【作者】 王光彬；

【导师】 柳澄； 武乐斌；

【作者基本信息】 山东大学 ， 影像医学与核医学， 2005， 博士

【摘要】 研究目的: 利用磁共振成像(magnetic resonance imaging,MRI)平面回波序列(echo planar imaging,EPI)的血氧水平依赖(blood oxygenation level dependent,BOLD)技术分别对足阳明胃经(ST)、足太阳膀胱经(BL)、足少阳胆经(GB)、足太阴脾经(SP)的原穴、合穴配伍刺激后进行脑功能成像实验研究,并于上述4经脉原穴、合穴周围分别选取1个非穴位针刺点进行同样的实验作为对照,探讨针刺不同经脉原、合穴引起的脑功能变化及其各功能区在脑内定位的异同和分布规律,寻找解释中医针灸临床治疗效果可能的原因所在。 研究方法: 选择无任何中枢神经神经系统症状及体征的健康在校大学生、硕士研究生志愿者30名,其中男性18人,女性12人,年龄21～26岁,平均22.93岁。所有志愿者均为右利手,实验前1周内无任何服药史及针灸史,女性志愿者避免月经期实验。30名志愿者每人进行4次实验,共120人次。分别配伍针刺足阳明胃经、足太阳膀胱经、足少阳胆经和足太阴脾经4条经脉的原穴与合穴(即冲阳与足三里、京骨与委中、丘更多还原

【Abstract】 Objective:To explore the functional localization and its distributing orderliness of the central nervous system (CNS) reaction on acupuncture stimulations of the Yuan-Source and He-Sea acupoints together of stomach meridian of foot-yangming (ST), bladder meridian of foot-taiyang (BL), gallbladder meridian of foot-shaoyang (GB), spleen meridian of foot-taiyin (SP), and two false acupoints near Yuan-Source and He-Sea acupoints of the three yang meridians which were mentioned above, respectively, using magnetic resonance imaging (MRI), blood oxygenation level dependent (BOLD) of echo planar imaging (EPI) sequence. And try to explore the secrecies of clinical effect of Chinese traditional medicine.Material and method:Thirty right-handed volunteers without any symptom and sign of the central nervous system (male 18, female 12; age ranged 21 to 26 years old, average 22.93) who were studying on campus as students or postgraduates were selected to take part in our studies. All of them had no history of taking drug and acupuncture within one week. Female volunteers were asked to avoid acupuncture test during menses. Every persion of these 30volunteers was performed our acupuncture studied 4 times (120 totally). Each person was acupunctured Chongyang (ST42) and Zusanli (ST36), Jinggu (BL64) and Weizhong (BL40), Qiuxu (GB40) and Yanglingquan (GB34), Taibai (SP3) and Yinlingquan (SP9), which were Yuan-Source and He-Sea acupoints of ST, BL, GB, SP, respectively. All acupuncture tests were performed on right legs.The order of test was determined by drawing cuts randomly. Meanwhile, as the contrast studies, ten of them were underwent functional MRI (fMRI) by stimulating two false acupoints together near Yuan-Source and He-Sea acupoints of the three yang meridians. One false acupoint was the hollow located inferior and backside of right capitulum of fibula. Another point was the area where was one Cun interior to Qiuxu (GB40), and on the line between Qiuxu (GB40) and Shugu (BL65).Images were required on a 1.5-T unit (63 SP Magnetom Sonata Maestro Class; Siemens Medical Systems; gradient strength, 40 mT/m/s ). In each subject, after a sagittal scout sequence was performed, 35 slices axial images of the entire area of the whole brain paralleled to the AC-PC line were obtained. Imaging sequences included spin echo (SE) TiWI, gradient field mapping, and EPI (BOLD) were performed. The parameters of MR imaging included: slice thickness, 3 mm; slice gap, 0.3 mm; FOV, 200 mm. TiWI: TR=600 ms, TE=15 ms; Matrix, 256 x 256; FA, 70°; Bandwidth, 130Hz/Px; Scan time, 4 minutes and 54 seconds. Gradient field map: TR = 483 ms, TE = 5.19 ms; NEX, 1; FA, 60°; Matrix, 64x100; Bandwidth, 260 Hz/Px; Scan time, 1 min and 4 seconds. T2’ WI of BOLD: TR = 3000 ms, TE = 50 ms; NEX, 1; FA, 90°; Matrix, 64x100; Bandwidth, 2604 Hz/Px, Scan time, 12 minutes and 21 seconds; Measurements, 245.For acupuncture, a Multi-purpose Health Device G6805-2 (made in Shanghai) was used. The parameters of it consisted of wave, continuous;frequency, 2 Hz; voltage, 6 volt; electric current, 0.8 mAs-1.4 mAs. The stainless no-magnet acupuncture needles we used were brand of "Huatuo" (made in Suzhou, O 0.35 mm* 40 mm and O 0.35 mm * 13 mm).The experiments were designed as "rest-acupuncture- rest". From the first measurement to the 85th was called No.l rest, the 86th to the 65th measurement was acupuncture period, and the 166th to the 245th was called the second rest. The stimulation with electric current were started at the 86th measurement and stopped at the end of the 165th measurement. Electric needles were taken out at the beginning of the 166th measurement. All studies were undergone during 18:30 - 21:30 after dinner. The blood pressure, frequency of breath, and pulse were measured before test for every volunteer.Data were analyzed by using Statistical Parametric Mapping software (SPM99; Wellcome Department of Cognitive Neurology, London, UK) implemented in Matlab 6.0 (Mathworks Inc, Sherborn, MA). The datasets were normalized to a standard space (Montreal Neurologic Institute space, MNI) within SPM99. This space was based on a template Tl-weighted dataset, a close analog of Talairach space developed by the MNI. The temporal datasets were smoothed by using an isotropic Gaussian filter kernel having a full-width at half maximum of 8X8X8 mm the normalized voxel size. Statistical parametric maps were generated by using the general linear model to characterize regionally specific effects in the imaging data. Terms in the model included the activity condition (acupuncture) and the globle mean value of each temporal dataset. A boxcar reference waveform convolved with a kernel that approximates the hemodynamic response curve was used to test specific hypotheses, resulting in a f value at each voxel. For all studies, statistical thresholding at significance level of p< 0.001 and k>30 was initially used to determine significant activation foreach vexol.Results:"De-Qi" sensation was felt in all volunteers except two students felt no "De-Qi" effect in contrast group studies on stimulation of two false acupoints.The fMRI activation data are summarized as follows.Stomach meridian of foot-yangming (ST): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann 22, 40, 24, 30, 7, and cerebellum, bilaterally. Signal decrease was shown in Broadmann 11, 38, bilaterally; and right Broadmann 47, 36.Bladder meridian of foot-taiyang (BL): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann 22, 40, 24, 29, 7, 6, and thalamus, bilaterally; Left insula, and central anterior gyrus. Signal decrease was shown in Broadmann 11, 38, bilaterally; and right Broadmann 36.Gallbladder meridian of foot-shaoyang (GB): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann 22, 6, 40, 24, 30, 7, bilaterally. Signal decrease was shown in Broadmann 11, 38, 20, 36, bilaterally.Spleen meridian of foot-taiyin (SP): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann 22, 40, 24, 32, 7, and cerebellum, thalamus, bilaterally. Signal decrease was shown in Broadmann 11, 38, bilaterally.In contrast group studies, signal increase was demonstrated in Broadmann 22, 6, 24, 32, and cerebellum, insula, thalamus. Signal decrease regions were not significant.Conclusions:1. Signal increase and Signal decrease, which elicited by acupuncture stimulating the Yuan-Source and He-Sea acupoints together of ST, BL, GB, SP respectively, were demonstrated in multiple brain regions. They are not uniform completely.2. Multiple brain regions where were shown signal increase and signal decrease elicited by acupuncture stimulating are belonged to the "splanchnic brain". This result prompts that the clinical effect of ST, BL, GB, and SP might be accomplished by adjusting the "splanchnic brain".3. Broadmann 7 areas are activated in our all studies by acupuncture stimulating the Yuan-Source and He-Sea acupoints together of ST, BL, GB, SP. And cerebellum, thalamus, insula, Broadmann 20 and 36 are activated depending on different meridians.4. The most signal increase regions elicited by acupuncture stimulating the Yuan-Source and He-Sea acupoints together of ST, BL, GB, SP, are located in left cerebral and cerebellar hemispheres. Otherwise, the most signal decrease regions are shown in right cerebral and cerebellar hemispheres.5. "De-Qi" sensation and signal increase of multiple brain regions are also occurred in contrasting studies by stimulating false acupoints. But the size and number of signal increase regions are smaller and less. Signal decrease regions are not significant.更多还原