针刺得气与脑功能区联系的研究课件

,针刺得气与脑功能区联系的研究,广安门医院放射科,王小玲,Suk-tak Chan,方继良,2013-7-27,针刺得气与脑功能区联系的研究广安门医院放射科,项目,项目,项目,背 景,得气对针刺疗效至关重要,大量,fMRI,研究表明，诱导得气的针刺调制了边缘叶,-,旁边缘叶,-,新皮层网络,(LPNN),的广泛负激活和体感区的激活,针刺时得气和痛觉对脑网络的影响存在差异,项目项目项目背 景得气对针刺疗效至关重要,得气与疼痛,针刺：得气，不伴疼痛，诱导广泛的负激活：额极、前额叶、扣带回、下丘脑、小脑蚓部,针刺：得气，伴随疼痛，诱导脑区激活：额极、扣带回前部、中部、后部,感觉对照组：诱导脑区的激活：额极、扣带回后部、丘脑、小脑蚓部,Hui KKS,Liu J,Marina O,et al.Neuroimage.2005,27:479-496.,得气与疼痛针刺：得气，不伴疼痛，诱导广泛的负激活：额极、前额,得 气,麻刺,压感,热,麻木,酸,胀满,冷,钝痛,麻刺压感热麻木 酸胀满 冷钝痛,脑网络,麻刺,压感,热,麻木,酸,胀满,冷,钝痛,麻刺压感热麻木 酸胀满 冷钝痛,材料与方法,37,例无针刺体验的健康受试者,30,人针灸刺激（,6,例,twice,）：,180,捻针刺激,15,人触觉刺激（,8,例,twice,）：,5.88 von Frey monofilament,轻拍,Athinoula A.Martinos Center for Biomedical Imaging at Massachusetts General Hospital,材料与方法37例无针刺体验的健康受试者 Athinoul,材料与方法,针感记录,扫描结束后，完成针感问卷,压感,、,沉重、胀满,、,麻木、麻刺,、热感、冷感、酸痛、钝痛和锐痛,针感记分,1-10,无针感记录为,0,材料与方法针感记录,材料与方法,fMRI acquisitions,1.5 Tesla scanner(Siemens Sonata,Erlangen,Germany),standard high-resolution sagittal images with a T1-weighted 3D-MPRAGE sequence,whole-brain BOLD fMRI,，,EPI sequence(TR=4000ms,TE=30ms,flip angle=90o,FOV=200mm,matrix=64x64,thickness=3mm,gap=0.6mm),Each fMRI run lasted 10 minutes,材料与方法fMRI acquisitions,材料与方法,针感数据分析,Chi-Square tests,（卡方检验）,组间每种针感频率的比较,Mann-Whitney U tests,（秩和检验）,组间每种针感强度的比较,材料与方法针感数据分析,材料与方法,fMRI data analysis,Analysis of Functional NeuroImage(,AFNI,),Brain volumes with percent MR signal change to acupuncture from different subjects were then grouped and analyzed with Analysis of Covariance(,ANCOVA,),where the scores of 5 individual needling sensations(pressure,numbness,heaviness,fullness and tingling)were included as,covariates,.,材料与方法 fMRI data analysis,结果与讨论（一）,Psychophysical response,针刺组（,n=36,）,对照组,（,n=23,）,压感最常见,针刺组大于对照组,压感、麻木和麻刺感,结果与讨论（一）Psychophysical resp,结果与讨论（一）,Psychophysical response,压感最强,针刺组大于对照组,压感、麻木和麻刺感,针刺组（,n=36,）,对照组,（,n=23,）,结果与讨论（一）Psychophysical resp,p=10,-5,p=10,-5,Fig 4.The mean brain positive(yellow)and negative(blue)BOLD responses to acupuncture stimulation.,The extensive deactivation showed in limbic-paralimbic-neocortical(LPNN)network,such as anterior cingulated cortex(ACC),parahippocampal gyrus(PHG),lingual gyrus(LgG),precuneus(Pcun)and cuneus.The orbital gyrus(OrG)also showed deactivation.Left thalamus(Th)and secondary somatosensory cortex(SII)demonstrated activation.,Z =-10 -5 0 15 40 Y=23,OrG,ACC,PHG,LgG,Cuneus,Pcun,Th,SII,R,结果与讨论（一）,p=10-5p=10-5Fig 4.The mean br,pressure,Mean effect,In addition to the highest frequency and intensity among all the related sensations of,deqi,response,pressure also contributed significantly to the extensive deactivation of LPNN,by which acupuncture may mediate its anti-pain,anti-anxiety and other diverse modulatory effect.,pressure sensation,Fang JL,etal.,Hum Brain Mapp,vol.,30,no.4,pp.1196-1206,2009.,pressureMean effectIn addition,acupuncture,Tactile stimulation,pressure sensation,postcentral cortex,insula,Such an extreme difference is likely due to the stimulation on the nerves at the,cutaneous level during tactile stimulation compared to deep nerve stimulation,during manual acupuncture.,acupuncture Tactile stimulat,pressure sensation,In tactile stimulation,the mechanoreceptors in the superficial layers transmit pressure sensation to sensorimotor regions by A and A fibers.,In acupuncture stimulation,the needle passage includes skin,subcutaneous tissue,the lateral side of the extensor hallucis brevis muscle,deep peroneal nerve,first dorsal metatarsal artery and vein and first dorsal interosseous muscle.,With the deep stimulation at LV3,gentle and repetitive manipulation producing mechanical pressure and tissue distortions activate more mechanoreceptors and nociceptors that are innervated by thin myelinated A and C fibers.,Eric RK,James HS,MJ T.,Principles of neural science,.2000.,Chen E.,Cross-section anatomy of acupoints,.1995.,Zhang ZJ,Wang XM,McAlonan GM.,Evid Based Complement Alternat Med,2012.,pressure sensationIn tactile s,pressure sensation,In tactile stimulation,the mechanoreceptors in the superficial layers transmit pressure sensation to sensorimotor regions by A and A fibers.,In acupuncture stimulation,the needle passage includes skin,subcutaneous tissue,the lateral side of the extensor hallucis brevis muscle,deep peroneal nerve,first dorsal metatarsal artery and vein and first dorsal interosseous muscle.,With the deep stimulation at LV3,gentle and repetitive manipulation producing mechanical pressure and tissue distortions activate more mechanoreceptors and nociceptors that are innervated by thin myelinated A and C fibers.,Eric RK,James HS,MJ T.,Principles of neural science,.2000.,Chen E.,Cross-section anatomy of acupoints,.1995.,Zhang ZJ,Wang XM,McAlonan GM.,Evid Based Complement Alternat Med,2012.,pressure sensationIn tactile s,Interplay of the sensations pressure,heaviness,fullness,tingling and numbness to the overlapped brain regions,结果与讨论（二）,Interplay of the sensations pr,p=10,-5,p=10,-5,Z =-10 -5 0 40,Z =-5 15 40 X=-3,STG,OrG,PHG,ACC,IPS,IPS,IPS,ACC,OrG,ACC,OrG,STG,Hi+PHG,MFG,IPS,aMCC,MO,CC,IPS,CC,Hi+PHG,R,