基于“肝主宗筋”理论治疗心理性ED的边缘系统网络整合机制

“Liver governs the tendons” is the important theoretical basis of Traditional Chinese Medicine for treating sexual dysfunction. With the guidance of this theory, using the Caihushugan powder to treat psychologic erectile dysfunction (ED) by soothing the stagnant liver qi has good effect, but the mechanism remains unclear. Recent studies and our researches indicated that limbic system played an important role in the central pathological changes of psychologic ED. So this study centers on the hypothesis "the central mechanism of the soothing-stagnant-liver-qi therapy treating for psychologic ED might associate with regulating the brain networks especially the cerebral activities of limbic system", and aims to (1)investigate the brain network responses to different therapies including Caihushugan powder, Tadalafil and placebo by functional magnetic resonance imaging (fMRI), and (2) analyze the correlation between cerebral responses and clinical variable so as to provide scientific evidence for the clinical application of Chinese Medicine based on the theory “Liver governs the tendons” for sexual dysfunction and a new approach of exploring the mechanism of Chinese Medicine therapy from the brain networks.

“肝主宗筋”是中医治疗性功能障碍的重要依据，基于该理论以疏肝解郁法治疗心理性勃起功能障碍（ED）疗效肯定，但其机理尚不明确。既往和我们前期研究表明，边缘系统结构和功能异常是心理性ED患者中枢病变的重要特征。因此，本研究以心理性ED患者为对象，以疏肝解郁代表方柴胡疏肝散为治疗手段，以在性行为中枢调控中起关键作用的边缘系统为重点，密切围绕“对以边缘系统为主的脑功能网络的调节是基于‘肝主宗筋’治疗心理性ED的重要中枢机制”这一假说，运用经典的功能磁共振技术，分别提取柴胡疏肝散、他达拉非、安慰剂三种干预手段所引起的脑功能网络和效应指标变化特征等，通过先进的脑网络模式分析与数据融合分析方法，建立基于“肝主宗筋”理论治疗心理性ED的边缘系统网络整合模型，为中药治疗性功能障碍的临床运用提供客观的可视化依据，为从复杂网络探讨中医传统治法的中枢机制提供新思路。

中药治疗心理性勃起功能障碍疗效确切，但作用机制尚不明确。本研究以60例肝气郁结型心理性勃起功能障碍（psychological Erectile Dysfunction，pED）患者和30例自然健康人为研究对象，综合运用高分辨率T1结构磁共振成像、基于血氧依赖水平的功能磁共振成像研究肝气郁结型pED患者的脑结构和功能活动特征；而后将60例肝气郁结型pED患者随机分为柴胡疏肝散组、他达拉非组、安慰剂治疗组，在评价临床疗效的基础上，比较不同干预方法治疗对患者脑功能活动的影响。研究结果发现，肝气郁结型pED患者存在边缘系统等自主神经调控中枢的结构和功能活动显著异常；柴胡疏肝散可有效调节前脑岛、海马、中扣带回等边缘系统核心脑区的脑功能活动，且相较于他达拉非组和安慰剂组治疗，柴胡疏肝散对肝气郁结型pED患者异常脑功能活动的调节更加显著，调节范围也更广。该研究结果表明：对前脑岛、海马、中扣带回等边缘系统核心脑区的调节是柴胡疏肝散可能的共同中枢机制。