电针对腰椎间盘突出症患者中短期疗效及脑功能的影响：基于静息态功能磁共振成像评估

关键词：腰椎间盘突出症  电针  静息态功能磁共振成像  局部一致性  度中心性

Keywords:lumbar disc herniation  electroacupuncture  resting-state functional magnetic resonance imaging  regional homogeneity  degree centrality

摘要：

      摘要 目的：观察电针对腰椎间盘突出症（LDH）患者的中短期临床疗效及基于静息态功能磁共振成像（rs-fMRI）技术探讨电针对LDH的脑效应。 方法：纳入30例LDH患者为试验组（LDH组），33例健康受试者为对照组（HC组）。LDH组予电针治疗，取双侧L3—S1夹脊穴、大肠俞，采用连续波，频率20Hz，强度以患者耐受为宜，留针20min，隔日1次，共10次。于治疗前及治疗1个月后，两组均行rs-fMRI扫描。观察LDH组治疗前及治疗后1个月、3个月、6个月改良Oswestry功能障碍指数（ODI）、健康状况调查简表（SF-36）的心理维度（MCS）及生理维度（PCS）评分。观察HC组及LDH组治疗前后脑区的局部一致性（ReHo）、度中心性（DC）差异。 结果：①LDH组经电针治疗后ODI评分各时期均有改善（P<0.05）。治疗后3个月、1个月PCS评分持续改善，且3个月时疗效最佳（P<0.05）；治疗后6个月呈下降趋势，但较治疗前仍有改善趋势（P=0.072）。治疗后3个月、1个月MCS评分均较前一时期改善，差异具有显著性意义（P<0.05），但在治疗后6个月呈下降趋势。②LDH组治疗前与HC组比较，左侧前扣带回ReHo值增高；右侧丘脑、左侧丘脑DC值增高，双侧中央后回DC值减低。③LDH组经电针治疗后，双侧楔前叶、右侧额中回的ReHo值增高；左侧中央后回DC值增高。 结论：电针能改善LDH患者中短期疗效，其中以中期疗效（3个月）最佳；此外电针改善疼痛和心理健康的作用与调控疼痛矩阵、默认模式脑网络和情绪认知控制网络相关。

Abstract:

      Abstract Objective： To observe the short-term and medium-term clinical effects of electroacupuncture (EA) on patients with lumbar disc herniation (LDH) and to explore the cerebral effects based on resting-state functional magnetic resonance (rs-fMRI). Method： Thirty patients with LDH received EA at bilateral L3—S1 jiaji (EX-B2) and Dachangshu (BL25) points in continuous-wave mode at 20Hz (intensity adjusted to patient tolerance), 20 minutes per session, every other day for ten sessions. Thirty-three age- and sex-matched healthy volunteers served as controls. All patients underwent rs-fMRI scans before treatment; The LDH group was rescanned one month after completion of EA. The modified Oswestry disability index （ODI）， mental health summary （MCS） and physical health summary （PCS） of the short form health survey（SF-36） were assessed in LDH group before treatment and one， three， and six months after treatment. Voxel-wise regional homogeneity （ReHo） and degree centrality （DC） in brain areas were computed to compare between the two groups at baseline and pre- and post-treatment in LDH group. Result： After EA, LDH patients experienced significant reductions in ODI scores at one, three, and six months compared with baseline (P<0.05). PCS score continued to significantly improve at 3 months and 1 month（P<0.05）， and the efficacy was the best at 3 months. There was a downward trend in 6 months after treatment， but still remained above baseline（P=0.072）. The MCS score also rose at one and three months (P<0.05) but declined by six months. Compared with the control group， LDH patients exhibited increased ReHo in the left anterior cingulate gyrus, elevated DC in bilateral thalami, and decreased DC in bilateral postcentral gyri. After EA treatment，the LDH group showed increased ReHo in bilateral precuneus and the right middle frontal gyrus, as well as increased DC in the left postcentral gyrus. Conclusion： Electroacupuncture improves the short-term and medium-term clinical outcomes in LDH patients， with maximal benefit at three months. The role of electroacupuncture in improving pain and mental health is related to the regulation of pain matrix， default mode brain network， and emotional cognitive control network.