【作者】 吴焕淦； 包春辉； 刘鹏； 刘慧荣； 吴璐一； 金小明； 施茵； 曾晓清； 马丽黎； 张建业； 秦伟； 田捷；

【Author】 Huangan WU;Chunhui BAO;Peng LIU;Huirong LIU;Luyi WU;Xiaoming JIN;Yin SHI;Xiaoqing ZENG;Lili MA;Jianye ZHANG;Wei QIN;Jie TIAN;Shanghai Research Institute of Acupuncture and Meridian,Shanghai University of Traditional Chinese Medicine;Life Sciences Research Center,School of Life Sciences and Technology,Xidian University;Stark Neurosciences Research Institute,Indiana University School of Medicine;Zhongshan Hospital,Fudan University;Department of Radiology,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine;

【机构】 上海市针灸经络研究所； 西安电子科技大学； Stark Neurosciences Research Institute Indiana University School of Medicine； 复旦大学附属中山医院； 上海市精神卫生中心；

【摘要】 研究目的:前期研究提示脑中枢神经系统异常可能在克罗恩病(CD)的病理生理学中扮演重要角色。电针和艾灸是一项治疗胃肠疾病临床技术,但效应机制尚不明确。本研究旨在观察电针和艾灸疗法治疗缓解期克罗恩病患者大脑响应的相似和不同之处,并探讨与临床疗效之间可能的相关性。研究方法:共纳入52例CD患者与36例健康受试者(HCs),并将36例愿意接受针灸干预的患者按1:1的比例随机分为接受电针或艾灸治疗12周,静息态功能磁共振成像(rs-f MRI)用来检测所有CD患者与健康受试者之间以及电针和艾灸治疗前后脑局部一致性(Re Ho)值的变化。克罗恩病活动指数(CDAI)和炎症性肠病问卷(IBDQ)评分用来评估疾病严重度和生活质量。研究结果:(i)CD患者静息状态下多个脑区的Re Ho值与健康受试者相比存在差异,脑皮层Re Ho值显著增加,而皮层下Re Ho值显著降低,脑皮层和皮层下之间偶联下降。(ii)经过治疗后,电针和艾灸两组患者的CDAI评分均显著降低,IBDQ评分均显著增加,两组之间比较无显著差异。两组患者脑皮层和皮层下异常的Re Ho值均被纠正,两者的偶联增强。两组的中扣带回、背外侧前额叶、中央前回、中央后回、辅助运动区以及颞极Re Ho值的变化率均与降低的CDAI评分具有显著相关性。此外,电针组的丘脑、前扣带回、脑岛和海马Re Ho值的变化量以及艾灸组的内侧前额叶和后扣带回Re Ho值的变化量也与降低的CDAI评分具有显著相关性。研究结论:电针和艾灸疗法治疗缓解期CD患者的大脑响应具有相似和不同之处。对偶联下降的皮层-皮层下脑区功能活动的调节可能是两者大脑响应的共同之处。对稳态传入加工网络更为显著的调节可能是电针疗法大脑响应的重要体现;对默认模式网络(DMN)更为显著的调节可能是艾灸疗法大脑响应的重要体现。更多还原

【Abstract】 Objectives: Abnormalities in the central nervous system might play a central role in Crohn’s Disease(CD). The aim of this study was to investigate the similarities and differences in brain response to electro-acupuncture and moxibustion in CD patients in remission and to evaluate the possible correlations between brain responses to electro-acupuncture and moxibustion with clinical outcomes. Methods: Thirty six CD patients were randomly assigned to receive either the electro-acupuncture or moxibustion treatment, in a 1:1 ratio, over a course of twelve weeks. 36 healthy subjects did not receive any treatment and were used to compare with CD patients before treatment. Resting state functional magnetic resonance imaging(rs-f MRI) was used to assess changes in Regional Homogeneity(Re Ho) levels before and after electro-acupuncture and moxibustion treatment. Crohn’s Disease Activity Index(CDAI)and Inflammatory Bowel Disease Questionnaire(IBDQ) scores were used to evaluate the severity of the disease and the quality of life. Results:(i) The Re Ho level in CD patients at resting state increased significantly in the cortex but declined significantly in the subcortical area, and the coupling between the cortical and subcortical areas also declined.(ii) There were significant decreases in CDAI scores and increases in IBDQ scores in both electro-acupuncture and moxibustion treatment groups, but there were no significant differences between the two treatment groups in both scores. The abnormal Re Ho values in cortical and subcortical regions were normalized in both treatment groups, leading to enhanced coupling between these brain regions. Changes of Re Ho value in middle cingulate cortex, dorsolateral prefrontal cortex, precentral cortex, postcentral cortex, supplementary motor area and temporal pole were significantly correlated with decrease of CDAI scores.Moreover, changes in the Re Ho values of the thalamus, anterior cingulate cortex, insula and hippocampus in the electro-acupuncture group, as well as those of the medial prefrontal cortex and posterior cingulate cortex in the moxibustion group, were also correlated with reduced CDAI scores.Conclusions: The brain shows similarities and differences in response to electro-acupuncture and moxibustion in CD patients in remission. Regulation of the cortex-subcortical regions of the brain with decreased coupling may be a shared pattern of the brain response to electro-acupuncture and moxibustion treatment in CD patients. Regulation of the homeostatic afferent processing network may be the primary pattern of brain response to electro-acupuncture, while regulation of the default mode network may be the primary pattern of brain response to moxibustion.更多还原