摘要
目的:基于静息态功能磁共振成像(rs-fMRI),观察调神法电针治疗慢性疲劳综合征(CFS)伴焦虑抑郁共病的局部一致性(ReHo)及功能脑网络的变化。方法:纳入医护人员群体中30例CFS伴焦虑抑郁共病患者作为观察组;招募性别、年龄、受教育年限相匹配的医学高校学生群体中30例健康受试者作为对照组,不进行任何针刺干预。观察组予调神法电针治疗,选取主穴孙氏头部情感区、腹针一区、腹针八区,配穴百会、关元,双侧足三里、三阴交,分别连接G6805-Ⅱ型电针治疗仪,予连续波,频率2 Hz,强度为患者最大耐受度,每次电针30 min,每天1次,连续治疗6 d,休息1 d,共2周(12次)。比较观察组治疗前后与对照组多维疲劳量表(MFI-20)、抑郁自评量表(SDS)、焦虑自评量表(SAS)、匹兹堡睡眠质量指数量表(PSQI)评分。采集观察组治疗前后及对照组基线期的rs-fMRI数据,分析调神法电针治疗对CFS伴焦虑抑郁共病患者ReHo及功能脑网络的影响及与临床量表的相关性。结果:观察组治疗前MFI-20综合性疲劳、躯体疲劳、精神疲劳、动力下降、活动下降5个维度评分及总分与SDS、SAS、PSQI评分均较对照组升高(P<0.05)。除MFI-20动力下降维度外,观察组治疗后MFI-20各维度评分及总分与SDS、SAS、PSQI评分均较治疗前降低(P<0.05)。与治疗前比较,观察组治疗后ReHo值增大的脑区为右侧楔前叶,ReHo值减少的脑区有左侧颞下回、左侧角回。与对照组比较,观察组治疗前ReHo值增大的脑区有左侧大脑下叶、半球间、右侧枕叶、丘脑,ReHo值减小的脑区有左侧颞中回、右侧中央后回、右侧颞中回、右侧眶部额中回、中央旁小叶、右侧梭状回。观察组治疗前右侧丘脑与左侧中央后回、右侧海马、右侧梭状回之间的功能连接减少,治疗后右侧丘脑与左侧中央后回、右侧梭状回之间的功能连接重新建立。与对照组比较,观察组治疗前右侧丘脑与左侧中央后回、右侧海马、右侧梭状回存在功能连接减少,治疗后右侧丘脑与海马间存在功能连接减少。差异脑区与MFI-20、SAS、SDS、PSQI评分进行Spearman相关分析,左侧颞中回、中央旁小叶、右侧楔前叶、左侧颞下回与以上临床量表间存在部分正相关,半球间区、丘脑、右侧梭状回、右侧颞中回与以上临床量表间存在部分负相关。结论:CFS伴焦虑抑郁共病患者存在多个脑区ReHo下降、局部脑功能网络连接数量减少,调神法电针治疗可能通过调节异常脑区及激活情感相关脑区从而改善患者临床症状。
Objective To observe the changes in the regional homogeneity(ReHo)and functional brain network in treatment of chronic fatigue syndrome(CFS)with anxiety and depression comorbidity with the mind-regulation electroacupuncture(EA),using resting-state functional magnetic resonance imaging(rs-fMRI).Methods Thirty CFS patients with anxiety and depression comorbidity were enrolled from medical staffs as the observation group.The other 30 healthy subjects were recruited from medical university students as the control group,matching gender,age and education years with the observation group.No any acupuncture intervention was delivered in the control group,and EA for regulating the mind was operated in the observation group.Main points were the emotional area of Sun's scalp acupuncture,the regions 1 and 8 of Sun's abdominal acupuncture.Supplementary acupoints included Baihui(GV 20),Guanyuan(CV 4)and bilateral Zusanli(ST 36)and Sanyinjiao(SP 6).The needles at the above points were attached to G6805-Ⅱelectric acupuncture apparatus,with continuous wave,2 Hz in frequency and the maximal tolerable intensity depending on patients.Each EA took 30 min,once daily and lasted for consecutively 6 days.The duration of intervention was 2 weeks(12 treatments)at the interval of 1 day.The scores of multidimensional fatigue inventory-20(MFI-20),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and Pittsburgh sleep quality index(PSQI)were compared before and after treatment in the two groups.The rs-fMRI data were collected before and after treatment in the observation group,as well as at the baseline in the control group separately.The effects of the mind-regulation EA therapy was analyzed on ReHo and functional brain network in CFS patients with anxiety and depression comorbidity,as well as the correlation between differential brain region and clinical scales.Results The scores of the five domains in MFI-20(i.e.general fatigue,physical fatigue,mental fatigue,reduced motivation and reduced activity),the total score of MFI-20,and the scores of SDS,SAS and PSQI in the observation group before treatment were higher than those of the control group(P<0.05).Except the score of reduced motivation in MFI-20,the scores of the other domains and the total score of MFI-20,as well as the scores of SDS,SAS and PSQI after treatment were lower than those before treatment in the observation group(P<0.05).Compared with the values before treatment,ReHo value was increased in the the right precuneus and decreased in the left inferior temporal gyrus and the left angular gyrus of the brain in the observation group after treatment.In the observation group,when compared with the control group,ReHo values were increased in the left inferior cerebral lobe,the interhemispheric region,the right occipital lobe and the thalamus;and it was reduced in the left middle temporal gyrus,the right posterior central gyrus,the right middle temporal gyrus,the right orbital middle frontal gyrus,the paracentral lobule and the right fusiform gyrus before treatment.In the observation group,the functional connectivity was decreased between the right thalamus and the left posterior central gyrus,the right hippocampus and the right fusiform gyrus before treatment,respectively;it was re-constructed after treatment between the right thalamus and the left posterior central gyrus,and the right fusiform gyrus.Compared with the control group,the functional connectivity between the right thalamus and the left posterior central gyrus,the right hippocampus,and the right fusiform gyrus was reduced before treatment;while after treatment,the functional connectivity was reduced between the right thalamus and the hippocampus in the observation group.With Spearman correlation analysis between the differential brain regions and the scores of MFI-20,SAS,SDS and PSQI,it was found that the left middle temporal gyrus,the paracentral lobule,the right precuneus,and the left inferior temporal gyrus had a partial positive correlation with the above clinical scales;and the interhemispheric region,the thalamus,the right fusiform gyrus,and the right middle temporal gyrus showed a partial negative correlation.Conclusion There is the decrease of ReHo in many brain regions and the numbers of the local brain functional network connectivity in CFS patients with anxiety and depression comorbidity.The mind-regulation electroacupuncture therapy may relieve the clinical symptoms of the patients through adjusting the abnormal brain regions and activating emotionrelated brain regions.
作者
曾祥新
冯楚文
张沐华
程为平
孙忠人
杨添淞
ZENG Xiangxin;FENG Chuwen;ZHANG Muhua;CHENG Weiping;SUN Zhongren;YANG Tiansong(Clinical Medical School of Chinese and Western Medicine,Heilongjiang University of CM,Harbin 150006,China;Department of Acupuncture and Moxibustion,Second Affiliated Hospital of Heilongjiang University of CM,Harbin 150001;Department of Acupuncture and Moxibustion,First Affiliated Hospital of Heilongjiang University of CM,Harbin 150040)
出处
《中国针灸》
CAS
CSCD
北大核心
2024年第1期3-11,共9页
Chinese Acupuncture & Moxibustion
基金
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
黑龙江省自然科学基金项目优秀青年项目:YQ2023H019
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。
关键词
慢性疲劳综合征
焦虑抑郁共病
调神法针刺
电针
功能磁共振
chronic fatigue syndrome(CFS)
anxiety and depression comorbidity
acupuncture for regulating the mind
electroacupuncture
functional magnetic resonance imaging(fMRI)
