足三里等下肢穴位刺激引发脑运动皮质去激活效应的fMRI研究

目的:观察刺激右侧足三里、阴陵泉、丰隆、三阴交穴区对人体左侧初级运动皮质,运动前区和辅助运动区的去激活效应。方法:共10例受试者接受功能性磁共振成像。采用3.0 T Siemens MAGNETOM Trio磁共振成像系统采集全脑T2*像。穴位刺激采用组块方式。以SPM5软件包分析数据,采用贝叶斯推断方法,识别相对于基线水平,穴位刺激引发的去激活效应信号。结果:无论刺激哪一穴位,在所有受试者中,均可观察到左侧初级运动皮质、运动前区及辅助运动区出现的去激活信号。刺激足三里穴可在8例受试者的左侧初级运动皮质发现激活体素,在9例中可在左侧运动前区及辅助运动区发现激活体素;刺激阴陵泉穴可在所有受试者的左侧初级运动皮质、以及运动前区及辅助运动区发现激活体素;刺激丰隆穴可在9例受试者的左侧初级运动皮质发现激活体素,9例左侧运动前区及辅助运动区发现激活体素;刺激三阴交穴可在9例受试者的左侧初级运动皮质发现激活体素,以及所有受试者左侧运动前区及辅助运动区发现激活体素。结论:刺激足三里、阴陵泉、丰隆、三阴交穴区可在多数受试者中激活初级运动皮质、PMA及SMA脑区,去激活效应的出现则更为广泛。这一现象提示,穴位刺激对中枢的功能调节既包括激活效应,也包括去激活效应。去激活效应在穴位刺激引发的脑功能网络状态变化过程中,发挥何种作用,值得深入研究。     

针刺镇痛对坐骨神经痛患者脑功能成像的影响

目的观察12例坐骨神经痛患者脑功能磁共振信息的变化,研究电针穴位镇痛影响脑功能区的位置及其效应的变化,探索电针镇痛的作用机制与脑功能成像关系。方法选足少阳胆经的阳陵泉和悬钟穴,分别选受试者患侧和健侧下肢穴,应用血氧水平依赖（BOLD）功能性磁共振成像技术（fMRI）全脑扫描,FSL3．2软件进行图像处理,P〈0．01分析得出脑功能图像。结果电针健侧和患侧肢体相同穴位后,脑激活区脑功能信号增加,包括对侧初级感觉皮层（SⅠ）与次级感觉皮层（SⅡ）区、双侧岛叶（Insula）、双侧扣带前回（ACC）（BA24）、双侧颞上回、双侧小脑等。电针患侧肢体穴位出现中脑导水管周围灰质（PAG）区信号明显增高,双侧尾状核及对侧豆状核（基底节核团Basalganlia）、对侧海马信号明显升高。电针健侧肢穴位,双侧杏仁体及视皮层信号改变,针刺患侧肢体与健侧肢体,引起的脑功能区变化有显著差异,以针刺患侧肢体的脑功能变化更明显。结论肢体在病理和生理状态下,针刺肢体相同穴位对中枢神经系统调节作用不完全相同,fMRI影像适合针刺穴位镇痛的研究,且进一步说明了针刺调节具有双向性特点。     

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。     

电针周围性面瘫患者地仓穴的fMRI研究

目的：采用功能性磁共振成像（fMRI）技术,研究电针周围性面瘫患者地仓穴对脑功能的影响。方法：筛选6例左侧周围性面瘫患者为研究对象,电针刺激,同时行全脑fMR I扫描,SPM软件进行图像后处理,t检验（P〈0.01）分析得出电针不同穴位的脑功能图像。结果：双侧中央前回、双侧中央后回等多个脑区信号发生变化。结论：电针刺激引起了多个脑区信号的变化,穴位治疗作用的发生可能是多个脑区互相联络,对信息进行分析、整合,共同作用的结果。     

不同强度电针刺激上巨虚后续效应磁共振成像比较

目的通过血氧水平依赖性-功能性磁共振成像,观察针刺后续效应,探讨不同强度电针刺激健康志愿者上巨虚(ST37)脑功能活动差异。方法将22名健康志愿者随机分为低强度电针组和高强度电针组。2组均针刺左侧上巨虚,辅助针在距离上巨虚0.3～0.5 cm近心端浅刺,电针疏密波,2～50 Hz,脉冲宽度0.2～0.6 ms,低强度电针组电流量以受试者感受穴位有微弱电流刺激为度,高强度电针组以受试者感觉穴位有强烈电流刺激而不痛为度。采集电针刺激前静息态和电针刺激后2个静息态数据,比较不同强度电针刺激前后具有显著差异的脑区及磁共振信号时间域振幅(AM)变化情况。结果不同强度电针刺激前后具有显著差异的脑区:颞上回,颞中回,颞下回,中央前回;顶上小叶,顶下小叶,中央后回;舌回,梭状回,楔叶,距状裂周围皮层;额中回,眶额叶皮层;岛叶,丘脑,前扣带回,后扣带回。与电针刺激前静息态比较,低强度电针组AM大部分减弱,高强度电针组AM大部分增强。结论不同强度电针刺激导致不同的脑功能活动。低强度电针组AM大部分减弱,高强度电针组AM大部分增强。     

膀胱经穴位推拿对腰椎间盘突出症患者脑功能磁共振成像的影响

目的观察膀胱经穴位推拿对腰椎间盘突出症患者脑功能磁共振的信号变化,探讨该治法的中枢作用机制。方法将20例腰椎间盘突出症患者随机分为2组,治疗组10例予膀胱经穴位推拿,对照组10例予非穴位推拿治疗。2组均治疗10次,分别在治疗前及最后1次治疗过程中应用脑功能磁共振成像技术(f MRI)观察2组治疗时脑功能信号,进行图像处理。结果推拿膀胱经穴与非穴位,脑功能磁共振成像有显著差异;治疗组脑功能区中脑导水管周围灰质、豆状核、前扣带回信号明显升高,对照组脑功能区豆状核苍白球信号明显降低;组内刺激状态与静息状态脑信号比较差异有统计学意义(P0.01)。结论膀胱经穴位推拿有明显中枢镇痛作用,穴位推拿与非穴位推拿临床疗效有明显差异,提示临床推拿治疗时经穴定位准确非常重要。     

针刺合谷穴激发前额叶BOLD信号与γ-氨基丁酸含量变化的多模态fMRI研究

目的:"面口合谷收"的大脑机制尚未明确,本研究通过观察针刺右侧合谷穴时前额叶脑皮层血流的血氧水平依赖功能磁共振成像(BOLD-fMRI)信号与相应皮层内磁共振波谱(MRS)检测到的神经递质γ-氨基丁酸(GABA)变化的关系,探索针刺合谷穴的作用机制。方法:本研究共招募到76名青年健康受试者,男23名,女53名,平均年龄(24. 5±1. 4)岁。受试者接受两次fMRI-MRS扫描,手针针刺和Von Frey纤毛针表皮刺激右侧合谷穴,两种刺激方式顺序随机分配,两次间隔1周。扫描序列含任务前静息态BOLD、MRS和任务态BOLD、MRS。感兴趣区(ROI)定位于双侧前额叶内侧皮层。fMRI数据采用SPM12、REST软件进行处理,MRS数据采用LC Model软件处理。随后进行脑激活区的组内、组间比较,计算ROI内皮层BOLD信号定量值,测量ROI内GABA值并进行矫正。最后统计分析BOLD信号与GABA含量的关系。结果:手针针刺与Von Frey纤毛针表皮刺激均诱发了大脑皮层广泛的BOLD负激活信号,主要集中在中线区(包含前额叶内侧皮层)和边缘叶脑区,但Von Frey纤毛针表皮刺激诱发的信号较少而弱。两组前额叶内侧皮层ROI内的BOLD信号与GABA+值在基线、任务后及其前后的差值均未发现明显相关性(手针针刺组:r=-0. 07,-0. 08,0. 04;P=0. 57,0. 88,0. 74;Von Frey纤毛针表皮刺激组:r=-0. 10,-0. 09,-0. 01;P=0. 43,0. 46,0. 96)。结论:手针针刺较Von Frey纤毛针表皮刺激合谷穴激发了更强更广的包含前额叶内侧皮层的边缘叶-旁边缘叶-新皮层网络负激活效应,但两种刺激下的前额叶内侧皮层ROI区域内BOLD信号与GABA含量及其变化未发现明确相关性,需进一步扩大样本量及在疾病状态下研究证实。     

NSM-S15P型MRI观察电针周围性面瘫患者左、右侧地仓穴fMRI的临床研究

目的:探讨NSM-S15P型MRI观察电针对周围性面瘫患者左、右侧地仓穴f MRI成像差异的临床研究。方法:选用2013年6月~2014年6月我院针灸科室就诊患者,总共4例,利用针灸科电针刺激,刺激患者左侧和右侧周围性面瘫,并且对患者进行磁共振扫描,扫描方式为f MRI全脑扫描,利用软件处理图像,来分析图像结果,主要是分析电针的不同穴位脑功能的图像有无差别。结果:左侧地仓穴经过电针后,右侧中央前回、双侧中央后回、左侧角回等脑区信号升高;右侧地仓穴经过电针后,右侧中央前回、左侧中央后回、右侧额下回、右侧脑岛、右侧颞上回等脑区信号升高。结论:两侧地仓穴经过电针后,脑功能图像有相同的情况,也有不同的情况,脑区的信号存在升高和降低不一致的现象,由此可以得出,人体中相同的穴位,在传导路径和治疗功效上也存在着差别。     

穴-脑联系的功能磁共振成像研究进展

功能磁共振成像（functional magnetic resonance imaging,fMRI）技术是研究针灸作用机制的有效手段,可对针灸穴位所产生的脑功能变化进行可视性研究。该文以经脉为纲,回顾了近年来国内外针灸效应的脑功能磁共振研究成果,对经脉、穴位的功效主治与大脑皮质功能的相关性进行论述,总结了研究中存在的问题,展望未来的研究方向,这将对今后穴位特异性、穴位配伍效应脑中介的针灸作用途径以及针灸的神经生理机制等研究起一定促进作用。     

基于低位脊髓功能磁共振技术电针刺激天枢穴和足三里穴神经通路机制可行性的探讨

脊髓功能磁共振影像(functional magnetic resonance imaging, fMRI)研究中,血管外质子信号增强fMRI(signal enhancement by extravascular protons-fMRI, SEEP-fMRI)较血氧水平依赖的fMRI (blood oxygen level dependent-fMRI, BOLD-fMRI)具有更高的信噪比。文章基于SEEP-fMRI技术,利用组块设计对1例健康受试者进行任务态观察。采用快速恢复快速自旋回波(fast recovery fast spin echo, FRFSE)序列,分别观察电针天枢穴和足三里穴时脊髓胸腰段功能的激活改变。发现针刺右侧天枢穴时,脊髓T_8～T_9节段灰质出现后角、侧角和前角区域的功能激活;针刺右侧足三里穴时,脊髓T_(12)节段灰质出现前角功能激活。电针天枢穴和足三里穴能够激活脊髓不同节段;SEEP-fMRI技术可用于针刺效应的低位脊髓fMRI研究,具有广阔的应用前景。     

用功能磁共振成像探讨经穴和大脑皮层的关系

目的:利用功能磁共振成像研究针刺人体穴位时引起大脑皮层神经兴奋的现象,探讨经穴、经络和大脑皮层的联系。方法:分别针刺足少阳胆经的穴位光明6例、阳陵泉6例和足阳明胃经穴位伏兔6例、足三里6例,均为健康人。用功能磁共振技术观察针刺时大脑的功能状态。结果:针刺足少阳胆经光明穴和阳陵泉穴,对侧枕叶视皮层均有明显兴奋,其中5例受试者(光明穴3例、阳陵泉穴2例)双侧枕叶视皮层都有明显的兴奋区;针刺后枕叶视皮层的平均BOLD信号强度增加的水平为(3.31±1.2)%。针刺足阳明胃经的足三里穴和伏兔穴可以引起下丘脑、海马回、额回的神经兴奋,平均BOLD信号强度增加(4.28±1.5)%。结论:功能磁共振成像显示针刺特定的穴位可以引起大脑相应区域的神经兴奋,同一条经脉上的穴位引起大脑兴奋的区域相同。提示经穴、经络和大脑皮层之间存在某种特定的联系。     

穴位热敏态脑机制功能性磁共振研究思路探讨

在针灸脑机制研究方面,基本上都是针刺的研究居多,也有经穴电刺激、按压穴位等方法,很少有灸法刺激穴位的脑功能效应研究.穴位敏化是穴位的功能状态之一,即穴位的反应性;穴位反应性的高低与疗效密切相关.穴位敏化的体现必然需要大脑对刺激信号的整合和加工.尤其是热敏化,热敏灸感生动描述都是病理状态下大脑对传入信息高度整合的结果.因...     

Carryover effects alter FMRI statistical analysis in an acupuncture study

Carryover effects can contaminate ON/OFF BOLD contrasts designated in an fMRI experiment. Yet, the ON/OFF contrasts are essential to facilitate statistical analysis based on the significance of contrast levels. Here, we conducted an fMRI experiment with acupuncture stimulation applied on ST42 acupoint as well as with tactile stimulation on its skin surface. Experiment consisted of three two-block acupuncture and one two-block tactile fMRI runs. Each block started with 26-sec OFF period followed by either 26-sec needle manipulation in the acupuncture runs or by scratching skin surface with sand paper in the tactile. To test if carryover effects could alter the BOLD contrasts, we analyzed different portions of fMRI data using GLM method. Our results showed analyses on different portions of acupuncture fMRI data gave significantly different results. Statistical parametric maps of group random effects resulted from the analysis on the very first fMRI trial formed the broadest coverage of the active brain areas. BOLD model time course also best explained the adjusted raw time course at peak active voxel (coefficient of determination = 0.88). Analyses on other portions of fMRI data only selected subset of the active brain areas delineated by the analysis on the very first data trial and the BOLD model only mildly accounted for the adjusted raw time courses. In tactile runs, results were more consistent across analyses. Therefore, in fMRI experiments with strong carryover effects, a single-block experimental design with multiple repetitions, separated by long enough periods of time, should be more suitable to extract task BOLD effects.     

Effect of acupuncture given at the HT 7, ST 36, ST 40 and KI 3 acupoints on various parts of the brains of Alzheimer' s disease patients

In this study, we explore various regions of the brains of Alzheimer' s Disease (AD) patients before and after acupuncture treatment of acupoints in the brain in order to determine the effect, if any, of acupuncture on AD. Twenty-six patients with clinically-diagnosed AD underwent functional magnetic resonance imaging (fMRI) while undergoing acupuncture at the four acupoints of Shenmen (HT 7), Zusanli (ST 36), Fenglong (ST 40) and Taixi (KI 3). fMRI Block design paradigm was chosen by electroacupumcture interval stimulation, and the data of fMRI were analyzed by Statistical Parametric Mapping (SPM 99). The result demonstrated that there were right main hemisphere activations (temporal lobe, such as hippocampal gyrus, insula, and some area of parietal lobe) and left activated regions (temporal lobe, parietal lobule, some regions of cerebellum). The activated regions induced by these acupoints were consistent with impaired areas in brain for AD patients, which were closely correlated with the cognitive function (memory, reason, language, executive, etc.). The present study provided the strong evidence that acupuncture had a potential effect on AD, and in partial revealed the mechanism.     

Acupuncture stimulation for motor cortex activities: a 3T fMRI study

The acupoint, GB34, located in the back of the knee, is known to be effective in recovering motor function after a stroke. This study uses a functional magnetic resonance imaging (fMRI) study with 3T scanner to investigate whether or not acupuncture of GB34 produces a significant response of the modulation of somatomotor areas. A fMRI of the whole brain was performed in ten normal healthy subjects during two task stimulations of acupuncture manipulation on GB34 and sham points, inserting and twisting the needle for 25 seconds at a rate of approximately 120 times per minute; the needle manipulation was paused for a duration of 25 seconds as a control state. The process was repeated four times to have four epochs of stimulation. Bilateral sensorimotor areas (BA 3, 4, 6 and 7) showed approximately 6% of stimulation-related BOLD signal contrast, whereas very few areas were activated when sham stimulation was given. Acupuncture stimulation in GB34 modulates the cortical activities of the somatomotor area in humans. The present findings may shed light on the CNS mechanism of motor function by acupuncture, and form a basis for future investigations of motor modulation circuits in stroke patients.     

EVOKED PRESSURE PAIN FUNCTIONAL MAGNETIC RESONANCE IMAGING(fMRI) PREDICTS CLINICAL RESPONSE TO SHAM BUT NOT VERUM ACUPUNCTURE IN FIBROMYALGIA

Objective: Previously, we showed that patients with fibromyalgia(FM) display enhanced sensitivity to experimental pressure-pain which predicts clinical response to sham acupuncture(SA) treatment.In this study, we investigated whether fMRI blood oxygen-leveldependent(BOLD) response to experimental pressure-pain predicts increased clinical pain reductions after SA as opposed to verum acupuncture(VA) treatment.Methods: Thirty-nine female patients satisfying American College of Rheumatology 1990 criteria for FM were randomized to receive either VA(n=18) or non-skin penetrating SA(n=21) with 9 treatments over the course of 4 weeks.Before treatment, patients underwent an fMRI evoked pressure-pain scan, during which 2 kg of pressure was presented to volunteers' left thumbs.Clinical pain was assessed both before and after treatment with the Short Form McGill Pain Questionnaire(SF-MPQ).Preprocessing and regression analyses of baseline BOLD signal(2 kg vs.touch) as a predictor for change in clinical pain were performed separately for each group in SPM8.The BOLD signal was extracted from significant clusters, and used in a General Linear Model(SPSS v21) for group*BOLD interactions.Significance was assigned at P0.05 corrected for multiple comparisons.Results: Baseline BOLD responses in the left posterior insula(r=-0.80, P=0.001), right posterior insula/putamen(r=-0.70, P=0.007), and the anterior cingulate cortex(r=-0.657, P=0.018) were all negatively correlated with change in clinical pain(SFMPQ affective scores; post-pre); posterior cingulated(r=-0.69, P=0.001) was correlated with change in clinical pain(SF-MPQ total scores; post-pre).No significant clusters were found for the VA group alone.However when the SA regions were used to extract BOLD signals from the VA group, significant group*BOLD interactions were obtained for the previously mentioned regions(P0.001, P=0.008, P=0.004, P=0.001, respectively).Conclusion: Results suggest that evoked pressure-pain fMRI BOLD response in pain responsive regions may be a factor in determining subsequent responsiveness to SA but not VA.     

电针正常人足三里和关元穴中枢效应的fMRI脑功能成像比较

目的:利用fMRI脑功能成像,比较电针时位于肢体的足三里穴及腹部的关元穴激活的脑功能区及其功能区网络连接的异同。方法:21名健康志愿者参加电针足三里穴、关元穴时的fMRI试验。分别在针刺前静息状态、留针、电针(15Hz,3次30s,间隔1min)、拔针后静息态采集fMRI脑功能数据,并记录电针任务时针感。采用t检验及卡方检验分析针感,SPM 2、短程和长程"中心度"法分析脑激活功能区及其之间的功能网络连接。结果:在电针电流无显著性差异条件下,电针足三里穴较关元穴诱导出了更强的胀满感及麻木感。电针两穴均产生了相似的前下扣带回-额叶内侧回网络的显著负激活效应,留针及电针能改变脑静息态脑功能默认功能模式,于额叶内侧回、扣带前回前下部短程脑功能网络出现了明显的即时针刺后效应。足三里穴较关元穴产生了更强的短程脑功能网络连接。结论:针刺足三里、关元穴具有显著相似的对脑边缘叶-额叶内侧皮层脑网络的调制作用,但也存在小的差异,体现穴位脑效应的相对特异性。     

从脑功能成像看针刺作用的中枢机制

目的:了解针刺负荷脑功能成像的研究进展,探讨针刺疗效的中枢机制.方法:收集、整理及分析了近10年来利用功能性磁共振成像(fMRI)、脑电图和诱发电位(EEG and EPs)、正电子发射断层扫描(PET)三种技术探测针刺穴位时,所引发脑内多个功能区域血流和代谢变化的相关研究的近40篇文献.结果:目前用脑功能成像技术所研究的穴位并不多,从已经研究的几个穴位来看,主要兴奋痛觉调制通路、运动相关功能区、视觉皮层及其它脑区.结论:针刺穴位对多个特异脑区的激活与多系统的治疗作用相关.     

Commonality and specificity of acupuncture action at three acupoints as evidenced by FMRI

Previous work from our team and others has shown that manual acupuncture at LI4 (hegu), ST36 (zusanli), and LV3 (taichong) deactivates a limbic-paralimbic-neocortical brain network, and at the same time activates somatosensory regions of the brain. The objective of the present study was to explore the specificity and commonality of the brain response to manual acupuncture at LI4, ST36, and LV3, acupoints that are located on different meridians and are used to treat pain disorders. We used functional magnetic resonance imaging (fMRI) to monitor the brain responses to acupuncture at three different acupoints; we examined 46 healthy subjects who, according to their psychophysical responses, experienced deqi sensation during acupuncture. Brain responses to stimulation at each of the acupoints were displayed in conjunction with one another to show the spatial distribution. We found clusters of deactivation in the medial prefrontal, medial parietal and medial temporal lobes showing significant convergence of two or all three of the acupoints. The largest regions showing common responses to all three acupoints were the right subgenual BA25, right subgenual cingulate, right isthmus of the cingulum bundle, and right BA31. We also noted differences in major sections of the medial prefrontal and medial temporal lobes, with LI4 predominating in the pregenual cingulate and hippocampal formation, ST36 predominating in the subgenual cingulate, and LV3 predominating in the posterior hippocampus and posterior cingulate. The results suggest that although these acupoints are commonly used for anti-pain and modulatory effects, they may mobilize the same intrinsic global networks, with substantial overlap of common brain regions to mediate their actions. Our findings showing preferential response of certain limbic-paralimbic structures suggests acupoints may also exhibit relative specificity.