| 李宇涛,牛晓敏,洪昆达,陈 剑,邱志伟,金灵璐,仲卫红.易筋经调控情绪缓解膝骨关节炎慢性疼痛的脑机制研究[J].中国康复医学杂志,2022,(11):1478~1484 |
| 易筋经调控情绪缓解膝骨关节炎慢性疼痛的脑机制研究 点此下载全文 |
| 李宇涛 牛晓敏 洪昆达 陈 剑 邱志伟 金灵璐 仲卫红 |
| 福建中医药大学，福建省福州市，350003 |
| 基金项目：中医骨伤及运动康复教育部重点实验室开放基金资助（ZD2020-2-2）；2019国家中医药管理局《中医药循证能力建设项目》（2019XZZY-GK001）；福建省康复技术重点实验室开放课题（KF2019027） |
| DOI：10.3969/j.issn.1001-1242.2022.11.007 |
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| 摘要： |
| 摘要
目的：观察膝骨关节炎患者易筋经干预前后，疼痛、焦虑以及脑区局部一致性（ReHo）的变化情况，探讨易筋经调控情绪缓解膝骨关节炎慢性疼痛的脑机制。
方法：将38例膝骨关节炎（KOA）慢性疼痛患者随机分配到易筋经组、静蹲组各19例，最终易筋经组18例，静蹲组16例完成试验。两组分别进行易筋经训练、静蹲训练，干预周期均为每周3次，每次30min，连续12周。所有受试者干预期间均未服用止痛药物。干预前后分别进行疼痛视觉模拟评分法（VAS）、汉密尔顿焦虑量表（HAMA）评分，并进行静息态fMRI扫描，分析组间、组内差异。
结果：12周干预后，两组患者VAS评分均有改善（P<0.05），易筋经组效果优于静蹲组（P<0.05）；易筋经组干预前后HAMA评分显著下降（P<0.05）。易筋经组干预后右侧颞极：颞中回、右侧颞下回、右侧颞中回、右侧枕中回、右侧中央沟盖、右侧脑岛、右侧距状裂周围皮层、右侧颞上回、右侧缘上回、右内侧和旁扣带脑回、左内侧和旁扣带脑回、左侧补充运动区、右侧中央后回、右侧中央前回等脑区ReHo值较干预前增强（P<0.05）；静蹲组干预后右侧梭状回ReHo值较干预前增加（P<0.05）；组间比较发现，易筋经组较静蹲组右内侧和旁扣带脑回、右侧角回、右侧顶上回等脑区ReHo值变化明显（P<0.05）。相关性分析发现，KOA慢性疼痛患者疼痛与焦虑呈正相关（P<0.05）；右侧角回、右内侧和旁扣带脑回激活峰值与疼痛程度呈负相关，与焦虑程度呈正相关（P<0.05）。
结论：易筋经能够缓解KOA慢性疼痛、焦虑症；KOA慢性疼痛严重程度与焦虑症相关；易筋经调节情绪相关脑区激活程度，从而缓解KOA慢性疼痛。 |
| 关键词：膝骨关节炎 慢性疼痛 易筋经 情绪 |
| Study on the brain mechanism of Yijinjing relieving chronic pain of knee osteoarthritis by regulating emotion Download Fulltext |
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| Fujian University of Traditional Chinese Medicine， Fuzhou， Fujian，350003 |
| Fund Project: |
| Abstract: |
| Abstract
Objective：To observe the changes of pain， anxiety and regional homogeneity (ReHo) in patients with knee osteoarthritis before and after Yijinjing intervention， and to explore the brain mechanism of Yijinjing emotion regulation to relieve chronic pain in knee osteoarthritis.
Method：Thirty-eight patients with chronic pain from knee osteoarthritis(KOA) were randomly assigned to the Yijinjing group and the static squatting group. Finally， the Yijinjing group (18 cases) and the static squatting group (16 cases) completed the experiment.The two groups were treated with Yijinjing training and squatting training respectively. The intervention period was 3 times a week， 30min each time， for 12 consecutive weeks.None of the subjects received analgesics during the intervention period.Visual analogue scale(VAS) and hamilton anxiety scale(HAMA) scores were performed before and after intervention， and resting state fMRI scans were performed to analyze the differences between and within groups.
Result：After 12 weeks of intervention， VAS scores in both groups were improved (P<0.05)， and the effect of Yijinjing group was better than that of static squatting group (P<0.05).The HAMA score of Yijinjing group was significantly decreased after intervention compared with before intervention (P<0.05).The Yijinjing group of KOA patients right temporal pole： middle temporal gyrus，right Inferior temporal gyrus， right middle temporal gyrus， right middle occipital gyrus， right rolandic operculum， right Insula， right calcarine fissure and surrounding cortex， right superior temporal gyrus， right supramarginal gyrus， right median cingulate and paracingulate gyri，left median cingulate and paracingulate gyri， left supplementary motor area， right postcentral gyrus， right precentral gyrus ReHo increase， compared with before (P<0.05).In the stationary squat group， there was an increase in ReHo in the right fusiform gyrus in patients with KOA(P<0.05).The difference of ReHo between the two groups before and after intervention showed that the changes of ReHo in the right median cingulate and paracingulate gyri，right angular gyrus， right superior parietal gyrus in the Yijinjing group were more significant than those in the stationary squat group(P<0.05).Correlation analysis showed that there was a positive correlation between pain and anxiety in patients with chronic pain (P<0.05).The activation peaks of right angular gyrus， right median cingulate and paracingulate gyri were negatively correlated with pain degree， and positively correlated with anxiety degree (P<0.05).
Conclusion：Yijinjing can relieve chronic pain and anxiety of KOA.KOA chronic pain severity was associated with anxiety.Yijinjing alleviates chronic KOA pain by regulating the activation of emotion related brain regions. |
| Keywords:knee osteoarthritis chronic pain Yijinjing emotion |
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