRSRSRSRS”模式。采用SPM2分析软件将实验所得数据进行处理。将激活区叠加于(加拿大蒙特利尔神经研究所montreal neurologic institute，MNI)标准三维模板脑，脑功能区域的解剖位置、Broadmann区(BA)定位、中心坐标由平均脑功能图得出。观察有统计学意义的体素大小(P<0.001, k>20)、所在脑区及其坐标(MNI坐标)。记录激活区的激活体积(cluster)及激活强度(用t-检验统计值“T”表示，T值越大，强度越高)。结果 ①电针刺真穴(光明穴)脑区激活的.位置主要为额叶上、中、下回(Brodmann10、11、45、47区)；颞上回(Brodmann38区)；楔叶和枕叶舌回(Brodmann18、19区)。②电针刺激假穴(光明穴前开0.5寸)脑区激活的位置主要为顶上小叶、顶下小叶(Brodmann7、40区)；额叶中、上回(Brodmann10、46区)；颞上回(Brodmann22区)；边缘叶后联合(Brodmann29区)。结论 ①与视觉相关的穴位和大脑的视觉中枢存在特殊的对应关系，穴位有其独立的、特殊的属性。②电针刺激视觉相关穴位引发的临床效应的中枢机制与高级视觉中枢的调节有特异关系。③电针刺激光明穴所引发的脑功能区激活的神经机制不是简单的穴位-视区对应，而是调动了多个脑区参与的复杂的过程。

【关键词】电针穴光明磁共振成像视皮质脑疾病氧

　　Brain BOLD-fMRI study of electroacupuncture stimulating the acupoint related visual

　　GUAN Yongqing,YANG Xinzhi.

　　Department of Ophthalmonogy, the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011

　　【Abstract】 Objective To discuss the effects of electroacupuncture at Guangming acupoint and sham acupoint on activating effects in various cerebral areas using magnetic resonance imaging (MRI),blood oxygenation level dependent (BOLD) of echo planar imaging (EPI) sequence,and try to explore the impossible cortical mechanisms of acupuncture treatment in the ophthalmic field.Methods Twelve right-handed volunteers without any symptom and sign of the central nervous system (male 5，female 7; age ranged 20 to 40 years old, average age is 27.5) who were studying as postgraduates or working as doctor in our hospital were selected to take part in our studies. The corrected vision of them was better than 1.0. every one of these 12 volunteers was performed our electroacupuncture stimulating two times, the first is true acupoint (GB37) stimulating and the second is sham acupoint stimulating. The BOLD-fMRI Images were required on a 1.5-T unit; For electroacupuncture, Device BT701-1A was used; The silver no-magnet acupuncture needles (Φ0.30 mm×25 mm) was used in our study. A block design as “RSRSRSRSRS” was adopted for the study. The fMRI Data were analyzed by using Statistical Parametric Mapping software implemented within Matlab. The datasets were normalized to a standard space within SPM2. For all studies, statistical thresholding at significance level of P<0.001 and k>20 was initially used to determine significant activation for each vexol.Results ①Electroacupuncture stimulation of GB37 produced major hemodynamic signal change in the superior, middle, inferior frontal gyrus (Broadmann 10,11,45,47); superior temporal gyrus (Broadmann 38); cuneus and lingual gyrus of occipital lobe (Broadmann 18,19).②Electroacupuncture stimulation of false acupoint produced major hemodynamic signal change in the superior, inferior parietal lobule (Broadmann 7, 40); superior, middle frontal gyrus (Broadmann 10,46);superior temporal gyrus (Broadmann 22); limbic lobe,posterior cingulated (Broadmann 29).Conclusions ①There is a special relationship between the acupoint related visual and the braincortices realated visual, and acupoints have their own attributes.②The cortical mechanisms of clinical effects induced by electroacupuncturing the acupoint related visual are related with accommodating the senior visual cortex.③The cortical mechanisms of electroacupuncturing true acupoint are not simple correspondence between acupoints and areas of brain visual cortex, and it should be a complex process mobilizing the more areas of brain cortices to take part in.

　　【Key words】 BOLD-fMRI；Electroacupuncture；Acupoint；Guangming(GB37)；Visual cortex

　　针灸是中国传统医学的重要组成部分,针灸的疗效已被国内外医学界认可。但针灸的很多理论目前尚无法与现代科学接轨。因此,如何利用现代医学理论与技术研究说明针灸疗法，近年来已成为国际热门课题之一。功能磁共振成像(functional magnetic resonance imaging,fMRI)技术可以直接显示针灸效应在中枢的定位,以便对临床针刺过程中的人体生理、病理变化规律进行实时、直观的研究。实现功能可视化,使其成为研究针刺对人脑和脊髓活动效应的一种方法。它为针刺治疗的作用机理及中西医结合研究提供了一条有效的途径。本研究课题是利用血氧水平依赖性(BOLD)-fMRI技术观察针刺视觉相关穴位引起的脑功能区信号变化，探寻针刺视觉相关穴位治疗眼科疾病的神经机制。

　　1 资料与方法

　　1.1 一般资料

　　国人健康志愿者12例均为我院青年医生和在读研究生，皆为右利手，汉族，男5例，女7例；年龄20～40岁，平均27.5岁；矫正视力均大于1.0。志愿者无神经及精神病史，无麻醉及镇静药物服药史。

　　1.2 实验设备

　　功能磁共振扫描设备采用德国生产的Siemens(Avanto 1.5T)超导磁共振扫描仪，标准CP头部线圈；电刺激设备采用上海华谊医用仪器厂生产的BT701-1A型电麻仪；为避免干扰磁场均匀度，所有针刺针均采用无菌处理的1寸银针，规格0.30 mm×25 mm。

　　1.3 实验设计

　　本实验采用组块设计(blocked design),如图1所示，静息相(R)与刺激相(S)交替进行，重复5次,即“RSRSRSRSRS”模式。其中“R”持续30 s，“S”持续60 s，真穴(光明穴)与假穴两步实验采用相同的刺激方式。

　　1.4 针刺方法

　　每名志愿者先后接受真穴(光明穴)和假穴两步电针刺激。真穴选择被认为能够多方面调节视觉功能的光明穴(GB37,属足少阳胆经)，运用平补平泻的手法捻转“得气”后针柄连接BT701-1A型电麻仪电极，左右构成回路，频率2 Hz，电流强度10～20 mA。

　　1.5 实验过程

　　受试者尽量做到视听封闭，仰卧于MRI扫描床上，扫描获取自旋回波横断位T1加权像(Tl-weighted imaging,T1WI)作为解剖定位图像。然后针灸师取双侧光明穴，垂直皮肤平面进针1.0寸，调试电流强度后开始第一步实验，扫描电针刺激光明穴时的功能像。扫描结束后，针灸师拔针。休息10 min后进行第二步实验，取

电针刺激视觉相关穴位光明穴的脑BOLD-fMRI研究

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