【作者】 杨洁；

【导师】 梁繁荣；

【作者基本信息】 成都中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 目的：本研究以偏头痛为疾病载体,观察循经取穴对发作期偏头痛患者脑内葡萄糖代谢的影响,探索循经取穴针刺即时镇痛效应的中枢机制,为循经取穴治疗偏头痛的临床运用提供依据。方法：将纳入的40例急性期偏头痛患者,随机分为4组,少阳经特定穴组(A组,又称本经特定穴组,选取风池、外关、阳陵泉),阳明经特定穴组(B组,又称他经特定穴组,选取头维、偏历、足三里),少阳经非特定穴组(C组,又称本经非特定穴组,选取颅息、三阳络、膝阳关)和偏头痛患者对照组(D组,不接受针刺治疗),每组10例。本经特定穴组、特经特定穴组和本经非特定穴组患者接受一次针刺治疗,偏头痛患者组不接受针刺治疗。对受试者针刺前后的头痛强度分级和VAS评分进行评估,观察不同取穴针刺对发作期偏头痛患者的即时镇痛效应。同时以正电子发射计算机断层扫描(Positron Emission Tomography-Computed Tomography, PET-CT)技术为研究手段,应用统计参数图(SPM2)软件,通过对比三个针刺组针刺后的脑葡萄糖代谢与偏头痛患者脑葡萄糖代谢差异的不同,探讨循经针刺对偏头痛患者即时镇痛效应的中枢机制。结果：1、四组偏头痛患者在性别、年龄、体重、身高、扫描前血糖、头痛发作时长、扫描前头痛强度分级和VAS评分等的基线一致,具有可比性；2、不同针刺方法对发作期偏头痛患者的及时镇痛效应评估,结果显示：①三个针刺组(A、B、C组)针刺后头痛强度分级分别较针刺前相比均有显著性差异(P<0.05),偏头痛对照组PET-CT扫描前后头痛强度分级相比差异无统计学意义(P>0.05)；经针刺治疗后,A组的头痛强度分级显著低于其他三组(P<0.05),C组头痛强度分级显著低于D组(P<0.05),B组和D组相比,差异无统计学意义(P>0.05)。②经针刺治疗后,各组头痛强度改善分值表现为A组>B、C组>D组, A组显著优于B、C、D三组(P<0.05),B组和D组相比有显著性差异(P<0.05),C组和D组相比有显著性差异(P<0.05),B组和C组相比,差异无统计学意义(P>0.05)。③三个针刺组(A、B、C组)针刺后VAS评分分别较针刺前相比均有显著性差异(P<0.05),偏头痛对照组PET-CT扫描后VAS评分较扫描前相比有显著性差异(P<0.05)；经针刺治疗后,VAS评分有A组<C组<B组<D组的趋势,且A组VAS评分显著低于B组(P<0.05)和D组(P<0.05),A组和C组相比,差异无统计学意义(P>0.05),B组和D组相比,差异无统计学意义(P>0.05),C组和D组相比,差异无统计学意义(P>0.05),B组和C组相比,差异无统计学意义(P>0.05)。④经针刺治疗后,各组VAS改善分值表现为A组>C组>B组>D组,其中A组显著优于其他三组(B、C、D组)(P<0.05),B组和D组相比有显著性差异(P<0.05),C组和D组相比有显著性差异(P<0.05),B组和C组相比,差异无统计学意义(P>0.05)。3.不同取穴针刺对偏头痛患者脑功能活动的影响有所差异,其中：①本经特定穴组针刺后与偏头痛患者相比颞中回(BA 17)、脑岛(BA 13)、额中回(BA 9,10)、楔前叶(BA31,39)、前扣带回(BA32)、中扣带回(BA31)和后扣带回(BA23,31)葡萄糖代谢增高；海马、旁海马、梭状回(BA 18,19)、中央后回(BA2)、小脑葡萄糖代谢降低；②本经非特定穴组针刺后与偏头痛患者相比额中回(BA6,11)、中央后回(BA7)、楔前叶(BA7)、中扣带回(BA32)、旁海马(BA34,35)和小脑葡萄糖代谢增高；额中回(BA21)葡萄糖代谢降低；③他经特定穴组针刺后与偏头痛患者相比颞中回(BA21)、中扣带回(BA31)葡萄糖代谢增高；梭状回(BA18,19)、小脑葡萄糖代谢降低。结论：1、不同取穴针刺方法对发作期偏头痛患者均有即时镇痛效应,且表现出循经特定穴取穴>循经非特定穴取穴>他经取穴的趋势；2、循经取穴与循经非特定穴、循经特定穴与他经取穴对偏头痛患者脑功能活动的影响均存在显著差别,这种差别主要体现在循经特定穴对偏头痛患者脑功能尤其是对前扣带回、脑岛、海马、旁海马等与疼痛相关脑区的影响更为明显。更多还原

【Abstract】 Objective:To observe the changes of cerebral glucose metabolism by puncturing at the acupoints on the involved meridian for migraine patients in the attack stage and explore the central mechanism of instant analgesic effect of puncturing at acupoints on the involved meridian for migraine patients.Methods:40 patients who matched the inclusion criteria were randomly divided into 4 groups. Three groups were administered puncturing at different acupoints:Group A: specific acupoints on the involved meridian(GB20,SJ5,GB34);Group B:acupoints on the non-involved meridian(ST8,LI6,ST36);Group C:non-specific acupoints on the involved meridian(SJ19,SJ8,GB33). Group D was waiting-list group. The former three groups were administered acupuncture treatment once. Headache intensity grading and VAS were assessed before and after acupuncture treatment to observe instant analgesic effect of puncturing at different acupoints. Positron emission tomography-computed tomography (PET-CT) was performed to detect the cerebral glucose metabolism among 40 patients after the first administration of puncturing. Then the difference among them was analyzed by SPM2, which was used to discuss the central mechanism of instant analgesic effect of puncturing at acupoints on the involved meridian for migraine patients.Results:1. The baseline of glucose, headache intensity grading and VAS before scanning, gender, age, weight, height, attack duration were no difference and comparable.2. Different instant analgesic effects of different puncturing methods before and after acupuncture treatment:①Headache intensity grading:Group A. Group B and Group C was of statistical significance(P<0.05); Group D was of no statistical significance (P>0.05);Group A was apparently lower than those of the other three groups (P<0.05);Group C was apparently lower than that of Group D (P<0.05); No statistical significance was found between Group B and Group D.②Headache intensity improvement:Group A> Group B、C> Group D; Group A was significantly better than the other three groups (P<0.05); Apparent statistical significance was found between Group B and Group D(P<0.05); Apparent statistical significance was found between Group C and Group D (P<0.05); No statistical significance was found between Group B and Group C (P>0.05)③VAS:Group A, Group B and Group C was of statistical significance(P<0.05); Group D was of statistical significance (P<0.05); The tendency of Group A<Group C<Group B<Group D was found; Group A was much lower than Group B (P< 0.05) and Group D (P<0.05), and no difference with Group C (P>0.05); No significance was found between Group B and Group D (P>0.05); No significance was found between Group C and Group D (P>0.05); No significance was found between Group B and Group C (P>0.05)④VAS improvement:Group A>Group B>Group C>Group D; Group A was significantly better than the other three groups (P<0.05); Significance was found between Group B and Group D (P<0.05); Significance was found between Group C and Group D (P<0.05); No significance was found between Group B and Group C (P>0.05)3. The characters of cerebral activities in migraine patients①The difference in cerebral activities between Group A and Group D: Compared to the Group D, the patients in Group A showed increased glucose metabolism in Middle Temporal(BA 17)、Insula(BA 13)、Medial Frontal(BA 9,10)、Precuneus(BA31,39)、ACC(BA32)、MCC(BA31)和PCC(BA23,31); decreased glucose metabolism in Left Hippocampus, Parahippocampal Gyrus, Fusiform Gyrus(BA18,19), Postcentral Gyrus(BA2) and Cerebellum;②The difference in cerebral activities he difference in cerebral activities between Group C and Group D:Compared to the Group D, the patients in Group C showed increased glucose metabolism in Middle Frontal (BA6,11)、Postcentral Gyrus (BA7)、Precuneus (BA7)、MCC (BA32)、Parahippocampus (BA34,35)和Cerebellum; decreased glucose metabolism in Middle Temporal (BA21)③The difference in cerebral activities he difference in cerebral activities between Group B and Group D:Compared to the Group D, the patients in Group B showed increased glucose metabolism in Middle Temporal (BA21) and MCC(BA31); decreased glucose metabolism in Fusiform Gyrus (BA18,19) and Cerebellum.Conclusions:1 Different puncturing method has instant analgesia effect in different degree, while the analgesia effect of puncturing at specific acupoints on the involved meridian was superior to that of puncturing at acupoints on the non-involved meridian.2 The effect of puncturing at the acupoints on the involved meridian and non-involved meridian to cerebral activities differed significantly. The difference primarily was reflected by the influence of specific acupoints in the involved meridian to cerebral activities, especially to regions related with pain, including Middle Cingulate Gyrus, Posterior Cingulate Gyrus, Insula, Hippocampus, and Parahippocampal Gyrus, etc更多还原