基于fMRI技术研究按摩治疗单纯性肥胖中枢机制的脑功能连接网络响应特征

发布时间：2019-04-24 17:51

【摘要】：目的1以单纯性肥胖患者为研究对象,健康受试者为基线对照,评价按摩治疗单纯性肥胖的临床效应指标的改善;2以下丘脑外侧区(lateralhypothalamicarea,LHA)为重点,从能量代谢平衡及下丘脑食欲调节网络切入,运用功能磁共振成像(fMRI)技术探讨按摩治疗单纯性肥胖的中枢作用机制及特点,为按摩治疗单纯性肥胖的临床运用提供科学的理论依据。方法本研究临床资料收集采用单纯性肥胖患者自身前后对照方法。课题纳入30例单纯性肥胖患者(按摩组)采用腹部按摩疗法进行干预,另纳入10例健康志愿者(正常组)作为基线对照及按摩组按摩治疗后对照,所有受试者(按摩组和正常组)于基线期进行体重、BMI、体脂率、腰围、臀围、股围、SF-36生活质量量表、焦虑自评量表和抑郁自评量表的临床测量与评价。所有单纯性肥胖患者分别于基线期及治疗6周后进行两次静息态功能性核磁共振扫描,并在治疗后再次进行体重、BMI、体脂率、腰围、臀围、股围的测定和SF-36生活质量量表的评定,正常组于基线期只进行一次静息态功能性核磁共振扫描,不给予任何干预。以LHA为种子点,使用静息态功能连接度(Resting State Functional Connectivity,Rs-fc)分析方法,分析单纯性肥胖患者按摩治疗前后与健康志愿者存在异常的LHA静息态功能连接度,以及腹部按摩疗法对单纯性肥胖患者LHA静息态功能连接度的调整作用特点。结果1临床资料结果基线期按摩组SF-36生活质量量表在PF、GH、VT、MH四个维度评分显著低于正常组(P0.05)。而抑郁自评量表及焦虑自评量表评分方面差异无统计学意义(P0.05),但按摩组评分趋势高于正常组。经过6周治疗干预后,按摩能显著改善按摩组单纯性肥胖患者的体重、BMI、体脂率、腰围、臀围和股围(P0.01)以及SF-36生活质量量表评分在PF、BP、GH、VT四个方面的评分(P0.05);其中在PF、GH、VT方面具有非常显著的改善(P0.01)。2单纯性肥胖患者LHA静息态功能连接度与健康受试者相比,单纯性肥胖患者LHA与左侧顶下小叶、右侧额上回、左侧额中回、左侧楔叶静息态功能连接度升高;与双侧壳核、丘脑、尾状核静息态功能连接度降低。经过按摩治疗后,单纯性肥胖患者LHA与双侧顶下小叶、右侧额上回、额中回、左侧距状回静息态功能连接度升高;与右侧小脑蚓部静息态功能连接度降低。单纯性肥胖患者按摩治疗前后相比,治疗后LHA与右侧中央后回静息态功能连接度升高;左侧额上回、额中回静息态功能连接度降低。单纯性肥胖患者治疗前后LHA rs-fc差异同体重变化回归分析:LHA和豆状核静息态功能连接度差异与体重变化成正相关,LHA和枕叶静息态功能连接度差异与体重变化成负相关。单纯性肥胖患者治疗前后LHA rs-fc差异同腰围变化回归分析:LHA和脑干、小脑前叶静息态功能连接度差异与腰围变化成正相关,和顶下小叶、颞叶、梭状回的静息态功能连接度差异与腰围变化成负相关。结论1按摩疗法能明显改善单纯性肥胖患者的体重、BMI、体脂率、腰围、臀围、股围等临床效应指标,提高患者的生活质量,改善情绪方面的问题。2下丘脑能量代谢平衡中心核团的功能异常,可能是导致肥胖发生的因素之一。3单纯性肥胖患者与正常人在认知功能系统等脑区可能存在差异。4按摩疗法可能通过躯体感觉中枢,并以边缘系统、奖赏回馈系统整合高级认知活动相关脑区对单纯性肥胖发挥治疗作用。
[Abstract]:Objective: To study the improvement of the clinical effect index for simple obesity with simple obesity, and to evaluate the clinical effect index of massage for simple obesity. Functional magnetic resonance imaging (fMRI) was used to study the central mechanism and characteristics of massage to treat simple obesity, and to provide a scientific basis for the clinical application of massage to treat simple obesity. Methods The clinical data of this study was used to collect the self-control methods of simple obese patients. Subjects included 30 simple obese patients (massage group) with abdominal massage therapy, and 10 healthy volunteers (normal group) as the baseline control and massage group massage treatment, all the subjects (the massage group and the normal group) were body weight and BMI in the baseline period. Clinical measurement and evaluation of body fat rate, waist circumference, hip circumference, thigh circumference, SF-36 life quality scale, anxiety self-rating scale and self-rating depression scale. All simple obese patients were subjected to two rest functional nuclear magnetic resonance scans at baseline and after 6 weeks of treatment, and the body weight, BMI, body fat rate, waist circumference, hip circumference, thigh circumference, and SF-36 quality of life scale were evaluated again after treatment. In the normal group, only one resting-state nuclear magnetic resonance scan was performed at baseline, and no intervention was given. With the LHA as the seed point, the resting state functional connectivity (Rs-fc) was used to analyze the function of the resting state of the LHA in the patients with simple obesity before and after the massage treatment. And the adjustment effect of the abdominal massage therapy on the function connection degree of the resting state of the LHA in the simple obesity patient. Results The SF-36 life quality scale of the baseline period massage group was significantly lower than that in the normal group (P0.05). The scores of self-rating and anxiety self-rating were not statistically significant (P0.05), but the scores of the massage group were higher than that of the normal group. After 6 weeks of treatment, the body weight, BMI, body fat rate, waist circumference, hip circumference and thigh circumference (P0.01) and the score of SF-36 life quality scale (P 0.01) and SF-36 life quality scale score in the four aspects of PF, BP, GH and VT were significantly improved (P0.05), and in PF, GH, There was a very significant improvement in VT (P0.01). Compared with healthy subjects, the function of LHA resting state in simple obesity patients was higher than that of healthy subjects. The function of the resting state of the thalamus and caudate nucleus decreased. After the massage treatment, the LHA in the simple obesity group and the lower lobe of the bilateral top, the right frontal gyrus, the frontal gyrus, the left-to-back rest state functional connection increased, and the function of the function of the resting state of the right cerebellar vermis was reduced. Compared with before and after the massage treatment of simple obese patients, the function of the function of the resting state of the LHA and the center of the right after treatment is increased, and the function of the function of the resting state in the frontal gyrus and the frontal gyrus is reduced. The analysis of the difference of LHA rs-fc and the change of body weight before and after the treatment of simple obese patients: the difference of the functional connectivity of the resting state of the LHA and the soybean-like nucleus is positively correlated with the weight change, and the difference of the functional connectivity of the resting state of the LHA and the occipital lobe is negatively correlated with the body weight change. The changes of LHA rs-fc and LHA rs-fc before and after treatment in simple obese patients were analyzed with the regression of the waist circumference: the difference of the functional connectivity of the resting state of the anterior and posterior lobe of the LHA and the brain stem was positively correlated with the change of the waist circumference, and the difference of the functional connectivity of the resting state of the lower lobule, the lower leaf and the shed was negatively correlated with the change of the waist circumference. Conclusion The massage therapy can obviously improve the body weight, BMI, body fat rate, waist circumference, hip circumference and thigh circumference of simple obesity patients, improve the quality of life and improve the emotional aspect of the patients. May be one of the factors leading to the occurrence of obesity. The reward and feedback system is used for the treatment of simple obesity in the relevant brain regions of the high-level cognitive activity.
【学位授予单位】：贵阳中医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R244.1

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