针刺舌根部穴对人生理状态下吞咽功能影响的功能性核磁共振成像研究

目的 通过对比健康成人舌根部穴针刺前后执行吞咽任务时脑功能区的激活差异,探讨针刺舌根部穴对吞咽功能影响的中枢机制。方法 青年健康志愿者10名,分别于针刺舌根部穴前后运用功能磁共振技术进行吞咽任务（含静息状态、吞咽准备和吞咽任务）扫描,分析针刺前后数据集,获得针刺舌根部穴后执行吞咽任务的差异脑功能激活区。结果 针刺前,脑激活区主要分布于左侧的颞上回和右侧的岛叶;针刺后,脑激活区主要分布于左侧小脑后叶、小脑叶、梭状回以及右侧舌状回,负激活区主要分布于左侧中央前回、中央后回以及右侧中央后回;针刺前后对比,差异脑激活区分布于左侧的梭状回、颞中回及额内侧回,负激活区位于左侧顶下小叶。结论 针刺舌根部穴影响吞咽功能的原因可能是通过增强吞咽相关脑区参与任务执行的积极性,提高吞咽任务执行效率,以达到调节吞咽运动肌群的目的。     

针刺足三里穴对胃黏膜保护及损伤因子影响与脑功能变化的相关性

目的 联合分析电针刺激足三里穴后外周血胃黏膜保护及损伤因子相关指标和功能磁共振(fMRI)信号的变化,探索针刺调节胃黏膜的中枢机制.方法 实验分为真穴组和假穴组;16名健康成人志愿者(均为同济大学在校学生)于2008年9-11月期间参加了两组实验,同一名受试者进行两次实验间隔2周以上.真穴组针刺受试者右侧足三里穴.实验前5 min及电针刺激停止后的5、15、25、30 min分别5次采集受试者外周血检测胃黏膜相关指标;针刺时进行fMRI扫描.用SPM2分析fMRI数据,检验P值<0.00l.结果 真穴组电针针刺停止后的5、15、25、30 min外周血中降钙素基因相关肽(CGRP)、前列腺素E2(PGE2)含量较针刺前均有明显升高(P<0.01),同时内皮素(ET)、胃泌素(GAS)的含量均较针刺前明显下降(P<0.01),各项指标于电针针刺后25 min达峰值.假穴组外周血中各时间点CGRP、PGE2、ET、GAS的含量针刺前后差异无统计学意义.电针刺激足三里穴主要激活双侧额中回、尾状核,扣带回,左侧中央前回、中央后回、额下回、下丘脑,右侧岛叶、海马、小脑半球.假穴组电针刺激后只激活了右侧旁中央小叶及小脑半球.结论 针刺足三里穴对胃黏膜的影响作用可能需要通过中枢特定脑区的介导作用于靶器官而实现.     

基于fMRI的合谷穴功能特异性研究

目的：研究合谷穴功能的特异性为临床应用提供依据。方法：将健康志愿受试者扫描序列分为对照序列和针刺序列。对照序列采用合谷穴与非经穴贴皮电刺激,针刺序列采用针刺合谷穴与非经穴贴皮形成电刺激。针刺受试者左合谷穴或右合谷穴,通过Bold-fMRI观察针刺合谷穴在大脑皮层的激活区域。采集fMRI大脑扫描数据进行分析得出脑功能图像。结果：针刺左侧合谷可激活右侧额内侧回、右侧颞上回、右侧颞中回、右侧岛叶、左侧尾状核,双侧额下回;针刺右侧合谷可激活：左侧额内侧回、左侧颞中回、左侧额下回、右侧辅助运动区。结论：针刺合谷穴可激活大脑皮层语言运用中枢、面部反应区、听觉皮区,与合谷穴功能基本吻合。     

浅针山根穴治疗原发性失眠静息态功能磁共振研究

目的探讨浅针山根穴治疗原发性失眠(PI)的中枢作用机制。方法对10例PI患者(治疗组)在浅针治疗前后及10例健康者(对照组)进行静息态功能磁共振技术(fMRI)扫描,比较2组之间及治疗组治疗前后脑区功能连接差异情况。结果治疗组与对照组比较,功能连接增强的脑区主要有双侧额中回、右侧中央前回、双侧中央后回、左侧楔前叶、右侧顶上小叶;功能连接减低的脑区主要有左侧脑岛、左侧前扣带回、右豆状核、左侧尾状核。治疗组治疗后与治疗前比较,功能连接增强的脑区主要有双侧脑岛、双侧脑干、左侧尾状核、双侧扣带回;功能连接减低的脑区主要有双侧额中回、右侧楔前叶。结论 PI患者存在情绪回路功能的异常;浅针刺激山根穴能改善情绪回路的功能,可能是浅针治疗PI的中枢机制之一。     

强迫症患者全脑灰质与静息态功能影像研究

目的探讨强迫症患者脑结构及脑功能异常以及治疗前后的变化。方法采用3.0T核磁共振仪对18例未服药强迫症患者治疗前后进行全脑扫描,获得高分辨率3D-T结构后,采用优化的基于体素的形态测量学方法（VBM）计算全脑灰质容积;静息态功能磁共振成像（fMRI）数据采用低频振幅（ALFF）方法处理,并与16例年龄、性别相匹配的正常人群相对照。结果与对照组相比,强迫症组右侧丘脑、双侧扣带回左侧尾状核及右侧苍白球体灰质容积减少（P＜0.05）;小脑前叶、左侧眶额上回、右侧额中回、左侧颞中回、左楔前叶、中央前回、中央后回等皮质结构灰质容积增加（P＜0.05）;右侧小脑与右侧顶叶静息态fMRI过度激活,左侧扣带回、豆状核与尾状核激活减弱（P＜0.05）;药物治疗反应良好的强迫症患者左侧丘脑、左侧豆状核、左侧壳核、左侧前、后扣带回灰质容积均较治疗前明显增加（均P＜0.05）;静息态fMRI结果提示治疗前后无统计学差异（P＞0.05）。结论强迫症患者存在多个脑区灰质容积和静息态脑功能异常,有效的药物治疗可部分逆转这种异常状态。     

慢性腰背痛患者前扣带回功能连接的fMRI研究

目的 利用功能磁共振成像技术(function magnetic resonance imaging,fMRI),探讨慢性腰背痛患者在静息状态下脑内功能连接情况。方法 对15例慢性腰背痛患者在静息状态下进行MR扫描,选择双侧前扣带回后部(posterior anterior cingulated cortex,p ACC)作为种子点,分析其脑内功能连接情况,采用两样本t检验方法与年龄分布相同的健康对照组进行比较。结果 与正常对照组相比,慢性腰背痛患者在静息状态下多个脑区与p ACC的功能连接存在异常:双侧距状回及邻近后扣带回、前额叶中内侧及邻近前扣带回、左侧中央前回及邻近中央后回、右侧扣带回中后部的功能连接减弱;右侧岛叶后部、左侧额下回(眶部、三角部)及邻近左侧岛叶前部、左侧颞上回的功能连接增强。结论 静息状态下慢性腰背痛患者多个脑区与p ACC的功能连接存在异常。     

针刺支沟穴前后健康人脑内以LPCG、RPCG为种子点功能连接网络时变效应的差异

目的运用静息态功能性磁共振成像(fMRI)技术研究针刺左侧支沟穴对健康人脑内左、右侧旁中央小叶(LPCG、RPCG)为种子点功能连接网络响应脑区在针刺前后不同时间序列内的差异。方法对18名健康受试者左前臂支沟穴进行fMRI扫描,包括:针刺前静息态扫描(R1)、留针期间扫描(R2～R5)和拔针后扫描(R6～R7),分别以LPCG、RPCG为种子点进行功能连接分析。结果①以LPCG为感兴趣区种子点,R2减R1功能连接差异脑区为双侧小脑后叶、左侧颞上回,R3减R1差异脑区为左侧中央后回、双侧额下回、右侧楔前叶,R4减R1差异脑区为右侧小脑后叶、左侧顶下小叶、左侧额下回,R5减R1差异脑区为左侧额下回,R6减R1差异脑区为左侧小脑后叶、右侧额内侧回、右侧额中回,R7减R1差异脑区为右侧小脑后叶、左侧额中回。②以RPCG为感兴趣区种子点,R2减R1差异脑区为左侧小脑后叶、双侧顶上小叶、双侧中央前回,R3减R1差异脑区为右侧梭状回、左侧楔前叶、右侧中央前回,R4减R1差异脑区为左侧中央前回,R5减R1差异脑区为右侧扣带前回,R6减R1差异脑区为左侧颞中回,R7减R1差异脑区为左侧中央前回。结论上述脑区与下肢感觉、运动功能及排尿、排便的中枢调控具有一定相关性,推测上述脑区与LPCG、RPCG所形成的随时间序列变化的功能连接网络是临床针刺支沟穴治疗下肢感觉、运动功能及二便排泄障碍的可能的中枢响应机制。     

针刺支沟穴对健康人脑内静息态fALFF时变效应的影响

目的运用静息态功能性磁共振成像(fMRI)技术研究针刺左侧支沟穴对健康被试者脑内低频振幅比率(f ALFF)在不同时间序列内的变化。方法对18名健康人左前臂支沟穴进行fMRI扫描,包括:第1次纯静息态扫描(R1)、针刺后留针期间静息态扫描(R2~R5)和拔针后静息态扫描(R6~R7),对采集数据进行f ALFF分析。结果 (1)双侧楔前叶f ALFF由针刺前负激活转变为正激活并延续至R6状态内(除R5状态内未见显著激活),且激活幅度及簇数值均较稳定;(2)额中回、额上回在针刺前正激活基础上增强,除R3状态内双侧均为正激活外,留针R2、R4、R5期间及拔针后R6状态内呈现左、右侧交替正激活效应;(3)顶下小叶由针刺前负激活转变为R2~R3状态内正激活,R4~R7状态未见显著变化;(4)小脑前、后叶在针刺后R2状态内和拔针后R6状态内出现正激活(R2:小脑后叶,R6:小脑前、后叶),针刺后R3和R5状态内则为负激活。结论该结果从脑能量代谢层面为临床针刺支沟穴治疗与楔前叶、额中回及额上回、顶下小叶等区域功能减弱、小脑前叶及小脑后叶功能亢进相关类疾病提供一定理论依据,并为临床留针期间的行针时间点和针刺后效应研究提供一定科学依据。     

针刺即时效应对急性脑梗死患者脑功能成像的影响

【目的】探讨针刺治疗急性脑梗死的作用机理。【方法】应用fMRI脑功能成像评价针刺内关穴的即时效应,对急性脑梗死患者及健康人相关脑功能区兴奋性的影响,对15例急性脑基底节区梗死患者和15例健康志愿者,针刺双侧内关穴,分别于针刺前、后行静息态fMRI脑功能成像扫描,获取两组被试静息态的fMRI数据,通过后处理软件得到脑梗死患者和健康对照组不同脑区的脑功能激活图像。【结果】患者针刺后,在右侧枕叶和左侧顶叶存在正激活,而左侧运动区有负激活。健康人针刺后,在双侧顶叶和枕叶出现正激活,在双侧额叶出现负激活。【结论】针刺内关穴对脑梗死患者和正常人的脑功能活动激活区域表现存在差异,提示针刺内关穴对机体病理与生理状态下fMRI脑功能成像影响不同。     

针刺足三里穴得气与非得气的大脑功能成像对比研究

目的 应用功能性磁共振技术-血氧水平依赖(blood oxgenation-level dependent,BOLDfMRI)技术,探讨针刺受试者右侧足三里穴在得气与非得气状态下,足三里穴的激活效应.方法 将22例健康成年(年龄25～35岁)、体型中等的男性志愿者随机分为两组:针刺得气组与针刺对照组,比例约为3∶1.针刺得气组:针刺足三里穴位,通过捻针和补泻的手法来刺激穴位;针刺对照组:仅针刺足三里穴位,无捻针和补泻的手法.对两组受试者大脑的兴奋区域进行统计学分析,比较两组的差异.结果 针刺得气组的脑功能区激活范围较广泛,包括单侧或双侧第Ⅱ躯体感觉皮质(SⅡ)、第Ⅰ躯体感觉皮质(SⅠ),以左侧为主的颞叶、岛叶皮质、运动区、辅助运动区、前扣带回、后扣带回、杏仁体、下丘脑等;针刺对照组仅见散在脑功能区激活,两者差异有统计学意义(P＜0.05).结论 针刺足三里穴得气后能够引起脑区的广泛激活,针刺足三里穴得气与否存在着一定的差异.     

Effects of three needling manipulations of the right-side Zusanli (ST 36) on brain using functional magnetic resonance imaging

Objective

To investigate the effects on the brain using three needling manipulations (twirling, lifting-thrusting, and twirling plus lifting-thrusting) when the right-side Zusanli (ST 36) acupoint was stimulated with needles.

Regional homogeneity analysis on acupoint specificity with resting-state functional magnetic resonance imaging

Background  The mechanism of acupuncture analgesia in craniotomy has been widely studied. However, the theoretical basis for selection of acupoints has not been examined. In this study, we used the regional homogeneity method blood oxygen level-dependent (BOLD) signals to determine changes in brain activity in response to transcutaneous electrical stimulation on acupoints and non-acupoints in resting state functional magnetic resonance imaging (fMRI).

Methods  Twelve healthy volunteers were enrolled in this study. BOLD fMRI scanning of the brain was performed for 306 seconds before and 30 minutes after transcutaneous electrical stimulation on acupoints UB63 (Jinmen), LV3 (Tai chong), ST36 (Zusanli), and GB40 (Qiuxu). The procedure was repeated after one week with stimulation on non-acupoints (one was 9 above BL67, the second was 12 above BL67 (Kunlun), the third was 7 above KI3, and the fourth was 10 above KI3 (Taixi)).

Results  The regional homogeneity in the acupoint group was increased in the left thalamus, caudate, putamen, lentiform nucleus (BA19, 30, 39), postcentral gyrus, precentral gyrus (BA3, 4, 30, 32), calcarine fissure, middle temporal gyrus (BA30), right superior temporal gyrus, inferior temporal gyrus (BA38), cuneus, and precuneus (BA7, 19) when compared to the non-acupoint group. The regional homogeneity of the acupoint group was decreased in the left cerebellum posterior lobe, middle frontal gyrus (BA10), double-side precuneus (BA7), and the postcentral gyrus (BA40).

Conclusions  The brain region activated following acupoint stimulation is the ipsilateral pain-related brain region, which may relate to the therapeutic effect of acupuncture on pain relief. Further acupoint stimulation causes different central nervous responses compared to non-acupoint stimulation.

     

温和灸功能性消化不良患者足三里的中枢即刻响应特征

目的:探讨温和灸功能性消化不良(Functional Dyspepsia,FD)患者足三里的即刻脑功能响应特征。方法:选取符合纳入与排除标准的FD患者38例,分定位相、结构相、艾灸前静息态(6 min)、艾灸足三里任务态(3 min)与艾灸后静息态(10 min)五个步骤进行BOLD-f MRI扫描,对采集数据运用DPARSF软件分析,足三里穴均取左侧,温和灸持续3 min。结果:与艾灸前相比,艾灸足三里时FD患者的左壳核、右额中回、右中央前回、左颞中回和左小脑等脑区磁共振数据降低;与艾灸后静息相比,艾灸足三里时FD患者的左枕叶中部,小脑,右枕叶中部等脑区磁共振数据降低;与艾灸后静息相比,艾灸前静息FD患者的左海马、右小脑脚等脑区磁共振数据降低。结论:温和灸FD患者足三里穴的中枢即刻响应特征可能为通过协调左小脑、左颞极、左颞中回脑区活动降低内脏敏感性,调节前额叶、中央前皮质、颞中回、颞上回、海马等脑区活动来抑制内脏感受传导,提高疼痛、饱胀等感觉的阈值。     

首发精神分裂症未治疗精神病持续时间与脑皮质形态学关系的磁共振研究

  目的  从多角度对精神分裂症患者脑结构分析以探讨患者精神病未治疗持续时间（duration of untreated psychosis,DUP）与临床结局间的关系。  方法  对85例患者及86例对照,进行临床症状和认知功能评估,通过磁共振扫描（magnetic resonance imaging, MRI）并采用free surfer分析提取脑区皮层厚度、表面积和体积等皮层结构值,基于患者组DUP的分布及中位数,以3个月、6个月、2年为界将患者分为4组,对上述指标进行组间比较及相关分析。  结果  DUP与左岛叶、眶部和右海马旁回、额上回、额颞极的表面积有关联;与左后扣带回、中央后回,右外侧枕叶皮质、岛盖部、内侧眶额皮质和双侧中央前回的皮质厚度有关;对皮质体积,DUP主要影响左中央后回,右楔前叶、外侧枕叶皮质、岛盖部、舌回、颞上回,双侧半球的楔叶、距状旁回、中央前回、顶上小叶和岛叶;发病后前三月是脑皮层结构和临床功能恶化的关键期。  结论  首发精神分裂症的DUP与颞叶、中央前回、眶额区皮质及枕叶内侧面的大部分脑区的皮质形态改变有关,对患者进行早期干预是非常重要的。     

Altered Brain Regional Homogeneity Following Contralateral Acupuncture at Quchi (LI 11) and Zusanli (ST 36) in Ischemic Stroke Patients with Left Hemiplegia: An fMRI Study

Objective: To study the effect of contralateral acupuncture (CAT) at acupoints of Quchi (LI 11) and Zusanli (ST 36) on the unaffected limbs of ischemic stroke patients with left hemiplegia based on regional homogeneity (ReHo) indices. Methods: Ten ischemic stroke patients with left hemiplegia received CAT on right side at LI 11 and ST 36. Functional magnetic resonance imaging (fMRI) was performed before and after acupuncture. A ReHo analytical method was used to compare brain responses of patients before and after CAT operated by REST software. Results: The stimulation at both LI 11 and ST 36 on the unaffected limbs produced significantly different neural activities. CAT elicited increased ReHo values at the right precentral gyrus and superior frontal gyrus, decreased ReHo value at right superior parietal lobule, left fusiform gyrus and left supplementary motor area. Conclusions: Acupuncture at one side could stimulate bilateral regions. CAT could evoke the gyrus which was possibly related to motor recovery from stroke. A promising indicator of neurobiological deficiencies could be represented by ReHo values in post-stroke patients.     

Brain glucose metabolism and neuropsychological test in patients with mild cognitive impairment

Objective To investigate the features of regional cerebral metabolic rate of glucose （rCMRglc） in patients with mild cognitive impairment(MCI) by positron emission-tomography and its relationship with neuropsychological test.Methods Positron emission tomography, mini-mental state examination and Wechsler memory scale were applied in 10 patients with MCI and 10 healthy volunteers as the control group. Results Scores of mini-mental state examination and Wechsler memory scale in MCI patients were lower than those in the control group (P&lt;0.01). rCMRglc of the left orbital gyrus, right middle temporal gyrus and right putamen was lower in the MCI group than in the control group (P&lt;0.05). Correlation analysis in the MCI group indicated that rCMRglc of many brain regions such as the orbital gyrus, putamen, left hippocampus and parahippocampal gyrus, cingulate gyrus, left amygdaloid body, precentral gyrus, postcentral gyrus, and medial occipitotemporal gyrus in MCI patients, were correlated negatively with age; while the rCMRglc of many parts of the brain such as the left putamen, temporal lobe, anterior cingulate gyrus, left insular lobe, amygdaloid body, precentral gyrus, postcentral gyrus and medial occipitotemporal gyrus were correlated positively with mini-mental state examination; and rCMRglc of the left putamen, temporal lobe, left insular lobe, precentral gyrus and postcentral gyrus were correlated positively with Wechsler memory scale. The right putamen, the right inferior temporal gyrus, precentral gyrus, and left postcentral gyrus were correlated positively with the length of education. However, only rCMRglc of the left amygdaloid body were correlated positively with gender. Conclusion The rCMRglc was lower in the orbital gyrus and putamen of MCI patients. Their rCMRglc were correlated with their cognitive impairment severity, age, length of education and sex.     

Study on the Regulatory Effect of Electro-acupuncture on Hegu Point （LI4） in Cerebral Response with Functional Magnetic Resonance Imaging

Objective To study, through blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI), the cerebral activated areas evoked by electro-acupuncturing (EA) the right Hegu point (LI4) or non-acupoint points on the face, and through comparing their similarities and differences, to speculate on the specific cerebral areas activated by stimulating LI4, for exploring the mechanism of its effect in potential clinical application. Methods EA was applied at volunteers’ right LI4 (of 9 subjects in the LI4 group) and facial non-acupoint points (of 5 subjects in the control group), and whole brain 3-dimensional T1 anatomical imaging of high resolution 1 × 1 × 1 mm³ used was performed with clustered stimulatory mode adopted by BOLD fMRI. Pretreatment and statistical t-test were conducted on the data by SPM2 software, then the statistical parameters were superimposed to the 3-dimensional anatomical imaging. Results Data from 3 testees of the 9 subjects in the LI4 group were given up eventually because they were unfit to the demand due to different causes such as movement of patients’ location or machinery factors. Statistical analysis showed that signal activation or deactivation was found in multiple cerebral areas in 6 subjects of LI4 group and 5 subjects of the control group (P<0.01). In the LI4 group, the areas which showed signal activation were: midline nuclear group of thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; those which showed signal deactivation were: bilateral hippocampus, parahippocampal gyrus, amygdala body area, rostral side/audal side of cingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, areas which showed signal activation were: bilateral frontal lobe, postcentral gyrus, Reil’s island lobe, primary somato-sensory cortex, cingulate gyrus, superior temporal gyrus, occipital cuneiform gyrus and/or precuneus gyrus and right brainstem; and the area that showed deactivation was left median frontal lobe. Conclusion The effects of EA LI4 in regulating cerebral activities could be displayed and recorded through BOLD fMRI, the distribution of signally deactivated area evoked by EA LI4 was similar to the known distribution of anatomical orientation of pain in brain, and closely related to the anatomic structure of limbic system, which areas are possibly the acupuncture analgesic effect’s cerebral regulating area. Furthermore, activated portion of left central anterior gyrus, which represent the movement of oral facial muscles, and the activated portion of cerebellum are possibly related with the effect of using EA LI4 in treating facial palsy and facial muscle spasm. As for the mechanism of signal deactivation of cerebral activities exhibited in the present study that is unable to be elucidated, it awaits for further research. Supported by the National Natural Science Foundation (No. 90209031)     

基于体素的形态测量学方法分析颞叶癫痫患者脑灰质体积变化

目的采用基于体素的形态测量学方法比较颞叶癫痫患者和正常人脑灰质的体积,探讨颞叶癫痫患者脑灰质体积的变化。方法收集22例经手术病例证实的颞叶癫痫患者及15例性别、年龄相匹配的健康志愿者,分别行全脑三维结构像扫描,采用基于体素的形态学测量学(VBM)方法分析病例组及对照组的数据,计算和比较两组脑灰质的体积。结果与对照组相比,左侧颞叶癫痫患者的右侧小脑前叶、左侧颞中回、左侧颞下回、左侧枕中回、左侧额下回、右侧额下回、右侧颞中回、左侧海马、左侧额上回、右侧尾状叶、右侧额中回、左侧中央后回、右侧中央前回灰质体积减小(P均0.05);右侧颞叶癫痫患者的右侧颞下回、右侧颞中回、左侧舌回、左侧枕下回、左侧颞下回、左侧海马旁回、右侧丘脑、左侧枕上回、左侧颞中回、右侧额上回、左侧中央前回、左侧中央后回、右侧中央前回灰质体积减小(P均0.05)。结论颞叶癫痫患者多个脑区脑灰质体积降低,通过采用基于体素的形态测量学技术可以反映脑灰质体积的变化。     

PET imaging of brain function while puncturing the acupoint ST36

Acupuncturehasgainedincreasing popularityinhealthcareandrecognitionamongscientificworkerslately Itstherapeuticmechanism ,however,isnotfullyexplored ,leadingtoitslimiteduseinsomewesterncountries Inthisexperiment,weattemptedtoacquiredataoncerebralglycometabolismwith positronemissiontomography(PET) ,andtoanalyzethembystatisticalparametricmapping (SPM) Certainincreaseinglycometabolismwasfoundinthehypothalamus,headofthecaudatenucleus,temporallobe,brainstem ,andsinistralcerebellum ,andpostcentral…