针刺原发性高血压患者太溪穴fcMRI脑功能连接研究

发布时间：2018-09-18 19:51

【摘要】：目的通过meta分析评价针药结合治疗原发性高血压(EH)的疗效。采用功能磁共振成像(fMRI)技术研究EH患者与健康志愿者(HCs)的脑功能连接(FC)差异,发现EH发病相关的异常FC,并探索针刺太溪穴降压疗效及中枢效应机制。方法1.Meta分析检索国内外数据库,按纳入排除标准筛出高质量随机对照试验,对其进行资料提取及分析,应用RevMan5.3软件对纳入研究的临床有效率、收缩压(SBP)、舒张压(DBP)等指标进行meta分析。2.EH患者脑功能连接的特点纳入76例EH患者及75例HCs,所有受试者均接受一次血压测量,后进行MRI扫描。MRI图像经处理及分析后,将ReHo结果与血压做相关性分析,确定血压变化相关的种子点(ROI)后进行ROI—全脑功能连接分析,比较EH患者与HCs与血压相关的FC差异脑区。3.针刺太溪穴对EH患者血压及脑功能连接的影响16例EH患者接受针刺太溪穴治疗2周,针刺5日后休息2日,共针刺10次。患者在针刺疗程中维持其原降压药种类及剂量不变。疗程前后均进行血压测量及MRI扫描。MRI图像经预处理后,将ReHo差异脑区信号疗程前后差值与血压差值做相关性分析,确定血压变化相关ROI,后进行ROI—全脑功能连接分析,比较针刺太溪穴疗程前后EH患者FC差异脑区。结果1.Meta分析共纳入8个研究,Meta分析显示:①临床有效率:OR合并=4.07,95%CI(2.45,6.67);②SBP:MD 合并=-6.85,95%CI(-8.78,-4.93);③DBP:MD合并=-4.44,其 95%CI 为(-6.19,-2.69)。2.EH患者脑功能连接特点研究与HCs比较,EH患者较多脑区ReHo显著降低:包括BA3、11、19、20、23、25、26、37、48,部分脑区ReHo升高,如BA6、7、11、25,双侧脑岛、前扣带回(ACC)与SBP显著相关。FC分析示:右侧脑岛与BA17、10之间,左侧脑岛与BA13之间,右侧ACC与BA10、17、24、48之间,左侧ACC与豆状核、BA24之间FC较HCs显著降低。3.针刺太溪穴对EH患者脑功能连接的影响15例EH患者完成针刺疗程治疗。疗程后SBP较前显著降低,DBP、SDBP无显著变化。针刺后BA6、18、19、23、47、48脑区ReHo升高,BA9、10、22、40脑区ReHo显著减弱;其中左侧额上回、脑岛、豆状核、后扣带回(PCC)及右侧丘脑与SBP差值呈显著相关。FC分析示:左侧额上回与BA30、37、海马旁回之间,左侧脑岛与BA6、19、25之间,左侧豆状核与BA8、13、41、47之间,左侧PCC与BA11、30之间,右侧丘脑与双侧尾状核、BA6、10之间FC显著升高;左侧额上回与BA7、31之间,左侧豆状核与BA10、19之间,右侧丘脑与BA5之间FC减弱。结论Meta分析表明,针药结合疗法治疗EH可更好地控制血压;血压升高与脑区活动有关,双侧脑岛、ACC与EH发病密切相关;短期疗程针刺太溪穴降低SBP疗效肯定;针刺降压的中枢效应可能是建立在针刺调节额上回、脑岛、豆状核、扣带回、丘脑与其他脑区功能连接的基础上。
[Abstract]:Objective to evaluate the efficacy of acupuncture combined with medicine in the treatment of essential hypertension (EH) by meta analysis. Functional magnetic resonance imaging (fMRI) was used to study the difference of brain functional junction (FC) between EH patients and healthy volunteers. The abnormal FC, associated with EH was found and the antihypertensive effect and central effect mechanism of acupuncture at Taixi were explored. Methods 1.Meta analysis was used to search domestic and foreign databases, and high quality randomized controlled trials were screened out according to the exclusion criteria. The data were extracted and analyzed. The clinical efficacy of the data was analyzed by using RevMan5.3 software. Systolic blood pressure (SBP),) and diastolic blood pressure (DBP) were analyzed by meta. 2. The characteristics of cerebral functional junction in patients with EH were included in 76 patients with EH and 75 subjects with HCs,. The correlation between ReHo results and blood pressure was analyzed, and ROI- global functional junction analysis was performed after (ROI), the seed point related to blood pressure changes, to compare the difference brain area of FC between EH patients and HCs and blood pressure. 3. Effect of acupuncture at Taixi point on blood pressure and brain function in patients with EH 16 patients with EH were treated with acupuncture at Taixi point for 2 weeks and rest for 2 days after acupuncture for 10 times. The type and dosage of antihypertensive drugs remained unchanged in the course of acupuncture. Blood pressure was measured before and after treatment, and MRI scanning. MRI images were pretreated. The correlation analysis was made between the difference of ReHo signal and the difference of blood pressure before and after the course of treatment, and the whole brain function connection analysis of ROI- was made after determining the changes of blood pressure related to ROI,. To compare the difference brain area of FC in patients with EH before and after acupuncture at Taixi. Results A total of 8 studies were included in the 1.Meta analysis. Meta-analysis showed that the clinical effective rate of 1: OR combined with 4.07% 95 CI (2.45 卤6.67) and 2SBP: MD combined with -6.85% 95 CI (-8.78 ~ -4.93) was significantly lower than that of HCs, and its 95%CI was (-6.19 ~ 2.69) .2.The characteristics of cerebral functional junction in patients with EH were significantly lower than those in patients with HCs. Including increased ReHo in some brain regions of BA3,11,19,20,23,25,26,37,48,, For example, in bilateral cerebral islands of BA6,7,11,25, (ACC) in anterior cingulate gyrus was significantly correlated with SBP. FC analysis showed that FC between right cerebral island and BA17,10, between left cerebral island and BA13, between right ACC and BA10,17,24,48, and between left ACC and lentiform nucleus was significantly lower than that between HCs. Effect of Acupuncture at Taixi Point on brain functional connection in patients with EH 15 patients with EH completed acupuncture course of treatment. There was no significant change in SBP after treatment. After acupuncture, the increase of ReHo in the BA6,18,19,23,47,48 brain area and the decrease of ReHo in the brain area of BA9 ~ (9) ~ 10 ~ 22 ~ (40) were found, among which, the difference between the left superior frontal gyrus, the island, the lentiform nucleus, the (PCC) of the posterior cingulate gyrus, and the right thalamus and the SBP was significantly correlated with that of the left superior frontal gyrus and the BA30,37, para-hippocampal gyrus. FC increased significantly between left cerebral island and BA6,19,25, between left lentiform nucleus and BA8,13,41,47, between left PCC and BA11,30, between right thalamus and bilateral caudate nucleus, between left superior frontal gyrus and BA7,31, between left lenticular nucleus and BA10,19, between left thalamus and bilateral caudate nucleus, between left superior frontal gyrus and BA7,31, between left lentiform nucleus and BA10,19, between left thalamus and bilateral caudate nucleus. FC between the right thalamus and BA5 was attenuated. Conclusion Meta analysis shows that acupuncture combined with medicine therapy can better control blood pressure, increase blood pressure is related to brain area activity, bilateral cerebral islet ACC is closely related to EH, acupuncture at Taixi point is effective in reducing SBP in short course of treatment. The central effect of acupuncture on lowering blood pressure may be based on the functional connection between superior frontal gyrus, cerebral island, lentiform nucleus, cingulate gyrus, thalamus and other brain regions.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.1

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