发散式体外冲击波对原发性痛经患者疼痛、情绪及脑功能的即刻影响

关键词：发散式体外冲击波  原发性痛经  静息态功能磁共振  分数低频振幅  焦虑  抑郁

Keywords:radial extracorporeal shock wave therapy  primary dysmenorrhea  resting-state functional magnetic resonance imaging  fraction amplitude of low frequency fluctuation  anxiety  depression

摘要：

      摘要 目的：探讨发散式体外冲击波（rESWT）对经期原发性痛经（PDM）患者疼痛、情绪的即刻疗效，并通过静息态功能磁共振（rs-fMRI）观察rESWT对PDM脑功能的影响。 方法：39例PDM患者被随机分为冲击波组（20例）和安慰剂组（19例）。采用简式McGill疼痛问卷（SF-MPQ）、中文版COX痛经症状量表（CMSS）、焦虑自评量表（SAS）和抑郁自评量表（SDS）评估患者的痛经强度、症状、焦虑和抑郁情绪，通过rs-fMRI记录分数低频振幅（fALFF）。比较患者非经期（月经周期的第12—16天）、经期（月经来潮48h内）治疗前、后的SAS、SDS和fALFF的差异，经期治疗前、后的SF-MPQ和CMSS的差异。 结果：经期治疗后，两组SF-MPQ、CMSS、SAS较经期治疗前均下降（P＜0.001），组间无显著差异；两组SDS得分在组内和组间均无显著差异；经期治疗后，冲击波组左侧颞中回的fALFF较非经期下降（P＜0.001）。 结论：单次冲击波未即刻改善PDM患者经期的疼痛强度、痛经症状、焦虑、抑郁情绪及静息态脑功能活动。

Abstract:

      Abstract Objective： To observe the immediate effect of radial extracorporeal shock wave （rESWT） on pain， emotion and brain function in primary dysmenorrhea （PDM） during menstruation. Method： Totally 39 subjects were recruited and randomly assigned to the ESWT group（n=20） and the placebo group（n=19）. The short-form McGill pain questionnaire（SF-MPQ）， the COX menstrual symptom scale （CMSS）， the self-rating anxiety scale（SAS） and the self-rating depression scale（SDS） were used to assess the patients' dysmenorrhea intensity， symptoms， anxiety and depression. Fractional low frequency amplitude（fALFF） was obtained by rs-fMRI. The differences of SAS， SDS and fALFF among in non-menstrual（days 6-12 of menstrual cycle）were assessed before and after intervention during menstruation（during the first 48 hours of menstruation）. The differences of SF-MPQ and CMSS before and after intervention during menstruation were also evaluated. Result： After treatment, the SF-MPQ， CMSS and SAS during menstruation were all decreased compared with those before treatment（P<0.001） in both groups， there was no significant difference between two groups; the SDS scores had no significant difference within and between groups. The fALFF of the left middle temporal gyrus after treatment was lower than that of the non-menstrual period in ESWT group （P<0.001）. Conclusion： A single radial shockwave treatment did not significantly improve pain intensity， pain symptoms， anxiety， depression， and the value of fraction amplitude of low frequency fluctuation in primary dysmenorrhea during menstruation.