针刺内关穴对机体不同功能状态下fMRI脑功能成像的影响

目的:观察机体在生理或病理状态下,针刺同一穴位时fMRI脑功能成像的变化,探讨内关穴的作用机制.方法:对老年健康人(正常组)和阿尔茨海默病患者(AD组)进行电针刺激内关穴,同时运用1.5 T磁共振成像系统,采集两组被试者脑部的fMRI功能像数据,通过SPM99进行统计分析,获取正常组和AD组脑内不同区域的功能活动图像.结果:正常组两侧额叶及颞叶均被不同程度激活,AD组表现在额叶、颞叶和扣带回、小脑等部位不同程度的激活,其他脑区无明显激活.结论:针刺内关穴对正常组和AD组的脑功能活动激活区域表现不同,说明针刺内关穴对机体不同功能状态下fMRI脑功能成像影响不同.     

针刺心包经腧穴对健康人静息态脑功能磁共振成像低频振幅的影响

目的观察针刺手厥阴心包经全经腧穴对健康人静息态（rest1,R1）脑功能磁共振成像低频振幅的影响。方法对16名健康受试者依次进行结构像T1、T2扫描和功能像磁共振成像扫描,功能像包括第1次R1扫描,扫描时间为8 min 6 s和针刺手厥阴心包经全经腧穴后留针状态（acupuncture,AP）扫描,扫描时间为8 min 6 s。对采集的结构像和功能像fMRI数据都进行格式转换和统计分析。结果 R1状态下,ALFF信号活跃的脑区：双侧额上回、额内侧回、枕中回、楔前叶、颞上回、扣带回。AP状态下ALFF信号活跃的脑区：双侧额上回、额内侧回、颞中回、左侧梭状回、楔前叶、后扣带回、小脑山坡部。与R1状态比较,针刺心包经使得ALFF信号明显差异的脑区：双侧楔叶、楔前叶、左侧后扣带回、右侧枕中回、右侧枕叶舌回。结论针刺手厥阴心包经全经腧穴后会显著改变大脑皮层固有活动状态,尤其是双侧额上回、额内侧回、楔前叶的激活。     

针刺申脉穴的fMRI脑功能成像研究

目的:研究针刺申脉穴脑功能变化的规律和激活脑区的定位信息。方法:利用血氧依赖性磁共振成像技术,获得健康志愿者的申脉穴在行针及留针不同针刺状态下的脑功能变化图像,利用SPM信号处理系统,对比分析不同针刺状态下脑功能变化的规律。结果:针刺申脉穴主要激活边缘系统(丘脑、扣带回、海马旁回)和额叶、颞叶等脑区,在行针和留针过程中激活的脑区存在较为明显的规律性变化,在行针过程中首先激活对侧脑区,留针后逐渐由对侧延伸到双侧。结论:激活的脑区可能在申脉穴治疗失眠等心境障碍性疾病时起一定作用。     

ACUPUNCTURE EFFECT ON MOTOR FUNCTIONAL CONNECTIVITY CHANGE IN FACIAL PALSY:AN fMRI STUDY

Background: Bell's palsy(BP) is common peripheral idiopathic disease that affects the facial nerve(CN VII) and causes an inability to control facial muscles on the affected side and it was known to be treated by acupuncture.We investigated acupuncture effects on the resting state brain connectivity due to neuroplasticity in patients with BP.We hypothesized that BP and acupuncture modulates motor cortex regions connectivity with other brain regions during resting state.Methods: According to disease duration and House-Brackmann score(grade the degree of nerve damage in BP), we enrolled59 BP patients(treated by acupuncture in Hegu(LI4)) in three groups: early(within two weeks after onset), later(after two weeks before recovery) and healed(after recovery).Some patients participated multiple times in different groups.We had35 healthy(normal) volunteers as control group.Two fMRI scans(pre- and post-acupuncture) using 1.5T MR scanner(Siemens Symphony, Siemens Medical, Erlanger, Germany)were applied(10 minutes resting state with 3 second TR).We used seed voxel analysis approach for investigating functional connectivity of M1 regions of mouth and forehead with other brain regions from normal to healed group.We took 4 regionsof interest(ROI), 2 right and 2 left based on our previous motor task research.Results: There were differences between later and healed in left S2, left superior and middle temporal gyrus with right forehead ROI and DLPFC and middle cingulate gyrus for left mouth ROI.And there were differences between normal and healed in left supramarginal gyrus, left S1 and M1 facial regions, left and right cuneus, and left and right lingual gyrus.Conclusion: We found functional neuroplasticity changes of brain regions connectivity with our ROIs due to the BP and acupuncture.The resulted regions are related to sensorymotor regions, motor association regions, attention and motor learning.     

针刺穴位和非穴位对脑功能连接影响的MR研究

目的:观察穴区与非穴区对脑功能连接的影响,以探讨腧穴作用特异性的基础.方法:选择21名健康志愿者,随机分为穴位组(12例)和非穴位组(9例),分别针刺受试者双侧足三里和足三里外侧3～4 mm处,采用捻针手法,分别于针刺前、出针后25 min进行功能磁共振扫描,以双侧扣带回作为种子点,分析穴位组和非穴位组脑功能连接情况.结果:穴位组和非穴位组均能产生广泛的脑功能连接,穴位组与非穴位组相比,穴位组在双侧小脑扁桃体、右侧小脑齿状核、双侧小脑悬雍垂、左侧小脑山坡、右侧小脑结节、左侧额下回、双侧颞中回、双侧旁中央小叶、左侧扣带回、右侧颞上回、右侧前扣带回等区域与后扣带回存在功能连接增强,而穴位组双侧额内侧回、右侧额下回与后扣带回的脑功能连接强度较非穴位组减弱.结论:穴位和非穴位所引发脑功能连接的脑区大部分相同,但穴位组在脑内的脑功能连接强度总体上高于非穴位组.     

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。     

针刺合谷与太冲fMRI脑功能成像的比较研究

目的:探讨针刺不同穴位对脑组织fMRI功能成像的影响.方法:将健康受试者随机分为针刺合谷组、太冲组、合谷配伍太冲组各7人,分别观察fMRI脑功能成像.结果:针刺合谷穴诱导额叶和枕叶脑组织血流量和血流容积的增加;针刺太冲穴仅诱导颞叶脑组织血流量和血流容积的增加;针刺合谷配太冲穴诱导额叶和颞叶脑组织血流量和血流容积的增加.结论:针刺不同穴位激发不同脑区的脑组织变化,而两个穴位配伍并不是两个穴位引起脑组织fMRI功能改变作用的叠加,而是引起脑组织fMRI功能重新分布.     

FUNCTIONAL CONNECTIVITY OF HYPOTHALAMUS AND AMYGDALA IN RESPONSE TO ACUTE ACUPUNCTURE STIMULATION DURING FUNCTIONAL MAGNETIC RESONANCE IMAGING IN “OVERWEIGHT” MALES

Objective: This study explores how acupoints ST36 and SP9 and their sham acupoints acutely act on blood glucose, core body temperature, hunger and sensations pertaining to needling(De-qi) via the limbic system and dopamine to affect various brain areas.Methods: Adults and "overweight" Chinese males were observed with functional magnetic resonance imaging.Connectivity analysis included the amygdala(AMY) and hypothalamus(HYP) as regions of interest in the discrete cosine transforming and seed correlation analysis methods.Results: Most important overlapping regions for both real acupuncture and minimal sham acupuncture for the HYP included the medial frontal gyrus and precuneus(P=0.005, T=2.898) and for the left AMY they were the inferior frontal gyrus(orbital part)(P=0.005, T=2.898), temporal pole: superior temporal gyrus(P=0.005, T=2.898) and superior frontal gyrus(P=0.005, T=2.898).For the right AMY, the regions consisted of the inferior temporal gyrus, cerebellum crus 2, middle temporal gyrus, inferior frontal gyrus(opercular part), and supramarginal gyrus(P=0.005, T=2.898).Conclusion: Based on the other results, there was a significant difference in the spatial patterns of the distinct brain regions between the two treatment groups.This was an important study in addressing the acupuncture effects and brain pathways involved in the physiology and appetite regulation of an overweight population.     

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.METHODS: Seventeen healthy subjects accepted three needling manipulations stimulating the right Zusanli(ST 36) over separate days. Functional magnetic resonance imaging was used to detect changes in the brain during the manipulations, and then the needling sensations were recorded using the MGH acupuncture sensation scale(MASS) after each scan. f MRI data were processed using Statistical Parametric Mapping 8 to analyze the positiveand negative activation in the brain induced by different acupuncture manipulations.RESULTS: The individual needling sensations showed no statistically significant differences among the three manipulations. However, the MASS index showed that lifting-thrusting twirling plus lifting-thrusting twirling. Lifting-thrusting activated left premotor cortex, left postcentral,right middle frontal gyrus, left inferior frontal gyrus,right lingual gyrus, left insula, right putamen, bilateral cingulate gyrus and right cerebellum; and deactivated bilateral hippocampus and left caudate.Twirling activated bilateral orbital middle frontal gyrus, left opercular and triangular inferior frontal gyrus, and right middle occipital gyrus; and deactivated bilateral precuneus, right amygdala, left anterior cingulate gyrus, right inferior temporal gyrus,right middle frontal gyrus, right supplementary motor gyrus, and left postcentral. Twirling plus lifting-thrusting activated bilateral postcentral, left inferior occipital gyrus, left insula, left thalamus, left cingulate gyrus, and right putamen; and deactivated right superior frontal gyrus, right superior parietal gyrus, right temporal gyrus, right middle occipital gyrus, right insula, and left lingual gyrus. Pairwise comparisons of the three manipulations showed that signals induced by lifting-thrusting were the strongest, especially in the limbic system,followed by twirling plus lifting-thrusting; twirling alone was the weakest.CONCLUSION: Three methods of needling manipulations similarly activated areas associated with the somatosensory system, vision, cognition, and emotional regulation. This may have significant implications for acupuncture in clinical practice.     

针刺太冲调节抑郁症脑功能的静息态功能磁共振研究

目的:探讨针刺太冲穴前后抑郁症患者脑功能变化的差异。方法:选取符合DSM-IV诊断标准的首发中度抑郁症患者26例及健康志愿者13名,运用3.0T磁共振分别在针刺前后进行静息态功能磁共振扫描,采用比率低频振幅(fALFF)和功能连接的分析方法,各组进行配对t检验比较。结果:与针刺前比较,针刺后正常对照组右侧额叶(BA11)fALFF值降低,抑郁太冲组右侧额叶(BA6)、右侧额中回(BA10)、左侧额上回中部(BA32)、双侧顶下小叶(BA40)、右侧楔前叶(BA7)fALFF值降低,抑郁非穴组左侧顶叶(BA42)、右侧顶叶(BA40)、左侧枕叶(BA17)fALFF值降低,抑郁太冲组左侧前扣带回皮质(BA32)与双侧额叶(BA8、BA46)、右侧颞叶(BA22)、左侧后扣带回(BA23)、双侧顶叶(BA40、BA7)、双侧尾状核功能连接增强。结论:针刺太冲可影响多个脑区功能的变化,并作用于与抑郁症情感调节相关的脑区,这可能是针刺治疗抑郁症的机制。     

足三里穴中枢神经网络作用机制的静息态脑功能磁共振成像研究

目的:应用静息态磁共振成像技术的局部一致性探讨足三里穴的中枢神经网络作用机制。方法:选择12名青年健康志愿者,于针刺足三里前及针刺足三里拔针后25 min分别进行静息态脑功能磁共振成像扫描,应用脑功能成像局部一致性(regional homogeneity,ReHo)方法处理功能磁共振(fMRI)成像数据。结果:针刺拔针后25 min后右侧额中回、左侧额上回、右侧颞上回、后扣带回、右侧中央旁小叶、右侧苍白球、右侧枕中回、左侧额内侧回等脑区的ReHo值较针刺前增高;双侧中央后回、左侧枕中回、左侧颞中回、左侧颞下回、左侧梭状回、左侧中央旁小叶、右侧额内侧回等脑区的ReHo值较针刺前减低(P0.05,K值≥10)。结论:针刺足三里后额叶、颞叶、枕叶、扣带回相关脑区局部一致性发生改变,提示足三里的认知影响、镇痛及胃肠功能调节的中枢神经网络作用机制存在。     

Analysis of the differences in brain function response after acupuncture and moxibustion at Zúsānlĭ (足三里ST36) in the patients with functional dyspepsia based on fractional amplitude of low frequency fluctuation of rest functional magnetic resonance imaging

Objectiveto explore the differences in the central response after acupuncture and moxibusbution at Zúsānl? (足三里ST36) in treatment of functional dyspepsia (FD) based on the analysis of fractional amplitude of low frequency fluctuation (fALFF) of resting-state functional magnetic resonance imaging (rfMRI).Methodsa total of 60 patients with FD were randomized into an acupuncture group and a moxibustion group, 30 cases in each one. In the acupuncture group, acupuncture was applied to bilateral ST36. In the moxibustion group, moxibustion was exerted at bilateral ST36. The treatment was given once a day, 5 times a week, totally for 4 weeks in each group, including 20 treatments with acupuncture or moxibustion. Separately, before and at the end of treatment, rfMRI scanning was conducted in two groups. Using data processing assistant for resting-state fMRI (DPARSF) software and MATLAB data platform, rfMRI data were collected for preprocessing and fALFF analysis.Resultscompared with the data before treatment, after treated with acupuncture at ST36 in FD patients, fALFF value was reduced in the right superior frontal gyrus, left superior frontal gyrus, left inferior frontal gyrus, right cuneus, left precuneus, right middle occipital gyrus, left middle occipital gyrus, etc., and it was increased in the left parahippocampus, right parahippocampus, left cerebellum, etc (all P < 0.01). After treated with moxibustion, the remarkable increase of fALFF was not discovered in brain areas, but fALFF decreased significantly in the left superior parietal gyrus (P < 0.01). Compared with moxibustion at ST36, after acupuncture at ST36 in FD patients, the increase of fALFF appeared in the right putamen and the decrease of it occurred in the middle occipital gyrus, indicating the statistical significance (both P < 0.05).Conclusionthe differences in central function responses are induced in treamtent with acupuncture and moxibustion, which is probably related to the resting-state default network associated with targeted regulation and ventral attention of brain areas in functional dyspepsia.     

针刺中渚后溪穴脑功能性磁共振成像研究

目的：研究针刺中渚穴、后溪穴脑功能变化的规律和脑激活区的定住信息。为针灸治疗的中枢机制提供实验依据。方法：利用fMRI—BOLD技术，获取8位健康志愿者的中渚穴和后溪穴在行针状态下的脑功能变化图像。利用AFNI软件分析针刺中渚穴和后溪穴时脑功能变化的规律。结果：针刺左侧中渚穴和后溪穴主要引起扣带回、颞叶、小脑、枕叶等的激活。结论：针刺的镇痛效果可能是通过多个脑功能区的相互作用而产生的。     

针刺委中穴正电子发射计算机体层摄影/CT脑功能成像的观察

目的 应用正电子发射计算机体层摄影（PET）／CT脑功能成像技术,观察针刺委中穴在脑内引起的代谢变化,探讨针刺疗法的中枢调节机制。方法 电针刺激8名健康志愿者右侧委中穴,同时行PET／CT脑功能成像,采用相同扫描技术对同8名受试者行无任何穴位刺激的PET／CT脑功能成像。使用统计参数图（SPM）的配对t检验模型,对比针刺委中穴组与静息对照组的差异脑功能图。结果 根据布劳德曼区（Broadmann area,BA）,（1）针刺诱发的平均功能激活脑区：左侧BA10、11、22、38、39、40、44、45、46,右侧BA10,双侧BA19、18以及左侧小脑皮层、屏状核、岛叶（t〉3．36,P〈0．01,k〉30voxels）;（2）针刺诱发平均功能抑制脑区：双侧BA24,左侧BA7、8、19、40,右侧BA1、3、6、20、44和左侧黑质。结论 委中穴与大脑存在着一定的联系,针刺委中穴是通过激活和抑制有功能联系的多个特异脑功能区,并通过神经体液机制共同发挥作用。其中前额区、岛叶及小脑的功能激活和扣带回、顶叶及黑质的功能抑制分析是针刺委中穴的中枢调节机制之一。本研究证明,PET／CT脑功能成像技术有助于揭示中医经络理论,为针刺疗法提供中枢调节机制的可视性试验依据。     

头针对抑郁症患者脑葡萄糖代谢的影响

目的 运用正电子发射型计算机断层显像(PET)技术,观察头针对抑郁症患者不同脑区葡萄糖代谢的影响。方法 12例抑郁症患者均接受头针治疗,取穴为顶中线(MS5)、额中线(MSI)和双侧额旁1线(MS2)。电针前和治疗6周后分别接受PET检测。框取感兴趣脑区(ROI),将各脑区所得葡萄糖代谢放射性计数采用半定量方式进行治疗前后比较。结果 上述穴位头针能升高双侧额叶、双侧顶叶、右侧扣带回、右侧尾核和左侧小脑葡萄糖代谢,降低右侧颞叶、双侧丘脑葡萄糖代谢。结论 电针抑郁症患者顶中线、额中线和双侧额旁1线能影响不同脑区的葡萄糖代谢,初步表明头针治疗抑郁症的机理与其调整皮质一边缘通路功能障碍、提高脑区葡萄糖代谢有关。     

针刺百会水沟神门对血管性痴呆患者大脑皮层葡萄糖代谢的影响

目的：运用正电子发射型计算机断层显像（PET）技术，研究百会、水沟、神门针刺前后，血管性痴呆（VD）患者大脑皮层葡萄糖代谢的变化，从该穴组对脑功能成像的影响，分析其作用机制。方法：10例VD病人随机分为两组。A组治以针对偏瘫的常规穴位（手足三阳经为主），B组加用百会、水沟、神门，治疗前后所有病人均接受PET检测。划定VD患者双侧额叶（眶回）、双侧顶叶、双侧颞叶（海马及海马旁回）、双侧枕叶为感兴趣区。分析各区葡萄糖代谢水平，并进行治疗前后的比较。结果：治疗组患者针刺治疗后，双侧额叶、健脑颞叶的葡萄糖代谢升高具有统计学意义；常规针刺组患者治疗后，健脑颞叶的代谢升高具有统计学意义。结论：初步表明，百会、水沟、神门治疗VD的机理．与其改善额叶、颞叶的葡萄糖代谢有关。     

针刺阳陵泉对中风偏瘫患者感觉运动网络影响的fMRI研究

[目的]观察针刺阳陵泉对中风偏瘫患者感觉运动网络的影响特征,探讨针刺阳陵泉穴促进中风偏瘫脑功能重塑的作用机制。[方法]选择符合纳入标准的12例中风偏瘫患者和8名健康受试者,分别进行针刺阳陵泉前后的功能磁共振(fMRI)扫描,采用广义线性模型的方法对提取的感觉运动网络成分进行统计分析,并对比两组激活的脑区特点。[结果]与健康受试者相比,针刺阳陵泉后中风偏瘫患者感觉运动网络成分增强的脑区主要有右扣带回、右额上回、右额内侧回、右舌回、右小脑山坡以及左楔前叶和左顶上小叶,减弱的脑区主要有左前扣带回、左额上回、右额上回、左额中回、左额下回、左额内侧回、右额内侧回、左颞上回、左楔叶、左楔前叶。[结论]针刺阳陵泉穴可通过调节双侧大脑半球感觉运动网络相关脑区活动,增强感觉反馈对运动输出的作用,促进中风偏瘫患者脑功能重塑。     

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。     

针灸对缓解期精神分裂症患者脑功能效应影响的研究

目的:探讨针灸对缓解期精神分裂症患者的脑功能效应。方法:选取缓解期精神分裂症患者101例,随机分为对照组51例,治疗组50例。对照组给予抗精神病药物治疗,治疗组在精神药物基础上给予针灸治疗。观察两组患者的临床疗效。并对两组各随机抽取10例患者,进行治疗前后的静息态功能性核磁共振成像(fMRI)数据采集,判断其脑功能的效应。结果:与治疗前比较,两组患者CGI评分降低(P<0.05)。与对照组治疗后比较,观察组患者治疗后CGI评分明显降低(P<0.05)。fMRI结果的低频振幅(ALFF)分析,针灸治疗的显著作用主要体现在左侧枕顶叶。局部一致性(ReHo)分析,治疗组的显著提升区域为左侧枕叶舌回。结论:针灸可以提高缓解期精神分裂症患者的临床治疗效果,且对于患者的神经元自发活动具有相关激发效应,这为精神分裂症患者提供辅助治疗的方案,促进中西医结合临床方向的发展。     

针刺足临泣对偏头痛低频振荡振幅的影响

目的：应用功能磁共振明确针刺足临泣对无先兆偏头痛脑功能区域低频振荡振幅的特征性影响。方法：选取2015年1月至2016年2月北京中医药大学东直门医院神经内科和北京中医药大学东方医院针灸科门诊就诊的无先兆偏头痛患者19例作为研究对象,在针刺前后进行静息态功能磁共振成像,匹配的18例健康受试者进行一次无针刺的功能磁共振扫描作为对照。分析偏头痛患者和正常受试者脑功能区的低频振荡振幅值差异以及患者针刺前后低频振荡振幅值的变化。结果：与健康对照组比较,无先兆偏头痛患者低频振荡振幅值显著增强的脑区为海马、海马旁回、右侧颞上回等脑区,显著减弱的脑区为左侧楔叶、顶上回等脑区;与针刺前比较,针刺后低频振荡振幅值显著增强的脑区为右侧中央前回和中央后回,显著减弱的脑区为右侧楔前叶、额中回等脑区;与健康对照组比较,无先兆偏头痛患者针刺足临泣穴后低频振荡振幅值显著增强的脑区为右侧的中央前回、中央后回等脑区,显著减弱的脑区为左侧楔叶、楔前叶等脑区。结论:针刺足临泣穴对无先兆偏头痛多个脑区的功能活动异常的起特征性调节作用,这可能为针刺干预的疗效机制提供功能影像学支持。