针刺治疗慢性偏头痛神经可塑性影响机制

慢性偏头痛是致残率高但关注度不足的一种神经功能障碍疾病。大量的临床研究表明中国传统的针刺疗法是一种疗效高、不良反应少的治疗方式。通过对1981年至2017年中国知网及Pub Med数据库中针灸和偏头痛相关的文献进行分析总结,探索针刺对慢性偏头痛神经可塑性影响机制。认为慢性偏头痛的进展涉及神经可塑性在神经结构和功能的改变,并从电生理、分子生化和影像学3个方面论证偏头痛慢性化过程中与神经敏化有关的神经可塑性;针刺亦通过其神经可塑性机制治疗和预防慢性偏头痛,但目前并没有相关的文献总结,阻碍了针刺治疗慢性偏头痛的进一步传播和发展。     

针刺治疗偏头痛动物实验研究进展

偏头痛是临床常见的特发性头痛,针刺治疗偏头痛疗效确切,在临床上广泛使用。近年,学者们对针刺治疗偏头痛的作用机制进行了许多深入研究,取得了不少成绩。本文从对神经源性炎性反应的抑制、改善脑微循环、调节血管活性物质等方面综述了针刺治疗偏头痛的有关机制,并认为今后的研究可从针刺对电压门控离子通道的影响等方面开展。     

针刺少阳经穴对慢性偏头痛患者脑内葡萄糖代谢的影响

目的:观察人脑对循经取穴针刺的响应特征,探讨循经取穴的中枢神经取效机制。方法:对6例慢性偏头痛患者进行针刺治疗。选取少阳经穴风池、外关、阳陵泉作为治疗穴位,应用正电子发射计算机断层显像(PET-CT)进行扫描,用统计参数图软件(SPM2)对重建图像进行数据分析并与健康人脑功能成像进行比较,观察针刺前后偏头痛患者脑内葡萄糖代谢变化。结果:针刺后患者的脑干、脑岛等疼痛矩阵脑区的兴奋区明显减少,脑功能减低区以右侧颞叶为主转变为双侧颞叶对称区域。结论:针刺少阳经对慢性偏头痛镇痛作用的可能靶点是脑桥、脑岛、额叶前部等脑区,针刺后引起双侧颞区脑代谢减低的转变可能是针刺足少阳经穴治疗偏头痛的机制之一。针刺可能通过对脑内能量代谢的协调再分配起到整体、良性的治疗效应。     

从脑功能影像角度探讨针刺治疗抑郁症的机制

脑功能成像技术应用于抑郁症的研究发现,抑郁症患者的不同脑区存在功能性改变,以额叶为主.本文从脑功能影像学角度,通过针刺对抑郁症患者不同脑区影像学的改变,探讨了针刺治疗抑郁症的中枢机制,肯定了针刺对抑郁症患者脑功能的调节作用,并提出了今后的研究方向.     

基于BOLD-fMRI的针刺干预弱视脑功能研究进展

近年来,功能影像学技术用于针灸干预弱视的脑功能研究日益引起关注,尤其是血氧水平依赖功能磁共振成像(BOLD-fMRI)技术能够检测评估弱视患者视觉异常脑区分布和功能连接,更有助于揭示针刺干预弱视的脑功能可塑性机制。文章总结了近年来的相关文献,发现可从弱视及针刺干预研究中BOLD-fMRI常用方法、对于弱视发病机制的研究、对于针灸干预弱视的脑功能机制的研究3部分进行综述,为进一步深化针刺干预弱视脑功能机制研究提供方法。     

对穴位-脑功能影像学研究现状的思考——基于功能连接与穴脑相关学说的探讨

目前穴位效应的脑功能影像学研究基本肯定了针刺穴位后脑内相关区域的影像学信号会产生不同程度的变化,然而这些变化中是否存在着某些潜在的规律性联系却是一个值得探讨的问题。利用脑功能影像学研究中"功能连接"的概念分析针刺作用下的穴-脑相关的作用机制,从目前血氧水平依赖的神经活动影像信号分析,过渡到基于神经生物学手段的基因表达分析,对于进一步探讨穴位的脑功能特异性有着较为积极的意义。     

针刺治疗偏头痛脑功能网络连接机制研究进展

针刺治疗偏头痛安全有效,已得到国内外学术界广泛认可,但其作用机理尚未完全明晰。该文基于功能磁共振成像技术,以“功能连接”为切入点,综述近年来在针刺治疗偏头痛研究中的相关应用进展,并从脑网络层面探寻针刺作用机制。     

基于神经影像学的针刺治疗偏头痛疗效预测的研究进展及思路探讨＊

针刺治疗头痛历史悠久,安全有效,其有效率为50%左右,如何筛选针刺有效人群对于优化针刺治疗方案、节约医疗成本、减轻病人负担意义重大。运用神经影像学技术进行疗效预测是目前的神经影像学研究热点之一,因此本文综述近年针刺治疗偏头痛的相关研究,并对针刺治疗偏头痛的疗效预测研究的现状和研究思路进行探讨。     

针刺影响脑功能成像的研究进展

脑功能成像主要包括正电子发射型计算机断层显像(positron emission tomography，PET)、单光子发射型计算机断层显像(single photon emission computed tomography，SPECT)和功能性磁共振成像(functional magnetic resonance imaging，FMRI)，能够在生理状态下、无创地研究人脑的形态结构和功能活动。本文回顾了针刺对脑功能成像影响的研究，包括生理状态(安静、运动、局部神经阻滞)、病理状态(痴呆、中风、脑瘫、摇头丸服食等)下的针刺效应，以及穴位、针刺频率、针刺手法对脑功能成像的影响，分析了针刺效应与脑功能成像之间的关系。     

针刺治疗偏头痛的三叉神经血管机制研究新进展

偏头痛的发生与三叉神经血管系统的异常密切相关。针刺治疗偏头痛的机制与调节神经、血管功能有关。文章综述了近年来针刺治疗偏头痛在三叉神经血管机制方面的一些新进展,皆在为偏头痛的针刺治疗与研究提供参考。     

EFFECTS OF LONG-TERM ACUPUNCTURE TREATMENT ON RESTING-STATE BRAIN ACTIVITY IN MIGRAINE PATIENTS:A COMPARATIVE STUDY ON ACTIVE ACUPOINTS AND INACTIVE ACUPOINTS

Objective: Acupuncture has been commonly used for preventing attacks and relieving pain, although there is limited knowledgeon the physiological mechanism behind this method.The objectives of this study were to compare the differences in brain activities evoked by active acupoints and inactive acupoints and to investigate the possible correlation between clinical efficacy and brain responses.Methods: Eighty migraineurs without aura were enrolled to receive either active acupoint acupuncture or inactive acupoint acupuncture treatment for 8 weeks.Twenty patients in each group were randomly selected for a resting-state fMRI examination.The treatment schedule lasted for 8 weeks.VAS score, frequency of the migraine attack, number of days with migraine, and HIT-6 score were employed to evaluate the efficacy of acupuncture treatment, and ReHo value was used to detect brain activity.Results: The decrease in the VAS score in the active acupoint group was significantly greater than that in the control group after treatment(P0.05).However, there were no significant differences between the two groups in others(P0.05).The neuroimaging data indicated that long-term active acupoint therapy elicited a more extensive and remarkable cerebral response compared with acupuncture at inactive acupoints.The decrease in the VAS score was significantly related to the increased average ReHo values in the ACC in the two groups(P=0.0020, P=0.0015).Moreover, the decrease in the VAS score was associated with the increased average ReHo values in the insula(P=0.0003), and SMA(P=0.0130), which could be detected in the active acupoint group.Conclusion: Active acupoints were significantly superior to inactive acupoints in alleviating pain intensity for migraineurs.The efficacy of acupuncture at active acupoints might result partly from regulating some disease-affected key regions and the pain circuitry for migraine, promoting reintegration of several dimensions of the inner body, and establishing psychophysical pain homeostasis.     

NEUROANTHROPOLOGY:A MIXED,INTERDISCIPLINARY APPROACH TO ACUPUNCTURE RESEARCH

Neuroimaging plays a critical role in future acupuncture research.To date, many esteemed researchers have shown that acupuncture modulates many key areas of the brain using fMRI, including the primary and secondary somatosensory cortices, limbic regions, insula, and prefrontal cortex.Such findings help to shed light on at least part of the physiological processes involved in acupuncture conducted on healthy subjects.They also pointed that neuroimaging has the potential to testify acupuncture's therapeutic effectiveness.Although several recent studies have used neuroimaging to demonstrate acupuncture's effect in various conditions, there remains a need for more clinically oriented neuroimaging research.However, in designing trials that include neuroimaging outcomes, the stakes are high due to the elevated costs involved using fMRI.This presentation introduces the emerging field of neuroanthropology as a potential methodological framework for designing richly informative, high-value acupuncture trials.Neuroanthropology focuses on the triangulation of neuroimaging data with qualitative data obtained through in-depth ethnographic interviews and fieldwork in order to test neuroscientific findings in natural human environments.Beyond simply validating basic neuroscientific findings about the general functions of the human brain with qualitative observational and interview data, neuroanthropology can also play a role in clinical neuroimaging research by linking changes in specific brain networks to changes in the experience of emotional, physical, and even spiritual symptoms.It is especially appropriate for acupuncture research focusing oneffectiveness as well as efficacy.This presentation thus examines potential strategies for the incorporation of neuroanthropological methods in clinical acupuncture research, including a discussion of how neuroanthropology fits within specific research design models such as whole systems and/or comparative effectiveness research.It further invites a deeper conversation about the challenges involved with organizing, funding, and conducting such deeply interdisciplinary and mixed-methods studies.     

基于图论理论探究针刺对无先兆偏头痛患者脑功能网络的研究

[目的] 观察无先兆偏头痛患者脑功能网络的拓扑属性改变，探究针刺治疗无先兆偏头痛的中枢效应机制。[方法] 纳入20例无先兆偏头痛患者和20例匹配的健康受试者，患者在针刺疗程前后分别进行1次功能磁共振扫描，采用基于全脑体素水平的度中心度（DC）分析方法和基于图论理论的大尺度脑功能网络分析方法，对比无先兆偏头痛患者与健康受试者、患者针刺前后拓扑指标的变化特点。[结果] 与健康受试者相比，无先兆偏头痛患者DC降低的脑区有左侧辅助运动区、边缘叶、额回内侧面、左侧扣带回中部，无DC升高脑区，且无先兆偏头痛患者的聚类系数和局部效率明显下降，最短路径、小世界指数、全局效率呈下降趋势。与针刺前相比，无先兆偏头痛患者针刺后的聚类系数、局部效率、小世界指数、全局效率有升高趋势。[结论] 针刺治疗能改善无先兆偏头痛患者下降的聚类系数和局部效率等拓扑指标。     

针灸疗法治疗偏头痛研究进展

针灸治疗偏头痛历史悠久，具有操作便捷、疗效显著的特点，以针灸为主的综合治疗方法在偏头痛的防治中应用越来越多，对于不适合药物治疗的偏头痛患者发挥了重要作用。本文通过对近年来针灸治疗偏头痛的文献进行整理，总结了偏头痛发生的病因病机，并从常用针灸取穴、常用针灸疗法等方面论述针灸治疗偏头痛的研究现状，结果发现针刺取穴以手足少阳经腧穴为主，针刺疗法包括毫针、电针、眼针、头针等，都具有明显的疗效。     

针刺对轻度至中度阻塞性睡眠呼吸暂停综合征患者的疗效:一项随机对照临床试验方案（英文）

Introduction:Obstructive sleep apnea syndrome(OSAS) is considered a major public health issue due to its high prevalence and severe consequences.Several published studies have revealed that electroacupuncture may relieve OSAS symptoms.However,the mechanism of electro-acupuncture in the treatment of patients with OSAS remains unclear.Methods and analysis:We evaluated the efficacy and mechanism of electro-acupuncture in the treatment of patients with OSAS.This was a two-group parallel randomized c...     

脑科学技术在针刺研究中的应用＊

近年来，脑科学是国际交叉科学研究的热点和前沿领域。技术是推动学科发展的重要工具。立足科学前沿及国家需求，脑科学技术也不断推动中医药现代化发展及脑科学研究与中医药特色疗法的紧密结合。针刺疗法是传统中医疗法中不可或缺的组成部分，“针刺治神”奠定了针刺疗法通过中枢整合体表刺激信息调制机体内环境稳态以发挥治疗作用的中医理论基础。探究针刺治疗疾病的中枢效应机制十分必要。目前，在针刺研究领域中，无论是临床研究还是基础研究，脑科学相关技术均得到了广泛应用。因此，本文主要以神经示踪、光遗传、化学遗传、膜片钳、脑微透析、功能磁共振成像、脑电技术为例，梳理了脑科学技术在针刺研究中的应用，旨在总结现有脑科学技术的特点，为脑科学技术创新及应用探究针刺的中枢效应机制提供新思路。     

针灸经络与脑相关调控效应研究进展

经络是中医针灸的核心理论基础,在中医理论中占居重要地位。在国家的大力支持下,科研人员在临床实践经验的基础上对经络实质问题进行了持续深入地探索。随着脑科学领域及先进科学技术的蓬勃发展,针灸(穴位)的整体调节效应、靶器官效应和局部效应机制日趋完善,经络效应和大脑之间的联系也逐渐被重视。系统回顾经络研究的历程和成就,梳理经络与脑科学前沿进展,并对中医脑科学未来研究方向进行了展望,以期为针灸调控效应对脑科学及脑病防治提供参考。