原络配穴协同调节偏头痛患者痛感受和痛情绪的脑基底节-皮层环路机制研究

Our previous NSFC program concluded the primary finding that Yuan-Luo acupoints combination exerts a higher impact on the intracranial neuroinformatics processing system than its nil control, it's capable of modulating the local anterior cingulate cortex(ACC)-insula functional network. Based on this, we further raise the hypothesis that 'Yuan-Luo acupoint combination yields integrative effect, the key of that to benefit migraineurs through regulating their pain perception and emotional distress of pain is the specific modulation to the structure, function and receptors of basal ganglia-cortical loop'. Featuring on the pain perception and emotional distress of pain, this study focuses on the integrative healing effect of Yuan-Luo acupoint combination for experimental subjects, chronic migraineurs. We would like to conduct qualitative, locational, and quantitative analyses on three different levels as brain structure, brain function, and cerebral receptors, respectively, by integrated functional and structural MRI and receptor PET imaging technology. The technological organization of multiple disciplinary research domains such as acupuncture, neuroimaging, biomedical engineering, and molecular biology, equipped us to basically compare Yuan-Luo acupuncture with Yuan acupoint, Luo acupoint, and non-acupoint, respectively, and to investigate its specific influential pattern on clinical efficacy, neurotransmitters, and central circuit of acupuncture for migraineurs. This study may provide us further evidence to deepen and widen our knowledge on the differences and similarities, and their correlations of Yuan-Luo acupoint combination, single Yuan acupoint, and Luo acupoint, in their effect on related brain basal ganglia-cortical loop, and therefore it could elucidate the scientific connotation of the integrated effect of Yuan-Luo acupoint combination.

在已完成的国家自然科学基金中，项目组采用脑功能成像技术，初步得出原络配穴针刺对偏头痛患者脑内神经信息调节强度比非原络配穴强，可调节前扣带回-脑岛局部功能网络。本项目在此基础上，紧密围绕"原络配穴针刺产生协同效应，改善偏头痛患者痛感受和痛情绪的关键环节是对脑基底节-皮层环路结构、功能和受体水平的特异性调节"的工作假说，以偏头痛患者为研究对象，从原络配穴协同效应入手，以痛感受和痛情绪为突破口，融合结构功能MRI和受体PET成像技术，从脑结构、脑功能和脑受体3个层次进行定性、定位和定量分析；依托针灸学、神经影像学、生物医学工程、分子生物学等多学科技术手段，研究原络配穴针刺与原穴、络穴和非穴比较，对偏头痛患者从临床效应-神经递质-中枢环路的特异性影响模式，深入挖掘原络配穴协同效应与单独针刺原穴、络穴对应的脑基底节-皮层环路调节模式的异同和相关性，阐释原络配穴协同效应产生的科学内涵。

原络配穴是针灸临床治疗偏头痛的有效配穴方法之一。深入研究原络配穴针刺治疗对偏头痛患者异常脑功能调节的模式，并分别与非经非穴、原穴和络穴比较其调节效应和调节模式的异同，对阐释原络配穴协同调节的中枢机制具有重要意义。通过本项目研究发现，不同病程偏头痛患者大脑功能可塑性改变不同，中枢神经系统异常与病程累积有关。随着偏头痛患者病程的增加，偏头痛相关功能连接的损伤会以疼痛感知回路为核心，向疼痛情感和疼痛认知评价网络扩展。月经性偏头痛患者大脑前扣带回、后扣带回和楔前叶的灰质密度显著降低，且患者前扣带回的灰质密度与LH的浓度呈显著正相关；患者楔前叶的灰质密度与5-HT的浓度呈显著负相关，与HIT-6得分呈显著负相关。患者双侧尾状核的ALFF值较健康受试者显著增高，颞中回和楔前叶的ALFF值显著降低；且楔前叶的ALFF值与前列腺素的浓度呈显著负相关，颞中回的ALFF值与VAS值呈显著正相关；患者双侧海马ReHo值显著降低，且海马与左侧DLPFC、双侧丘脑、双侧杏仁核、左侧颞中回和右侧小脑功能连接度显著降低，其中海马-DLPFC的功能连接度与病程呈负相关。原络配穴针刺后可显著增强海马-DLPFC的功能连接度，并与患者头痛发作次数和头痛发作程度的改善密切相关。非经非穴组针刺后显著降低海马-前扣带回的功能连接度，且与焦虑情绪的改善密切相关；络穴组针刺后显著降低海马-额上回的功能连接度，且与焦虑情绪的改善密切相关。