基于fMRI初探宁神通窍法针刺对主观性耳鸣患者前扣带回与全脑功能连接的调控作用

张雅婷; 查必祥; 石海平; 樊吟秋; 郑云子; 戎志豪; 杨骏

doi:10.13703/j.0255-2930.20230628-0003

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基于fMRI初探宁神通窍法针刺对主观性耳鸣患者前扣带回与全脑功能连接的调控作用

针灸影像临床与基础 | 更新时间：2024-06-03

- 基于fMRI初探宁神通窍法针刺对主观性耳鸣患者前扣带回与全脑功能连接的调控作用
- Exploring the regulatory effect of acupuncture for Ningshen Tongqiao on the functional connectivity between the anterior cingulate cortex and the whole brain in the patients with subjective tinnitus based on fMRI
- 中国针灸 2024年44卷第1期页码：12-18
- 作者机构：
  
  1.安徽中医药大学第一临床医学院，合肥 230038
  2.安徽中医药大学第一附属医院
- 作者简介：
  
  张雅婷，安徽中医药大学博士研究生。E-mail：894011724@qq.com
  杨骏，主任医师、教授。E-mail：yangjunacup@126.com
- 基金信息：
  
  黑龙江省中医药科研项目(ZHY2022-167);黑龙江中医药大学科研基金面上项目(201814);孙申田青年人才基金项目(ky-201809);黑龙江省自然科学基金项目(LH2020H092);国家自然科学基金面上项目(82074539);黑龙江省中医药科研课题项目(ZHY2022-136);黑龙江省中医药学会2022-2024年度青年人才托举工程项目(2022-QNRC1-05);黑龙江省自然科学基金项目优秀青年项目(YQ2023H019)
- DOI：10.13703/j.0255-2930.20230628-0003
  中图分类号：
- 收稿：2023-06-28，
  
  网络首发：2023-10-17，
  
  纸质出版：2024-01-12
- 稿件说明：
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张雅婷,查必祥,石海平等.基于fMRI初探宁神通窍法针刺对主观性耳鸣患者前扣带回与全脑功能连接的调控作用[J].中国针灸,2024,44(01):12-18.

ZHANG Yating,ZHA Bixiang,SHI Haiping,et al.Exploring the regulatory effect of acupuncture for Ningshen Tongqiao on the functional connectivity between the anterior cingulate cortex and the whole brain in the patients with subjective tinnitus based on fMRI[J].Chinese Acupuncture & Moxibustion,2024,44(01):12-18.
张雅婷,查必祥,石海平等.基于fMRI初探宁神通窍法针刺对主观性耳鸣患者前扣带回与全脑功能连接的调控作用[J].中国针灸,2024,44(01):12-18. DOI： 10.13703/j.0255-2930.20230628-0003.

ZHANG Yating,ZHA Bixiang,SHI Haiping,et al.Exploring the regulatory effect of acupuncture for Ningshen Tongqiao on the functional connectivity between the anterior cingulate cortex and the whole brain in the patients with subjective tinnitus based on fMRI[J].Chinese Acupuncture & Moxibustion,2024,44(01):12-18. DOI： 10.13703/j.0255-2930.20230628-0003.

摘要

目的

采用静息态功能磁共振成像（fMRI）探究宁神通窍法针刺对主观性耳鸣患者前扣带回（ACC）与全脑功能连接的影响。

方法

招募40例主观性耳鸣患者和40例健康受试者。主观性耳鸣患者予宁神通窍法针刺治疗，穴取哑门、百会及患侧听宫、头窍阴、率谷，听宫、头窍阴连接电针仪，使用疏密波，频率2 Hz/50 Hz。隔日针刺1次，每周针刺3次，共治疗10次。分别于治疗前后观察主观性耳鸣患者耳鸣评价量表（TEQ）、耳鸣残疾评估量表（THI）、耳鸣视觉模拟量表（VAS）评分，并评定临床疗效。主观性耳鸣患者分别在治疗前后2 d内进行1次fMRI扫描，健康受试者纳入后进行1次fMRI扫描。将双侧ACC作为感兴趣区域（ROI），采用matlab R2017b软件计算ACC和全脑之间的功能连接（FC）。

结果

治疗后，主观性耳鸣患者TEQ、THI、VAS评分均较治疗前降低（

0.01），总有效率为92.5%（37/40）。治疗前，与健康受试者比较，主观性耳鸣患者右侧ACC与左侧颞中回、左侧颞上回、左侧额上回FC降低。治疗后，与健康受试者比较，主观性耳鸣患者右侧ACC与左侧额中回、双侧角回FC降低；左侧ACC与左侧额中回、左侧丘脑、左侧角回、左侧颞中回FC降低。与治疗前比较，主观性耳鸣患者治疗后右侧ACC与左侧舌回、左侧丘脑FC降低；左侧ACC与右侧额中回、右侧额上回FC降低。

结论

针刺可有效改善主观性耳鸣患者临床症状，促进颞叶、额叶、丘脑等听觉及情绪相关脑区功能重组。

Abstract

Objective

To explore the effect of acupuncture for

Ningshen Tongqiao

(tranquilizing the spirit and unblocking the orifices) on the functional connectivity (FC) between the anterior cingulate cortex (ACC) and the whole brain in the patients with subjective tinnitus using the resting-state functional magnetic resonance imaging (fMRI).

Methods

Forty patients with subjective tinni

tus and 40 healthy subjects were recruited. The patients with subjective tinnitus were treated with acupuncture for

Ningshen Tongqiao

at Yamen (GV 15) and Baihui (GV 20)

as well as Tinggong (SI 19)， Touqiaoyin (GB 11) and Shuaigu (GB 8) on the affected side; and Tinggong (SI 19) and Touqiaoyin (GB 11) were attached to the electric acupuncture apparatus and stimulated with disperse-dense wave and 2 Hz/50 Hz in frequency. Acupuncture was operated once daily

3 times a week and 10 treatments were required. Before and after treatment

the scores of tinnitus evaluation questionnaire (TEQ)

tinnitus handicap inventory (THI) and tinnitus visual analogue scale (VAS) were evaluated; and the clinical therapeutic effect was assessed. Separately

the patients with subjective tinnitus received one time of fMRI within 2 days before and after treatment

and the healthy subjects underwent one time of fMRI after enrollment. The bilateral ACC was taken as the region of interest (ROI). Using matlab R2017b software

FC between ACC and the whole brain was calculated.

Results

After treatment

the scores of THI

TEQ and VAS were reduced in the subjective tinnitus patients compared with those before treatment (

0.01); and the total effective rate was 92.5% (37/40). Before treatment

compared with the healthy subjects

FC between the right ACC and the left middle temporal gyrus

the left superior temporal gyrus and the left superior frontal gyrus decreased in the subjective tinnitus patients. FC between the right ACC and the left middle frontal gyrus and the bilateral angular gyrus was dropped

while that between the left ACC and the left middle frontal gyrus

the left thalamus

the left angular gyrus and the left middle temporal gyrus was decreased in the subjective tinnitus patients when compared with the healthy subjects after treatment. Compared with those before treatment

FC between the right ACC and the left lingual gyrus and the left thalamus were declined

and

that between the left ACC and the right middle frontal gyrus and the right superior frontal gyrus was decreased in the subjective tinnitus patients after treatment.

Conclusion

Acupuncture can effectively relieve the clinical symptoms of subjective tinnitus patients

and promote the functional re-construction of the auditory regions (temporal lobe

frontal lobe and thalamus) and the emotion-related brain regions.

关键词

Keywords

references

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