【作者】 李学智；

【导师】 梁繁荣；

【作者基本信息】 成都中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 目的：观察电针少阳经特定穴对偏头痛患者脑内葡萄糖代谢的影响,探索循经取穴干预偏头痛的脑内特异性响应特征,探讨经穴效应的脑内神经信息调制基础。方法：健康受试者8名,偏头痛（无先兆型,左侧痛）患者30例。将偏头痛患者随机分为3组：少阳经特定穴电针组、非穴电针组、偏头痛组,前两组分别应用电针刺激左侧少阳经穴及非穴进行治疗,少阳经特定穴选取风池、外关、阳陵泉,非穴选取上下肢的3个非经非穴点。治疗结束后,运用正电子发射计算机断层显像(¹⁸F-FDG PET)采集脑内葡萄糖代谢信号,健康受试者及偏头痛组不针刺直接行PET扫描。应用统计参数图（SPM2）软件分析电针经穴与非穴的脑内神经信息响应特征。结果：1.扫描后三组偏头痛患者的疼痛视觉模拟评分（VAS）均有降低,少阳经特定穴电针前后与非穴组、偏头痛组扫描前后比较,VAS评分的降低均有显著性差异（P<0.05）。2.偏头痛患者脑内葡萄糖代谢增高区主要见于同侧（左侧）脑干（脑桥及中脑）、双侧小脑前后叶、同侧枕叶的梭状回和舌回、双侧海马旁回及双颞叶部分区域；代谢减低区主要见于前额叶皮质、眶额叶皮质（BA11、47）、右扣带回前部（BA24、25）和左扣带回后部（BA23、31）、双侧顶下小叶和中央后回以及双侧颞叶部分区域。3.与偏头痛组相比,电针少阳经穴激活了对侧（右侧）岛叶（BA44、45）、对侧前扣带回、顶下小叶等区域,代谢减低区见于左右小脑、对侧海马旁回及基底核区、感觉运动皮质（中央前后回,BA3、6、40）；针刺后脑功能变化有回归正常的趋势。4.与偏头痛组相比,电针非穴激活了边缘系统的双侧海马旁回、扣带回后部、双侧顶叶缘上回、顶下小叶（BA40）、额叶（双侧BA4、6）、双侧颞叶、双侧枕叶梭状回、楔叶、楔前叶等区域；代谢减低区见于小脑前后叶、前额叶、海马旁回、右颞叶部分区域。与健康人相比,有明显的脑干、双侧顶枕叶（枕中回、枕上回、楔叶、楔前叶、顶上小叶,BA5、7、18、19）等代谢增高区以及前额叶皮质、右前扣带回等代谢减低区。结论：1.少阳经穴相对于非穴电针干预偏头痛显示出相对特异性的脑内神经信息响应特征。2.针刺少阳经穴可能通过脑干-丘脑-基底节-岛叶-边缘系统-皮质的综合调控网络发挥对偏头痛的镇痛效应。3.边缘系统中的前扣带回、海马旁回等结构,可能参与针刺的镇痛神经调制网络,但在针刺经穴和非穴不同刺激负荷下,其兴奋或抑制的性质、部位和强度可能不同。更多还原

【Abstract】 OBJECTIVE:To observe changes of glucose metabolism in migraineurs’brain associated with electroacupuncture stimulation at special points of ShaoYang meridian. To investigate the characteristic that central neurons respond to XunJingQuXue, and discuss the neurophysiological modulation mechanism of effects of stimulating at acupoints.METHORDS:The participants include 8 healthy volunteers and 30 migraineurs. Assigned migraineurs into 3 groups randomly, they are ShaoYang point group, non-point group and migraine group. Electroacupuncture was used to treat migraine in former two groups. The ShaoYang points we stimulated are Fengchi（GB20）,Waiguan（SJ5）, Yanglingquan（GB34）, the non-points are 3 spots locate at upper and lower limb.The instant analgesia effect of electroacupunture were observed and the glucose metabolism signals were recorded by ¹⁸F-FDG PET scanner. The participants in migraine group and the healthy ones reserved PET scan without electroacupuncture. The functional neuroimaging of glucose metabolism were analysed by Statistical Parameter Mapping （SPM） software.RESULTS:1.The visual analoge scale（VAS）of the headache descented in all three groups after PET scan, the analgesia effect of point electroacupuncture group was better than non-point group and the group without treating （P<0.05）.2.The activation areas of migraine include ipsilateral brainstem（pons and midbrain）. bilateral anterior and posterior lobes of celebellum, fusiform gyrus and lingual gyrus of ipsilateral occipital lobe,bilateral parahippocampus and parts of temporal lobe. The deactivate areas include prefrontal cortex, orbitofrantal cortex （BA1147）, right anterior cingulate cortex （BA24,25）, bilateral parietal lobe and temporal lobe.3. In the comparison of migraine group, ShaoYang points electroacupuncture stimuation elicited right insula （BA44,45）, anterior cingulate gyrus, there were decreaced areas of cerebral metabolism in bilateral cerebellum, right parahippocampus, basal ganglia and somatosensory-motor cortex （BA3,6,40）. The change of functional neuroimage has the trend of returning to normal state.4. Non-points electroacupuncture stimulation elicited activate areas in limbic system structures included bilateral parahippocampus and posterior cingulate cortex, bilateral supramarginal gyrus, inferior parietal lobe（BA40）, bilateral frontal lobe（BA4.6）, temporal lobe.fusiform gyrus, cuneus and precuneus lobe. Reduction in cerebral metabolism was seen in anterior and posterior lobe of cerebellum, prefrontal lobe, parahippocampus gyrus and contralateral temporal lobe. There are distinct activation areas on parietal Iobe and occipital lobe （BA5,7,18,19） and deactivation areas in prefrontal cortex in contrast to healthy ones.·CONCLUSIONS:1. Electroacupuncture stimulation at ShaoYang points to treat migraine showed comparatively special characteristics of cerebral neuronal responses. 2. The special cerebral pathway of network maybe includes brainstem-thalamus-basal ganglia-insula-limic system-cortex, through which to modulate acupoints’analgesia effects.3. A certain of regions of limbic system such as anterior cingulate and hippocampus maybe involved in the modulation network of analgesia of acupuncture,but not special to respond to point stimulation.更多还原