基于功能磁共振成像技术研究踝三针对第5腰椎神经根性痛镇痛作用的中枢机制

目的运用静息态功能磁共振成像(fMRI)技术,阐明踝三针对腰椎间盘突出症第5腰椎(L5)神经根性痛镇痛的中枢作用机制。方法对10名腰椎间盘突出症L5神经根性痛患者分别进行第1次静息态功能磁共振扫描、针刺踝三针之"根痛2"穴位后功能像扫描和第2次静息态功能像扫描,应用相关软件对获得的试验图像和数据进行分析和处理。结果纯静息态激活的脑区有双侧的旁中央小叶、扣带回、丘脑、枕叶,及第三脑室周围、视交叉、中脑导水管周围灰质、小脑蚓等部位。针刺时激活的脑区有双侧枕叶、颞叶、顶叶,中脑的左侧,小脑也有散在性的激活区域。出针后激活的脑区有双侧颞叶、丘脑左侧、胼胝体压部、视交叉、右侧内囊、脑桥、中脑导水管周围灰质等部位。结论 L5神经根性痛使大脑功能区发生变化,静息态默认网络的活动受到抑制,活动水平下降。针刺"根痛2"穴位后,其信号通过神经通路到达相应的脑功能区,使之被激活或者抑制,产生镇痛效应。

Central mechanism of analgesic effect of Huaisanzhen on L5 nerve root pain based on functional magnetic resonance imaging

Objective To illuminate the central mechanism of analgesic effect of Huaisanzhen on nerve root pain of the fifth lumbar vertebra (L5) of lumbar disc herniation (LDH) by applying resting functional magnetic resonance imaging (fMRI).Methods The patients (n=10) with L5 nerve root pain of LDH were given the first resting fMRI, then acupuncture in acupoint of Gentong 2 of Huaisanzhen, and finally the second resting fMRI.The obtained test imagines and data were analyzed and processed by using relevant software.Results The brain regions activated by pure resting state included bilateral paracentral lobules, cingulate gyrus, thalamus and occipital lobe, third periventricular zones, optic chiasm, midbrain periaqueductal gray and cerebellar vermis and other parts.The brain regions activated by acupuncture included bilateral occipital lobe, temporal lobe, parietal lobe and left side of the midbrain, and some scattered activation regions in cerebellum.The brain regions activated after acupuncture included bilateral temporal lobe, left thalamus, splenium of corpus callosum, optic chiasm, right internal capsule, pons, midbrain periaqueductal gray and other parts.Conclusion L5 nerve root pain causes the changes of brain function areas, and activities and active levels of resting state default network are inhibited and reduced.After acupuncture in acupoint of Gentong 2, the signals reaches the functional regions of brain through nerve pathways and they were activated or inhibited resulting in analgesic effect.