针刺得气的PET脑功能成像研究

目的:运用正电子发射计算机断层成像(PET)技术,基于脑功能区葡萄糖代谢变化,探讨针刺得气的脑功能成像特点。方法:18例健康志愿者,随机分为经穴组、非穴组、对照组,分别施以外关穴针刺、非穴针刺、不针刺,以18F-FDG为显影剂,运用PET进行脑部扫描,获得志愿者脑功能区葡萄糖代谢变化的图像数据,扫描完毕随即运用针刺感觉量表量化志愿者的感觉,依据感觉量化结果将所得图像数据分为酸麻胀重感组、刺痛感组与无感觉组进行比较,数据在Matlab平台上采用SPM 2.0软件包进行处理和分析。结果:(1)临床针刺效应:外关穴组6人,5人有酸麻胀重感,视觉模拟评分(VAS)4.23±1.50;非穴组6人,5人有刺痛感,VAS 5.73±2.40;两组VAS比较差异有统计学意义(P<0.05)。(2)脑功能成像结果按照P<0.001、相连像素大于10个的统计学标准:酸麻胀重感组与无感觉组比较,显著激活BA 7、13、20、22、39、42、45,主要涉及左颞叶、颞上回等;刺痛感组与无感觉组比较,显著激活BA 18、19、22、24、25、32、36、40、45,主要涉及左边缘叶、海马回等。结论:针刺腧穴产生的感觉主要以徐和的酸麻胀重等得气指征为主,针刺非穴产生的感觉以刺痛为主,前者所激活脑区的调控功能与腧穴的主治作用密切相关;得气的关键与腧穴的定位准确度相关;针刺得气是"针刺"腧穴"感觉"腧穴效应"等的综合体现。

Characteristics of PET cerebral functional imaging during "Deqi" of acupuncture in healthy volunteers

Objective To observe the characteristics of needling sensation of "Deqi"(feelings of soreness,numbness,distending and heaviness,SNDH) by using positron emission tomography(PET) based on changes of glucose metabolism in diffe-rent functional brain areas.Methods Eighteen normal volunteers [9 men and 9 women,mean age(23.23±3.32) years] were randomly divided into control,Waiguan(SJ 5) and non-acupoint groups(n=6 in each group).SJ 5 and non-acupoint(the midpoint between SJ 5 and the running course of the Small Intestine Meridian on the right forearm) were punctured by using a sterilized filiform needle.PET scan of the brain began 40 min after intravenous 18F-fluorodeoxyglucose(FDG) injection(0.11 mCi/kg body weight,left opisthenar vein).Needling sensations including "Deqi"(n=5),tingling(n=5) and no-apparently-specific-feeling(NASF) were acquired by acupuncture stimulation and grouped.The needling sensations were evaluated by using Visual Analog Scale(VAS).The acquired image data of different needling-sensation groups were analyzed using SPM 2.0 software in the Matlab Platform.Results After receiving acupuncture stimulation of SJ 5,5 volunteers in the Waiguan(SJ 5) group experienced fee-lings of SNDH,with the mean VAS score being 4.23±1.50,and 5 volunteers of the non-acupoint group had a tingling feeling,with the mean VAS score being 5.73±2.40.The VAS score of the tingling group was significantly higher than that of SNDH group(P<0.05).Compared with the NASF control group,the activated cerebral areas were Brodmann area(BA) 7,13,20,22,39,42 and BA 45 in the SNDH group,mainly involving the left temporal lobe,superior temporal gyrus,etc.and being obviously different to those of the control group(P<0.001,k>10 voxels).The activated cerebral areas in the tingling group were BA 18,19,22,24,25,32,36,40 and BA 45,predominantly involving the left limbic lobe,hippocampal gyrus,etc.and being appa-rently different to those of the control group(P<0.001,k>10 voxels).Conclusion Acupuncture of Waiguan(SJ 5) mainly produces feelings of soreness,numbness,distending and heaviness,and the activated cerebral areas mainly involve the left temporal lobe,superior temporal gyrus,etc.;while acupuncture of its neighboring non-acupoint chiefly induces a feeling of tingling in the healthy subjects,and the activated regions predominately involve the left limbic lobe,hippocampal gyrus,etc.