本文選題：腸易激綜合征　切入點：腦功能成像　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1.探討與焦慮情緒有關(guān)的腦部功能活動和IBS發(fā)病的相關(guān)性2.通過觀察針刺治療對IBS患者腦部功能活動的影響探討針刺治療IBS的機制。方法:選取15例健康志愿者為對照組,15例IBS患者為針刺治療組,對治療組患者進行每周3次,共6周的"調(diào)神健脾"針刺治療,治療組患者在治療前后各接受1次靜息態(tài)功能磁共振檢查,對照組接受1次靜息態(tài)功能磁共振檢查。觀察針刺治療前后患者的IBS-SSS評分、HAMA評分的變化情況;觀察IBS患者和對照組不同頻段下低頻振幅的靜息態(tài)腦部功能變化情況。然后選取有顯著差異的頻率,并用此頻率比較針刺治療前后患者腦部功能變化情況,最后將感興趣腦區(qū)和漢密爾頓焦慮量表進行相關(guān)性分析,觀察兩組治療前后的差別。結(jié)果:1.治療前和健康對照組比較,具有頻段的主效應(yīng),在全腦的神經(jīng)活動無差異,而組間主效應(yīng)具有顯著差異,腦區(qū)是右側(cè)顳中回、左側(cè)額中回、右側(cè)額中回、右側(cè)額上回、前扣帶回(P0.05)。其中右側(cè)顳中回的神經(jīng)活動IBS組較健康人下降,而左側(cè)額中回、右側(cè)額中回、右側(cè)額上回、前扣帶回的神經(jīng)活動IBS組較健康人升高。具有交互效應(yīng)的腦區(qū)主要分布在右側(cè)顳中回、左側(cè)中央后回,并且試驗組治療前的神經(jīng)活動較健康對照組升高(P0.05)。2.針刺治療前和治療后患者的IBS-SSS總評分及腹痛程度、腹痛天數(shù)、排便滿意度、生活影響度四個維度評分,經(jīng)配對樣本t檢驗P0.01,有極顯著統(tǒng)計學(xué)意義;腹脹程度評分治療前與治療后比較P0.05,無統(tǒng)計學(xué)意義。針刺治療前后IBS患者的HAMA評分經(jīng)配對樣本t檢驗有顯著差異(P0.01)。3.slow-4頻段下,針刺治療前后患者的腦部功能活動存在差異,其中左側(cè)額中回、左側(cè)丘腦治療后神經(jīng)活動較治療前下降(P0.05),左側(cè)顳上回治療后神經(jīng)活動較治療前升高(P0.05);slow-5頻段下,左側(cè)前扣帶回治療后的神經(jīng)活動較治療前下降(P0.05),左側(cè)顳上回的神經(jīng)活動治療后較治療前升高(P0.05)。4.slow-4、slow-5頻段下,治療前感興趣腦區(qū)左側(cè)顳上回、左側(cè)丘腦的ALFF值和HAMA之間存在正相關(guān)性,左側(cè)額中回、左側(cè)前扣帶回、左側(cè)額上回的ALFF值和HAMA之間存在負(fù)相關(guān)性。治療后感興趣腦區(qū)左側(cè)顳上回、左側(cè)前扣帶回和HAMA之間存在正相關(guān)性,左側(cè)丘腦、左側(cè)額中回、左側(cè)額上回的ALFF值和HAMA之間存在負(fù)相關(guān)性。結(jié)論:1."調(diào)神健脾"針法能夠改善IBS患者的腹痛、排便滿意度等胃腸癥狀及焦慮等神經(jīng)、心理癥狀,能夠改善患者的生活質(zhì)量。2.IBS患者和正常人的腦部神經(jīng)活動存在差異,其中以額葉、前扣帶回、顳葉等與控制精神、認(rèn)知功能的中樞神經(jīng)系統(tǒng)有關(guān)。3."調(diào)神健脾"針法能夠改善不同頻段下IBS患者的腦部神經(jīng)活動,其中以slow-4、slow-5為主,并且伴隨焦慮癥狀的IBS患者其發(fā)病可能與左側(cè)額中回、顳葉、前扣帶回等腦區(qū)異常的功能活動有關(guān),針刺可能是通過腦部神經(jīng)活動影響中樞神經(jīng)系統(tǒng)和胃腸神經(jīng)系統(tǒng)的功能,從而起到治療作用的。此外,IBS患者治療前后與情緒相關(guān)腦區(qū)和HAMA評分之間存在相關(guān)性,不同激活腦區(qū)和HAMA之間的相關(guān)性不同。
[Abstract]:Objective: 1. to investigate anxiety and related brain function activities and the incidence of IBS between the 2. by observing the effect of acupuncture on brain functional activity in patients with IBS to explore the mechanism of acupuncture treatment of IBS. Methods: 15 healthy volunteers were enrolled as control group, 15 cases of IBS patients with acupuncture treatment group, the patients in treatment group had a week 3 times, a total of 6 weeks of "metality spleen" acupuncture treatment, patients in the treatment group before and after treatment each received 1 resting state functional magnetic resonance imaging, the control group received 1 times of resting state functional MRI. IBS-SSS scores were observed before and after acupuncture treatment, the changes of HAMA score were observed in patients with IBS and control; the changes of the resting brain functional groups under different frequency bands. Then select the low frequency amplitude had significant difference compared with the frequency, and this frequency before and after acupuncture treatment of brain function in patients with changes, finally interested brain regions And the Hamilton anxiety scale correlation analysis, the difference between the two groups were observed before and after treatment. Results: before treatment and 1. healthy control group, has the main effect of frequency, no differences in neural activity in whole brain, and the main effect between groups had significant differences, the brain area is the right middle temporal gyrus, left middle frontal gyrus, right middle frontal gyrus, right superior frontal gyrus, anterior cingulate cortex (P0.05). The neural activity in group IBS right middle temporal gyrus compared to healthy individuals decreased, and left middle frontal gyrus, right middle frontal gyrus, right superior frontal gyrus, anterior cingulate cortex neural activity in IBS group compared with healthy people increased. Brain areas with interactive the effect is mainly distributed in the right middle temporal gyrus, left postcentral gyrus, and neural activity test group before treatment were higher than health control group (P0.05) IBS-SSS total score and the degree of abdominal pain,.2. acupuncture before and after treatment in patients with abdominal pain duration, defecation satisfaction, life four The scores, the paired sample t test P0.01, there were significantly statistical significance; comparison of P0.05 score of abdominal distension before and after the treatment, no statistical significance. IBS HAMA score of patients before and after acupuncture treatment by paired sample t test were significantly different (P0.01).3.slow-4 band, the brain functional activities of patients before and after acupuncture treatment differences among them, the left middle frontal gyrus, left thalamus nerve activity after treatment than before treatment decreased (P0.05), left superior temporal gyrus neural activity after treatment than before treatment increased (P0.05); slow-5 band, left anterior cingulate nerve activity back after treatment than before treatment decreased (P0.05), treatment of neural activity in the left superior temporal gyrus after higher than before treatment (P0.05).4.slow-4, slow-5 band, before the treatment of brain region of interest in the left superior temporal gyrus, left thalamus, there is a positive correlation between ALFF value and HAMA, left middle frontal gyrus, left anterior cingulate, left 渚ч涓婂洖鐨凙LFF鍊煎拰HAMA涔嬮棿瀛樺湪璐熺浉鍏蟲，

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