针刺对IBS患者大脑相关情绪调控区域脑功能磁共振成像影响的研究

发布时间：2018-03-17 05:04

  本文选题：肠易激综合征　切入点：脑功能成像　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.探讨与焦虑情绪有关的脑部功能活动和IBS发病的相关性2.通过观察针刺治疗对IBS患者脑部功能活动的影响探讨针刺治疗IBS的机制。方法:选取15例健康志愿者为对照组,15例IBS患者为针刺治疗组,对治疗组患者进行每周3次,共6周的"调神健脾"针刺治疗,治疗组患者在治疗前后各接受1次静息态功能磁共振检查,对照组接受1次静息态功能磁共振检查。观察针刺治疗前后患者的IBS-SSS评分、HAMA评分的变化情况;观察IBS患者和对照组不同频段下低频振幅的静息态脑部功能变化情况。然后选取有显著差异的频率,并用此频率比较针刺治疗前后患者脑部功能变化情况,最后将感兴趣脑区和汉密尔顿焦虑量表进行相关性分析,观察两组治疗前后的差别。结果:1.治疗前和健康对照组比较,具有频段的主效应,在全脑的神经活动无差异,而组间主效应具有显著差异,脑区是右侧颞中回、左侧额中回、右侧额中回、右侧额上回、前扣带回(P0.05)。其中右侧颞中回的神经活动IBS组较健康人下降,而左侧额中回、右侧额中回、右侧额上回、前扣带回的神经活动IBS组较健康人升高。具有交互效应的脑区主要分布在右侧颞中回、左侧中央后回,并且试验组治疗前的神经活动较健康对照组升高(P0.05)。2.针刺治疗前和治疗后患者的IBS-SSS总评分及腹痛程度、腹痛天数、排便满意度、生活影响度四个维度评分,经配对样本t检验P0.01,有极显著统计学意义;腹胀程度评分治疗前与治疗后比较P0.05,无统计学意义。针刺治疗前后IBS患者的HAMA评分经配对样本t检验有显著差异(P0.01)。3.slow-4频段下,针刺治疗前后患者的脑部功能活动存在差异,其中左侧额中回、左侧丘脑治疗后神经活动较治疗前下降(P0.05),左侧颞上回治疗后神经活动较治疗前升高(P0.05);slow-5频段下,左侧前扣带回治疗后的神经活动较治疗前下降(P0.05),左侧颞上回的神经活动治疗后较治疗前升高(P0.05)。4.slow-4、slow-5频段下,治疗前感兴趣脑区左侧颞上回、左侧丘脑的ALFF值和HAMA之间存在正相关性,左侧额中回、左侧前扣带回、左侧额上回的ALFF值和HAMA之间存在负相关性。治疗后感兴趣脑区左侧颞上回、左侧前扣带回和HAMA之间存在正相关性,左侧丘脑、左侧额中回、左侧额上回的ALFF值和HAMA之间存在负相关性。结论:1."调神健脾"针法能够改善IBS患者的腹痛、排便满意度等胃肠症状及焦虑等神经、心理症状,能够改善患者的生活质量。2.IBS患者和正常人的脑部神经活动存在差异,其中以额叶、前扣带回、颞叶等与控制精神、认知功能的中枢神经系统有关。3."调神健脾"针法能够改善不同频段下IBS患者的脑部神经活动,其中以slow-4、slow-5为主,并且伴随焦虑症状的IBS患者其发病可能与左侧额中回、颞叶、前扣带回等脑区异常的功能活动有关,针刺可能是通过脑部神经活动影响中枢神经系统和胃肠神经系统的功能,从而起到治疗作用的。此外,IBS患者治疗前后与情绪相关脑区和HAMA评分之间存在相关性,不同激活脑区和HAMA之间的相关性不同。
[Abstract]:Objective: 1. to investigate anxiety and related brain function activities and the incidence of IBS between the 2. by observing the effect of acupuncture on brain functional activity in patients with IBS to explore the mechanism of acupuncture treatment of IBS. Methods: 15 healthy volunteers were enrolled as control group, 15 cases of IBS patients with acupuncture treatment group, the patients in treatment group had a week 3 times, a total of 6 weeks of "metality spleen" acupuncture treatment, patients in the treatment group before and after treatment each received 1 resting state functional magnetic resonance imaging, the control group received 1 times of resting state functional MRI. IBS-SSS scores were observed before and after acupuncture treatment, the changes of HAMA score were observed in patients with IBS and control; the changes of the resting brain functional groups under different frequency bands. Then select the low frequency amplitude had significant difference compared with the frequency, and this frequency before and after acupuncture treatment of brain function in patients with changes, finally interested brain regions And the Hamilton anxiety scale correlation analysis, the difference between the two groups were observed before and after treatment. Results: before treatment and 1. healthy control group, has the main effect of frequency, no differences in neural activity in whole brain, and the main effect between groups had significant differences, the brain area is the right middle temporal gyrus, left middle frontal gyrus, right middle frontal gyrus, right superior frontal gyrus, anterior cingulate cortex (P0.05). The neural activity in group IBS right middle temporal gyrus compared to healthy individuals decreased, and left middle frontal gyrus, right middle frontal gyrus, right superior frontal gyrus, anterior cingulate cortex neural activity in IBS group compared with healthy people increased. Brain areas with interactive the effect is mainly distributed in the right middle temporal gyrus, left postcentral gyrus, and neural activity test group before treatment were higher than health control group (P0.05) IBS-SSS total score and the degree of abdominal pain,.2. acupuncture before and after treatment in patients with abdominal pain duration, defecation satisfaction, life four The scores, the paired sample t test P0.01, there were significantly statistical significance; comparison of P0.05 score of abdominal distension before and after the treatment, no statistical significance. IBS HAMA score of patients before and after acupuncture treatment by paired sample t test were significantly different (P0.01).3.slow-4 band, the brain functional activities of patients before and after acupuncture treatment differences among them, the left middle frontal gyrus, left thalamus nerve activity after treatment than before treatment decreased (P0.05), left superior temporal gyrus neural activity after treatment than before treatment increased (P0.05); slow-5 band, left anterior cingulate nerve activity back after treatment than before treatment decreased (P0.05), treatment of neural activity in the left superior temporal gyrus after higher than before treatment (P0.05).4.slow-4, slow-5 band, before the treatment of brain region of interest in the left superior temporal gyrus, left thalamus, there is a positive correlation between ALFF value and HAMA, left middle frontal gyrus, left anterior cingulate, left 渚ч�濅笂鍥炵殑ALFF鍊煎拰HAMA涔嬮棿瀛樺湪璐熺浉鍏虫，

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