从肝论治针刺调节围绝经期失眠情绪中枢整合效应研究

Primary insomnia and mood disorder are closely related.Surveys revealed that perimenopausal insomnia is mostly affected by negative emotion such as anxiety, depression,etc. Our recent research indicates that acupuncture has curative effect on primary insomnia by treating from liver,and has obvious advantages on mood disorders. But the specific mechanism is unclear.Studies have shown that emotional center and sleep mechanism are strongly coupled. The evidence also indicates that there has abnormal neural function of brain emotion circuit of insomnia patients. This project based on treating perimenopausal insomnia patient,study on the analyzing the neural functional variety such as connection between the amygdala and the important encephalic regions of emotion circuit,apply the fMRI techniques and sleep monitor methods,research the variation characteristics of cranial neural signal which is integrated at emotion circuit and has response.The variation is under the control of cortical area after the accumulative continued effects of acupuncture to the body. Aim to reveal the integrated mechanism of emotional center of treating perimenopausal insomnia from liver by acupuncture，and provide visual theory basis from neuroimaging aspect.

临床上围绝经期失眠和情绪障碍密切相关。调查显示焦虑、抑郁等负性情绪是影响围绝经期失眠的主要原因。前期研究证实从肝论治针刺对失眠疗效显著且改善情绪障碍优势明显，但其中枢机制尚未明确。相关研究显示情绪中枢与睡眠机制密切相关，并且失眠患者的情绪环路存在神经功能异常。因此，本项目以围绝经期失眠患者为研究对象，以情绪中枢环路的神经功能变化为切入点，应用fMRI技术结合睡眠监测分析方法，研究针刺持续积累效应作用于机体后，在情绪中枢的调节作用下，脑神经信号在情绪神经环路得到整合并进一步产生应答后的变化特征，旨在揭示从肝论治针刺调节围绝经期失眠的情绪中枢整合效应机制，从神经影像学角度为从肝论治针刺治疗围绝经期失眠提供可视化的理论依据。

临床上围绝经期失眠和情绪障碍密切相关。本项目以围绝经期失眠患者为研究对象，应用fMRI技术结合睡眠监测分析方法，以脑区局部一致性(ReHo)和低频振幅(ALFF)变化为指标，研究患者在从肝论治针刺治疗下的中枢脑区响应特征，并结合临床疗效探讨该疗法可能的中枢作用机制，从神经影像学角度为从肝论治针刺治疗围绝经期失眠提供可视化的理论依据。. 结果：.1.临床指标结果显示，治疗组（针刺组）和对照组（药物组）均可有效改善患者PSQI评分、HAMA评分、HAMD评分（P<0.05)，治疗组在HAMD评分的改善上优于对照组（P<0.05)；睡眠结构方面，治疗组在深睡眠占比和REM占比的改善上优于对照组（P<0.05)。.2.脑功能成像特征结果显示，围绝经期失眠患者在双侧小脑，枕叶的舌回、枕下回，边缘叶和前扣带回等脑区的ALFF显著下降（P<0.05，alphasim已校正）。.3.治疗后脑功能变化结果显示，治疗组患者的右侧小脑 、额叶、额中回、中央前回等脑区ALFF显著升高（P<0.05，alphasim已校正），双侧小脑、前额叶、额中回、中央旁小叶等脑区的ReHo显著升高（P<0.05，alphasim已校正），对照组患者均为检测出有显著意义的ALFF变化及ReHo变化情况（P>0.05)。.4.fMRI指标与临床指标的相关性分析结果显示，治疗组的HAMA与ReHo指标呈负相关趋势（p=0.0857），其它指标的变化均未检测出相关性或趋势。. 结论：.1.从肝论治针刺可有效缓解围绝经期失眠症状，改善情绪障碍，优化睡眠结构。.2.围绝经期失眠可能与情绪脑区的功能减退有关，从而导致视觉功能和协调、平衡功能减退。.3.从肝论治针刺可能通过调节额叶的情绪整合功能改善围绝经期失眠，从而相应的改善患者的协调、运动、平衡功能。