| 徐 婷,戴德纯,薛 琴,吕 莹,屠建春.基于静息态fMRI的针刺治疗慢性非特异性腰痛脑功能重塑机制[J].中国康复医学杂志,2025,(4):542~549 |
| 基于静息态fMRI的针刺治疗慢性非特异性腰痛脑功能重塑机制 点此下载全文 |
| 徐 婷 戴德纯 薛 琴 吕 莹 屠建春 |
| 昆山市中医医院，江苏省昆山市，215300 |
| 基金项目：昆山高层次医学人才柔性引进团队项目（01201802）；江苏省重点研发计划项目（BE2021675）；江苏省中医药科技发展项目（MS2022086） |
| DOI：10.3969/j.issn.1001-1242.2025.04.010 |
| 摘要点击次数: 111 |
| 全文下载次数: 62 |
| 摘要： |
| 摘要
目的：基于静息态fMRI观察慢性非特异性腰痛（CNLBP）脑功能活动特点，探讨针刺治疗可能存在的脑功能重塑机制。
方法：纳入接受诊治的22例CNLBP患者为CNLBP组、22例健康受试者（HCs）为HCs组。采集CNLBP组在针刺治疗前后的疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、腰椎JOA评分（JOA）及所有被试的静息态fMRI数据。提取治疗前CNLBP组与HCs组差异脑区的低频振幅分数（fALLF）值，与VAS、ODI、JOA评分的差值进行相关性分析。
结果：针刺治疗可以显著改善CNLBP组VAS、ODI、JOA评分（P<0.001）；治疗前CNLBP组右侧眶部额中回/右侧前扣带回/左侧前扣带回、左侧楔前叶的fALFF值较HCs组增高，右侧中央前回/右侧中央后回、左侧中央前回/左侧中央后回、右侧丘脑、右侧中央后回/右侧中央前回和左侧丘脑的fALFF值较HCs组减低；治疗后CNLBP组右侧中央前回/中央后回、左侧中央前回/中央后回、左侧颞中回的fALFF值较治疗前增高，左内侧额上回、右侧楔前叶/左侧楔前叶的fALFF值较治疗前减低；治疗前CNLBP组右侧眶额中回/右侧前扣带回/左侧前扣带回的fALFF值与VAS评分差值呈明显负相关（r=﹣0.699，P=0.000）。
结论：针刺治疗可以有效改善CNLBP的疼痛强度和腰椎功能障碍程度；CNLBP存在多个与痛觉内外侧调节通路及默认模式网络（DMN）相关脑区功能活动异常；针刺治疗可恢复大部分异常的脑区活动；CNLBP治疗前右侧眶额中回/右侧前扣带回/左侧前扣带回脑功能活动特征（fALFF值）与VAS评分差值相关，为疗效预测提供了潜在的影像学标志物。 |
| 关键词：慢性非特异性腰痛 静息态功能磁共振成像 针刺 |
| The potential mechanism of brain functional remodeling in acupuncture treatment in patients with chronic non-specific low back pain based on resting-state fMRI Download Fulltext |
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| Kunshan Hospital of Chinese Medicine，Kunshan，Jiangsu，215300 |
| Fund Project: |
| Abstract: |
| Abstract
Objective： To observe the characteristics of brain functional activity in patients with chronic non-specific low back pain （CNLBP） and to explore the potential mechanism of brain functional remodeling in acupuncture treatment based on resting-state fMRI.
Method： The 22 patients with CNLBP were included as the CNLBP group， and 22 healthy subjects （HCs） were included as the HCs group. The visual analogue scale （VAS） for pain， Oswestry disability index （ODI）， Japanese Orthopedic Association （JOA） score for lumbar spine were collected before and after acupuncture treatment in the CNLBP group. Resting-state fMRI data were acquired for all participants. The fractional amplitude of low frequency fluctuation（fALFF） values of the different brain regions in CNLBP patients before treatment compared with the HCs group were extracted and correlated with the differences in VAS， ODI， and JOA scores.
Result：Acupuncture treatment significantly improved the VAS， ODI， and JOA scores in the CNLBP group （P<0.001）；Before treatment， the CNLBP group showed higher fALFF values in the right orbital middle frontal gyrus, right anterior cingulate gyrus, left anterior cingulate gyrus and left precuneus compared to the HCs group， while lower fALFF values were observed in the right precentral gyrus/right postcentral gyrus， left precentral gyrus/left postcentral gyrus， right thalamus， right postcentral gyrus/precentral gyrus， and left thalamus. After treatment， the CNLBP group exhibited increased fALFF values in the right precentral gyrus/postcentral gyrus， left precentral gyrus/postcentral gyrus， and left middle temporal gyrus, and decreased fALFF values in the left medial superior frontal gyrus， right precuneus/left precuneus compared to pre-treatment. Additionally, pre-treatment fALFF value in the right orbital part of the middle frontal gyrus, right anterior cingulate gyrus and left anterior cingulate gyrus in the CNLBP group was negatively correlated with the changes in VAS scores（r=﹣0.699， P=0.000）.
Conclusion： Acupuncture treatment can significantly improve pain intensity and lumbar spinal dysfunction in CNLBP. CNLBP has multiple abnormalities in brain functional activities related to pain regulation pathways and the default mode network （DMN）， and acupuncture treatment can restore most of these abnormal brain activities； the characteristic of brain functional activity in the right orbital part of the middle frontal gyrus, right anterior cingulate gyrus and left anterior cingulate gyrus before CNLBP treatment is related to the difference in VAS score， providing a potential imaging biomarker for predicting treatment efficacy. |
| Keywords:chronic nonspecific low back pain resting-state functional magnetic resonance imaging acupuncture |
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