青少年偏头痛早期诊断与针刺疗效影像学研究

How to treat migraine attack, relieve pain intensity and reverse brain dysfunctional activity caused by migraine, has bothered patients and their clinicians for long time. The lack of objective and effective early diagnostic criteria restrict the development of migraine treatment. In this study, we aim to detect the neuroimaging marker of early diagnosis in adolescent migraine suffers, and based on our findings we investigate clinical effect of acupuncture therapy in these patients. By apply the one-year longitudinal research methods, pain-related empathy experimental design and multimodal neuroimaging techniques, the interaction between headache activity development and brain morphological changes were investigated. We also study the relationship between abnormal resting state brain activity and pain-related image induced brain responses in migraine patients. By combining an objective neuroimaging analysis and clinical headache activity measurements, the brain functional-structural alterations which are closely related to migraine activity and migraine progression are treated as disease biomarker in the current study. A multivariate pattern analysis (MVPA) classifier was used to evaluate the power of neuroimaging markers for categorizing migraine patients from different time points. By using the regression model analysis, the psychological factors are also considered. We hypothesis that the brain alterations related to psychological factors may not always arise secondarily to headache activity; it may be in a vicious cycle of more brain disturbances and increased psychological symptoms. Acupuncture is a commonly used therapy for treating migraine, although the mechanism remains unclear. After two month acupuncture therapy on same group of migraine patients, we consider the question whether the real acupuncture is more effective than nonpenetrating placebo needles for the reduction of headache activity. If we have a positive result, the second objectives of this study were to investigate the differences in brain changes evoked by acupuncture and sham acupuncture and to explore the possible correlations between brain responses and clinical efficacy.

如何规范治疗偏头痛发作、减轻偏头痛导致的功能损害，一直困扰着患者和临床工作者，当前缺乏客观有效的早期诊断标准及症状发展标记是制约偏头痛临床治疗的重要原因。本课题针对青少年偏头痛早期诊断的客观需求，结合多时间点纵向研究实验设计、疼痛相关移情任务刺激和多模态神经影像数据采集，研究不同症状发展程度下病患大脑形态学改变与疼痛认知行为异常之间的交互关系，试图建立青少年偏头痛症状逐步发展与大脑结构-功能异常改变关联模型；借助多变量模式分类算法，验证所构建影像学模型特征是否能够高正确率预测青少年偏头痛患者中枢持续性变化和头痛活动，优化青少年偏头痛早期诊断影像学特征；基于纵向研究偏头痛大脑结构-功能异常影像学标记，结合针刺治疗偏头痛临床头痛参数改善，探寻针刺是否调控以及如何调控这些靶点达到治愈目的，将有助于为针刺疗法的世界推广和应用提供客观、科学的证据。

在本项目的资助下，申请人以偏头痛为研究对象，针对临床早期诊断的客观要求，考察患者临床治疗前基线下大脑结构、功能个体差异影像学特性，及长期疼痛在中枢神经系统中的累积特征，初步建立大脑结构-功能持续性异常变化与疾病症状关联影像学标记；在上述基础上，系统、科学地阐明杏仁核-前额叶连接回路的影像学结构特性可预测针刺安慰剂干预偏头痛的疗效差异，未来继续深入研究针刺干预组的针刺效应，进一步采用线性预测模型，考察去除安慰剂效应后是否存在针刺疗效的影像学预测标记，为针刺治疗的推广应用提供科学的证据。当前，在本项目的资助下，共发表SCI检索论文13篇，相关研究成果获得中国体视学学会科学技术奖自然科学一等奖，团队原创白质纤维束统计分析计算平台授权国家发明专利一项。