針刺原發(fā)性高血壓患者太溪穴fcMRI腦功能連接研究
發(fā)布時(shí)間：2018-09-18 19:51
【摘要】：目的通過meta分析評價(jià)針?biāo)幗Y(jié)合治療原發(fā)性高血壓(EH)的療效。采用功能磁共振成像(fMRI)技術(shù)研究EH患者與健康志愿者(HCs)的腦功能連接(FC)差異,發(fā)現(xiàn)EH發(fā)病相關(guān)的異常FC,并探索針刺太溪穴降壓療效及中樞效應(yīng)機(jī)制。方法1.Meta分析檢索國內(nèi)外數(shù)據(jù)庫,按納入排除標(biāo)準(zhǔn)篩出高質(zhì)量隨機(jī)對照試驗(yàn),對其進(jìn)行資料提取及分析,應(yīng)用RevMan5.3軟件對納入研究的臨床有效率、收縮壓(SBP)、舒張壓(DBP)等指標(biāo)進(jìn)行meta分析。2.EH患者腦功能連接的特點(diǎn)納入76例EH患者及75例HCs,所有受試者均接受一次血壓測量,后進(jìn)行MRI掃描。MRI圖像經(jīng)處理及分析后,將ReHo結(jié)果與血壓做相關(guān)性分析,確定血壓變化相關(guān)的種子點(diǎn)(ROI)后進(jìn)行ROI—全腦功能連接分析,比較EH患者與HCs與血壓相關(guān)的FC差異腦區(qū)。3.針刺太溪穴對EH患者血壓及腦功能連接的影響16例EH患者接受針刺太溪穴治療2周,針刺5日后休息2日,共針刺10次�；颊咴卺槾摊煶讨芯S持其原降壓藥種類及劑量不變。療程前后均進(jìn)行血壓測量及MRI掃描。MRI圖像經(jīng)預(yù)處理后,將ReHo差異腦區(qū)信號療程前后差值與血壓差值做相關(guān)性分析,確定血壓變化相關(guān)ROI,后進(jìn)行ROI—全腦功能連接分析,比較針刺太溪穴療程前后EH患者FC差異腦區(qū)。結(jié)果1.Meta分析共納入8個(gè)研究,Meta分析顯示:①臨床有效率:OR合并=4.07,95%CI(2.45,6.67);②SBP:MD 合并=-6.85,95%CI(-8.78,-4.93);③DBP:MD合并=-4.44,其 95%CI 為(-6.19,-2.69)。2.EH患者腦功能連接特點(diǎn)研究與HCs比較,EH患者較多腦區(qū)ReHo顯著降低:包括BA3、11、19、20、23、25、26、37、48,部分腦區(qū)ReHo升高,如BA6、7、11、25,雙側(cè)腦島、前扣帶回(ACC)與SBP顯著相關(guān)。FC分析示:右側(cè)腦島與BA17、10之間,左側(cè)腦島與BA13之間,右側(cè)ACC與BA10、17、24、48之間,左側(cè)ACC與豆?fàn)詈�、BA24之間FC較HCs顯著降低。3.針刺太溪穴對EH患者腦功能連接的影響15例EH患者完成針刺療程治療。療程后SBP較前顯著降低,DBP、SDBP無顯著變化。針刺后BA6、18、19、23、47、48腦區(qū)ReHo升高,BA9、10、22、40腦區(qū)ReHo顯著減弱;其中左側(cè)額上回、腦島、豆?fàn)詈恕⒑罂蹘Щ?PCC)及右側(cè)丘腦與SBP差值呈顯著相關(guān)。FC分析示:左側(cè)額上回與BA30、37、海馬旁回之間,左側(cè)腦島與BA6、19、25之間,左側(cè)豆?fàn)詈伺cBA8、13、41、47之間,左側(cè)PCC與BA11、30之間,右側(cè)丘腦與雙側(cè)尾狀核、BA6、10之間FC顯著升高;左側(cè)額上回與BA7、31之間,左側(cè)豆?fàn)詈伺cBA10、19之間,右側(cè)丘腦與BA5之間FC減弱。結(jié)論Meta分析表明,針?biāo)幗Y(jié)合療法治療EH可更好地控制血壓;血壓升高與腦區(qū)活動有關(guān),雙側(cè)腦島、ACC與EH發(fā)病密切相關(guān);短期療程針刺太溪穴降低SBP療效肯定;針刺降壓的中樞效應(yīng)可能是建立在針刺調(diào)節(jié)額上回、腦島、豆?fàn)詈�、扣帶回、丘腦與其他腦區(qū)功能連接的基礎(chǔ)上。
[Abstract]:Objective to evaluate the efficacy of acupuncture combined with medicine in the treatment of essential hypertension (EH) by meta analysis. Functional magnetic resonance imaging (fMRI) was used to study the difference of brain functional junction (FC) between EH patients and healthy volunteers. The abnormal FC, associated with EH was found and the antihypertensive effect and central effect mechanism of acupuncture at Taixi were explored. Methods 1.Meta analysis was used to search domestic and foreign databases, and high quality randomized controlled trials were screened out according to the exclusion criteria. The data were extracted and analyzed. The clinical efficacy of the data was analyzed by using RevMan5.3 software. Systolic blood pressure (SBP),) and diastolic blood pressure (DBP) were analyzed by meta. 2. The characteristics of cerebral functional junction in patients with EH were included in 76 patients with EH and 75 subjects with HCs,. The correlation between ReHo results and blood pressure was analyzed, and ROI- global functional junction analysis was performed after (ROI), the seed point related to blood pressure changes, to compare the difference brain area of FC between EH patients and HCs and blood pressure. 3. Effect of acupuncture at Taixi point on blood pressure and brain function in patients with EH 16 patients with EH were treated with acupuncture at Taixi point for 2 weeks and rest for 2 days after acupuncture for 10 times. The type and dosage of antihypertensive drugs remained unchanged in the course of acupuncture. Blood pressure was measured before and after treatment, and MRI scanning. MRI images were pretreated. The correlation analysis was made between the difference of ReHo signal and the difference of blood pressure before and after the course of treatment, and the whole brain function connection analysis of ROI- was made after determining the changes of blood pressure related to ROI,. To compare the difference brain area of FC in patients with EH before and after acupuncture at Taixi. Results A total of 8 studies were included in the 1.Meta analysis. Meta-analysis showed that the clinical effective rate of 1: OR combined with 4.07% 95 CI (2.45 鹵6.67) and 2SBP: MD combined with -6.85% 95 CI (-8.78 ~ -4.93) was significantly lower than that of HCs, and its 95%CI was (-6.19 ~ 2.69) .2.The characteristics of cerebral functional junction in patients with EH were significantly lower than those in patients with HCs. Including increased ReHo in some brain regions of BA3,11,19,20,23,25,26,37,48,, For example, in bilateral cerebral islands of BA6,7,11,25, (ACC) in anterior cingulate gyrus was significantly correlated with SBP. FC analysis showed that FC between right cerebral island and BA17,10, between left cerebral island and BA13, between right ACC and BA10,17,24,48, and between left ACC and lentiform nucleus was significantly lower than that between HCs. Effect of Acupuncture at Taixi Point on brain functional connection in patients with EH 15 patients with EH completed acupuncture course of treatment. There was no significant change in SBP after treatment. After acupuncture, the increase of ReHo in the BA6,18,19,23,47,48 brain area and the decrease of ReHo in the brain area of BA9 ~ (9) ~ 10 ~ 22 ~ (40) were found, among which, the difference between the left superior frontal gyrus, the island, the lentiform nucleus, the (PCC) of the posterior cingulate gyrus, and the right thalamus and the SBP was significantly correlated with that of the left superior frontal gyrus and the BA30,37, para-hippocampal gyrus. FC increased significantly between left cerebral island and BA6,19,25, between left lentiform nucleus and BA8,13,41,47, between left PCC and BA11,30, between right thalamus and bilateral caudate nucleus, between left superior frontal gyrus and BA7,31, between left lenticular nucleus and BA10,19, between left thalamus and bilateral caudate nucleus, between left superior frontal gyrus and BA7,31, between left lentiform nucleus and BA10,19, between left thalamus and bilateral caudate nucleus. FC between the right thalamus and BA5 was attenuated. Conclusion Meta analysis shows that acupuncture combined with medicine therapy can better control blood pressure, increase blood pressure is related to brain area activity, bilateral cerebral islet ACC is closely related to EH, acupuncture at Taixi point is effective in reducing SBP in short course of treatment. The central effect of acupuncture on lowering blood pressure may be based on the functional connection between superior frontal gyrus, cerebral island, lentiform nucleus, cingulate gyrus, thalamus and other brain regions.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.1
本文編號：2248950
[Abstract]:Objective to evaluate the efficacy of acupuncture combined with medicine in the treatment of essential hypertension (EH) by meta analysis. Functional magnetic resonance imaging (fMRI) was used to study the difference of brain functional junction (FC) between EH patients and healthy volunteers. The abnormal FC, associated with EH was found and the antihypertensive effect and central effect mechanism of acupuncture at Taixi were explored. Methods 1.Meta analysis was used to search domestic and foreign databases, and high quality randomized controlled trials were screened out according to the exclusion criteria. The data were extracted and analyzed. The clinical efficacy of the data was analyzed by using RevMan5.3 software. Systolic blood pressure (SBP),) and diastolic blood pressure (DBP) were analyzed by meta. 2. The characteristics of cerebral functional junction in patients with EH were included in 76 patients with EH and 75 subjects with HCs,. The correlation between ReHo results and blood pressure was analyzed, and ROI- global functional junction analysis was performed after (ROI), the seed point related to blood pressure changes, to compare the difference brain area of FC between EH patients and HCs and blood pressure. 3. Effect of acupuncture at Taixi point on blood pressure and brain function in patients with EH 16 patients with EH were treated with acupuncture at Taixi point for 2 weeks and rest for 2 days after acupuncture for 10 times. The type and dosage of antihypertensive drugs remained unchanged in the course of acupuncture. Blood pressure was measured before and after treatment, and MRI scanning. MRI images were pretreated. The correlation analysis was made between the difference of ReHo signal and the difference of blood pressure before and after the course of treatment, and the whole brain function connection analysis of ROI- was made after determining the changes of blood pressure related to ROI,. To compare the difference brain area of FC in patients with EH before and after acupuncture at Taixi. Results A total of 8 studies were included in the 1.Meta analysis. Meta-analysis showed that the clinical effective rate of 1: OR combined with 4.07% 95 CI (2.45 鹵6.67) and 2SBP: MD combined with -6.85% 95 CI (-8.78 ~ -4.93) was significantly lower than that of HCs, and its 95%CI was (-6.19 ~ 2.69) .2.The characteristics of cerebral functional junction in patients with EH were significantly lower than those in patients with HCs. Including increased ReHo in some brain regions of BA3,11,19,20,23,25,26,37,48,, For example, in bilateral cerebral islands of BA6,7,11,25, (ACC) in anterior cingulate gyrus was significantly correlated with SBP. FC analysis showed that FC between right cerebral island and BA17,10, between left cerebral island and BA13, between right ACC and BA10,17,24,48, and between left ACC and lentiform nucleus was significantly lower than that between HCs. Effect of Acupuncture at Taixi Point on brain functional connection in patients with EH 15 patients with EH completed acupuncture course of treatment. There was no significant change in SBP after treatment. After acupuncture, the increase of ReHo in the BA6,18,19,23,47,48 brain area and the decrease of ReHo in the brain area of BA9 ~ (9) ~ 10 ~ 22 ~ (40) were found, among which, the difference between the left superior frontal gyrus, the island, the lentiform nucleus, the (PCC) of the posterior cingulate gyrus, and the right thalamus and the SBP was significantly correlated with that of the left superior frontal gyrus and the BA30,37, para-hippocampal gyrus. FC increased significantly between left cerebral island and BA6,19,25, between left lentiform nucleus and BA8,13,41,47, between left PCC and BA11,30, between right thalamus and bilateral caudate nucleus, between left superior frontal gyrus and BA7,31, between left lenticular nucleus and BA10,19, between left thalamus and bilateral caudate nucleus, between left superior frontal gyrus and BA7,31, between left lentiform nucleus and BA10,19, between left thalamus and bilateral caudate nucleus. FC between the right thalamus and BA5 was attenuated. Conclusion Meta analysis shows that acupuncture combined with medicine therapy can better control blood pressure, increase blood pressure is related to brain area activity, bilateral cerebral islet ACC is closely related to EH, acupuncture at Taixi point is effective in reducing SBP in short course of treatment. The central effect of acupuncture on lowering blood pressure may be based on the functional connection between superior frontal gyrus, cerebral island, lentiform nucleus, cingulate gyrus, thalamus and other brain regions.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.1
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