针刺治疗原发性痛经的中枢神经响应特征的提取与多模态验证

Primary dysmenorrhea (PDM) is a common gynecological disease. Though acupuncture is significantly effective for the treatment of primary dysmenorrhea, its central mechanism requires further elucidation. In this study, based on the presentation of functional and anatomical abnormality in patients with PDM and our pre-experimental outcomes, together with central integration of acupuncture analgesia as key point, we therefore hypothesize that 'central analgesia effect of acupuncture treating PDM has a close relationship with modulation of OFC-ACC functional cerebral network'. Thus we plan to combine BOLD-fMRI and MRSI organically to explore the mechanism of acupuncture stimulation at Sanyinjiao (SP6). The OFC, ACC etc. and other disease-relevant brain regions are interested regions we would like to observe. Then subsequently analyze data with methods of ReHo and functional connectivity, etc. We will extract characteristics of cerebral responses to acupuncture stimulation at SP6 versus sham acupuncture, and construct functional cerebral network based on it. We also would cross verify results of BOLD-fMRI and MRSI. Hence we anticipate further unveiling the scientific connotation of acupuncture stimulation at Sanyinjiao (SP6) for treating PDM, which may furthermore provide more subjective and visualized evidence to support and promote its clinical practice. Finally, the outcomes may elicit great significance in terms of both academic importance and practical value, to facilitate its clinical application of acupuncture treating PDM.

原发性痛经(PDM)是妇科临床常见病，针灸治疗PDM疗效显著，优势明显，但其中枢作用机制有待深入阐释。本课题基于PDM患者存在皮质中枢功能和结构的异常、针刺镇痛效应中枢整合是关键，结合前期预实验结果，提出"针刺治疗PDM中枢镇痛效应与调节额眶皮层-前扣带回大脑功能网络有关"的研究假说。研究拟以针刺三阴交为研究对象，融合运用BOLD-fMRI与MRSI技术，以OFC和ACC等与PDM病情相关的结构异常脑区为感兴趣区，综合运用局部一致性、功能连接度等数据分析方法，以针刺非穴位为对照，在提取针刺三阴交治疗前后PDM患者中枢信息响应特征的基础上，构建大脑功能网络，并与MRSI结果进行交叉验证，以期为揭示针刺治疗PDM的中枢作用机制提供客观、可视化证据。研究结果将对促进针灸治疗PDM临床推广有着重要的科学意义和实用价值。

针刺治疗原发性痛经（PD）具有显著临床疗效，但是其神经影像机制仍不明确。本研究在评价针刺治疗PD临床疗效的基础上，通过脑内神经信息的检测、提取，挖掘针刺治疗PD的神经信息特征，发现大脑在静息状态下左侧前扣带回、右侧枕上回、左侧丘脑、右侧距状裂周围皮层、左侧脑岛、左侧舌回、右侧楔叶存在ReHo信号改变，且以左侧海马为种子点的静息脑网络中左侧海马与左侧眶额回、右侧丘脑、左侧脑岛、右侧中央后回、右侧海马的功能连接度发生改变，右侧海马为种子点的静息脑网络中左侧海马与左侧眶额回、右侧丘脑、左侧脑岛、右侧中央后回的功能连接度发生改变；与非穴相比，针刺三阴交治疗后功能连接有所显著改善。而在脑代谢方面，由于样本量较小以及针刺时间较短等原因，痛经受试者与健康受试者，针刺穴位与非穴治疗前后暂时未发现显著性差异。本研究为从脑功能、脑网络及脑代谢角度对针刺镇痛效应机理做进一步阐释，为针刺的临床运用提供更为充分的科学依据。