针刺三阴交对痛经患者脑葡萄糖代谢的影响

目的：探讨针刺三阴交治疗痛经的中枢作用机制。方法：对6例痛经患者行经疼痛时行右侧三阴交假针刺和针刺，用数字疼痛强度分级法比较刺激前后疼痛情况，并在假针刺和针刺时利用正电子发射断层摄影技术（positron emission tomograph，PET）对痛经患者行埔F—FDG脑功能成像，用SPM软件分析，获得针刺激活的脑解剖功能区。结果：假针刺前后疼痛值差异无显著性意义（P〉0．05），针刺三阴交后疼痛值比针刺前明显降低（P〈0．01）。针刺右侧三阴交引起痛经患者多个与疼痛相关脑区被激活，针刺使同侧豆状核（苍白球、壳）、同侧小脑、同侧岛叶、双侧背侧丘脑、同侧中央旁小叶、双侧杏仁体、对侧中脑黑质、双侧第Ⅱ躯体感觉区、同侧海马回、同侧扣带回前部、对侧下丘脑乳头体葡萄糖代谢增强，大脑皮质小区域葡萄糖代谢降低。结论：针刺三阴交能明显缓解痛经患者疼痛，其机理为针刺三阴交可激活皮质、皮质下边缘系统和小脑与疼痛相关脑区，可能通过平衡与疼痛有关的中枢网络而减轻疼痛，神经内分泌也可能在治疗中起作用。

Effect of acupuncture at Sanyinjiao (SP 6) on glucose metabolism in the patient of dysmenorrhea

OBJECTIVE: To investigate the central modulating mechanism of acupuncture at Sanyinjiao (SP 6) in treatment of primary dysmenorrhea. METHODS: 18F-FDG positron emission tomograph imaging of whole brain was performed in six patients with primary dysmenorrhea during two stimulation: pseudo acupuncture and real acupuncture at Sanyinjiao (SP 6). The areas of cerebral glycometabolism change were obtained by using statistical parametric mapping (SPM). Meanwhile the pain intensity before and after pseudo-acupuncture and real acupuncture was assessed with 0-10 numerical pain intensity scale. RESULTS: No differences in the values of pain before and after pseudo-acupuncture (P > 0.05). The value of pain after acupuncture was significantly lower than that before acupuncture (P < 0.01). Most of the activated brain areas were shared with the areas activated by pain as described in the literature. The brain areas of increasing glycometabolism were ipsilateral lentiformn nucleus (globus pallidus, putamen), cerebellum and insula, bilateral thalamus, ipsilateral paracentral lobule, bilateral amygdala, contralateral midbrain, bilateral second somatosensory cortex, ipsilateral hippocampus and anterior cingulate, contralateral mammillary body. The brain areas of decreasing glycometabolism were limited in small cerebral cortex. CONCLUSION: Acupuncture at Sanyinjiao (SP 6) can relieve significantly the pain of the patient. Primary dysmenorrhea is cured mainly by activating the area involved in pain. It is indicated that acupuncture can relieve pain and balancing the pain-related central networks. Also neuroendocrine may play a role in the therapy.