【摘要】：目的1以單純性肥胖患者為研究對(duì)象,健康受試者為基線對(duì)照,評(píng)價(jià)按摩治療單純性肥胖的臨床效應(yīng)指標(biāo)的改善;2以下丘腦外側(cè)區(qū)(lateralhypothalamicarea,LHA)為重點(diǎn),從能量代謝平衡及下丘腦食欲調(diào)節(jié)網(wǎng)絡(luò)切入,運(yùn)用功能磁共振成像(fMRI)技術(shù)探討按摩治療單純性肥胖的中樞作用機(jī)制及特點(diǎn),為按摩治療單純性肥胖的臨床運(yùn)用提供科學(xué)的理論依據(jù)。方法本研究臨床資料收集采用單純性肥胖患者自身前后對(duì)照方法。課題納入30例單純性肥胖患者(按摩組)采用腹部按摩療法進(jìn)行干預(yù),另納入10例健康志愿者(正常組)作為基線對(duì)照及按摩組按摩治療后對(duì)照,所有受試者(按摩組和正常組)于基線期進(jìn)行體重、BMI、體脂率、腰圍、臀圍、股圍、SF-36生活質(zhì)量量表、焦慮自評(píng)量表和抑郁自評(píng)量表的臨床測(cè)量與評(píng)價(jià)。所有單純性肥胖患者分別于基線期及治療6周后進(jìn)行兩次靜息態(tài)功能性核磁共振掃描,并在治療后再次進(jìn)行體重、BMI、體脂率、腰圍、臀圍、股圍的測(cè)定和SF-36生活質(zhì)量量表的評(píng)定,正常組于基線期只進(jìn)行一次靜息態(tài)功能性核磁共振掃描,不給予任何干預(yù)。以LHA為種子點(diǎn),使用靜息態(tài)功能連接度(Resting State Functional Connectivity,Rs-fc)分析方法,分析單純性肥胖患者按摩治療前后與健康志愿者存在異常的LHA靜息態(tài)功能連接度,以及腹部按摩療法對(duì)單純性肥胖患者LHA靜息態(tài)功能連接度的調(diào)整作用特點(diǎn)。結(jié)果1臨床資料結(jié)果基線期按摩組SF-36生活質(zhì)量量表在PF、GH、VT、MH四個(gè)維度評(píng)分顯著低于正常組(P0.05)。而抑郁自評(píng)量表及焦慮自評(píng)量表評(píng)分方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但按摩組評(píng)分趨勢(shì)高于正常組。經(jīng)過(guò)6周治療干預(yù)后,按摩能顯著改善按摩組單純性肥胖患者的體重、BMI、體脂率、腰圍、臀圍和股圍(P0.01)以及SF-36生活質(zhì)量量表評(píng)分在PF、BP、GH、VT四個(gè)方面的評(píng)分(P0.05);其中在PF、GH、VT方面具有非常顯著的改善(P0.01)。2單純性肥胖患者LHA靜息態(tài)功能連接度與健康受試者相比,單純性肥胖患者LHA與左側(cè)頂下小葉、右側(cè)額上回、左側(cè)額中回、左側(cè)楔葉靜息態(tài)功能連接度升高;與雙側(cè)殼核、丘腦、尾狀核靜息態(tài)功能連接度降低。經(jīng)過(guò)按摩治療后,單純性肥胖患者LHA與雙側(cè)頂下小葉、右側(cè)額上回、額中回、左側(cè)距狀回靜息態(tài)功能連接度升高;與右側(cè)小腦蚓部靜息態(tài)功能連接度降低。單純性肥胖患者按摩治療前后相比,治療后LHA與右側(cè)中央后回靜息態(tài)功能連接度升高;左側(cè)額上回、額中回靜息態(tài)功能連接度降低。單純性肥胖患者治療前后LHA rs-fc差異同體重變化回歸分析:LHA和豆?fàn)詈遂o息態(tài)功能連接度差異與體重變化成正相關(guān),LHA和枕葉靜息態(tài)功能連接度差異與體重變化成負(fù)相關(guān)。單純性肥胖患者治療前后LHA rs-fc差異同腰圍變化回歸分析:LHA和腦干、小腦前葉靜息態(tài)功能連接度差異與腰圍變化成正相關(guān),和頂下小葉、顳葉、梭狀回的靜息態(tài)功能連接度差異與腰圍變化成負(fù)相關(guān)。結(jié)論1按摩療法能明顯改善單純性肥胖患者的體重、BMI、體脂率、腰圍、臀圍、股圍等臨床效應(yīng)指標(biāo),提高患者的生活質(zhì)量,改善情緒方面的問(wèn)題。2下丘腦能量代謝平衡中心核團(tuán)的功能異常,可能是導(dǎo)致肥胖發(fā)生的因素之一。3單純性肥胖患者與正常人在認(rèn)知功能系統(tǒng)等腦區(qū)可能存在差異。4按摩療法可能通過(guò)軀體感覺(jué)中樞,并以邊緣系統(tǒng)、獎(jiǎng)賞回饋系統(tǒng)整合高級(jí)認(rèn)知活動(dòng)相關(guān)腦區(qū)對(duì)單純性肥胖發(fā)揮治療作用。
[Abstract]:Objective: To study the improvement of the clinical effect index for simple obesity with simple obesity, and to evaluate the clinical effect index of massage for simple obesity. Functional magnetic resonance imaging (fMRI) was used to study the central mechanism and characteristics of massage to treat simple obesity, and to provide a scientific basis for the clinical application of massage to treat simple obesity. Methods The clinical data of this study was used to collect the self-control methods of simple obese patients. Subjects included 30 simple obese patients (massage group) with abdominal massage therapy, and 10 healthy volunteers (normal group) as the baseline control and massage group massage treatment, all the subjects (the massage group and the normal group) were body weight and BMI in the baseline period. Clinical measurement and evaluation of body fat rate, waist circumference, hip circumference, thigh circumference, SF-36 life quality scale, anxiety self-rating scale and self-rating depression scale. All simple obese patients were subjected to two rest functional nuclear magnetic resonance scans at baseline and after 6 weeks of treatment, and the body weight, BMI, body fat rate, waist circumference, hip circumference, thigh circumference, and SF-36 quality of life scale were evaluated again after treatment. In the normal group, only one resting-state nuclear magnetic resonance scan was performed at baseline, and no intervention was given. With the LHA as the seed point, the resting state functional connectivity (Rs-fc) was used to analyze the function of the resting state of the LHA in the patients with simple obesity before and after the massage treatment. And the adjustment effect of the abdominal massage therapy on the function connection degree of the resting state of the LHA in the simple obesity patient. Results The SF-36 life quality scale of the baseline period massage group was significantly lower than that in the normal group (P0.05). The scores of self-rating and anxiety self-rating were not statistically significant (P0.05), but the scores of the massage group were higher than that of the normal group. After 6 weeks of treatment, the body weight, BMI, body fat rate, waist circumference, hip circumference and thigh circumference (P0.01) and the score of SF-36 life quality scale (P 0.01) and SF-36 life quality scale score in the four aspects of PF, BP, GH and VT were significantly improved (P0.05), and in PF, GH, There was a very significant improvement in VT (P0.01). Compared with healthy subjects, the function of LHA resting state in simple obesity patients was higher than that of healthy subjects. The function of the resting state of the thalamus and caudate nucleus decreased. After the massage treatment, the LHA in the simple obesity group and the lower lobe of the bilateral top, the right frontal gyrus, the frontal gyrus, the left-to-back rest state functional connection increased, and the function of the function of the resting state of the right cerebellar vermis was reduced. Compared with before and after the massage treatment of simple obese patients, the function of the function of the resting state of the LHA and the center of the right after treatment is increased, and the function of the function of the resting state in the frontal gyrus and the frontal gyrus is reduced. The analysis of the difference of LHA rs-fc and the change of body weight before and after the treatment of simple obese patients: the difference of the functional connectivity of the resting state of the LHA and the soybean-like nucleus is positively correlated with the weight change, and the difference of the functional connectivity of the resting state of the LHA and the occipital lobe is negatively correlated with the body weight change. The changes of LHA rs-fc and LHA rs-fc before and after treatment in simple obese patients were analyzed with the regression of the waist circumference: the difference of the functional connectivity of the resting state of the anterior and posterior lobe of the LHA and the brain stem was positively correlated with the change of the waist circumference, and the difference of the functional connectivity of the resting state of the lower lobule, the lower leaf and the shed was negatively correlated with the change of the waist circumference. Conclusion The massage therapy can obviously improve the body weight, BMI, body fat rate, waist circumference, hip circumference and thigh circumference of simple obesity patients, improve the quality of life and improve the emotional aspect of the patients. May be one of the factors leading to the occurrence of obesity. The reward and feedback system is used for the treatment of simple obesity in the relevant brain regions of the high-level cognitive activity.
【學(xué)位授予單位】：貴陽(yáng)中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R244.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 曾慶云;王強(qiáng);霍勇軍;王敏;曹曉嵐;謝雁鳴;王永炎;;應(yīng)用BOLD-fMRI探討推拿對(duì)缺血性卒中后運(yùn)動(dòng)皮質(zhì)功能重組影響的研究[J];中國(guó)康復(fù)醫(yī)學(xué)雜志;2015年10期

2 彭旭明;范志勇;黃勇;陳尚杰;吳健文;張靜;李健萍;繆輝宇;曲崇正;張家維;;一指禪推法作用于膽腎經(jīng)原穴的腦功能磁共振研究[J];遼寧中醫(yī)藥大學(xué)學(xué)報(bào);2015年07期

3 郭汝寶;翁軍;李增圖;張喜林;嚴(yán)雋陶;;推拿手法對(duì)家兔失神經(jīng)支配后肌球蛋白重鏈mRNA表達(dá)的影響[J];中華中醫(yī)藥學(xué)刊;2015年01期

4 付建飛;王欣;陳士勇;王安世;張慧琴;張曉宏;;白色脂肪細(xì)胞分化起源的研究進(jìn)展[J];公共衛(wèi)生與預(yù)防醫(yī)學(xué);2014年04期

5 張欣;劉明軍;尚坤;吳萌;楊寄渝;李亞;王之虹;;基于“皮部”理論推拿療法對(duì)家兔免疫功能調(diào)節(jié)作用研究[J];中華中醫(yī)藥雜志;2014年05期

6 謝輝;唐成林;陳曉琳;唐念珍;;按摩促進(jìn)骨骼肌損傷后肌纖維再生機(jī)理的研究[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2015年02期

7 閻博華;彭趣思;魏?jiǎn)⑷A;豐芬;;經(jīng)穴推拿對(duì)單純性肥胖患者體質(zhì)量、體質(zhì)量指數(shù)、腰圍及臀圍的影響:隨機(jī)對(duì)照研究(英文)[J];World Journal of Acupuncture-Moxibustion;2014年01期

8 梅旭暉;紀(jì)倩;姚斌彬;吳劍聰;魯夢(mèng)倩;于天源;;推拿對(duì)坐骨神經(jīng)損傷大鼠神經(jīng)生長(zhǎng)因子及其受體p75NTR的影響[J];中華中醫(yī)藥雜志;2013年07期

9 陳尚杰;許瓊瑜;彭旭明;程華軍;;針刺與推拿太溪穴激活不同腦功能區(qū)的fMRI研究[J];針灸臨床雜志;2013年06期

10 林清;張宏;趙謙;牛坤;張國(guó)輝;王勇麗;屈慶;;推拿法引發(fā)人骨骼肌細(xì)胞生物學(xué)效應(yīng)的機(jī)制探討[J];上海中醫(yī)藥大學(xué)學(xué)報(bào);2013年02期

相關(guān)會(huì)議論文 前3條

1 張健康;王衛(wèi)剛;;循經(jīng)推拿治療單純性肥胖癥100例[A];全國(guó)中醫(yī)藥創(chuàng)新與發(fā)展研討會(huì)專輯[C];2005年

2 崔瑾;陳波;賈瑩;吳高鑫;向開維;王興桂;宋和蘭;劉鯤;周燁泓;;按摩對(duì)肥胖模型大鼠作用機(jī)制的研究[A];2011中國(guó)針灸學(xué)會(huì)年會(huì)論文集（摘要）[C];2011年

3 劉明軍;王之虹;張欣;卓越;陳邵濤;;運(yùn)腹通經(jīng)推拿法治療單純性肥胖癥臨床研究[A];第十二次全國(guó)推拿學(xué)術(shù)年會(huì)暨推拿手法調(diào)治亞健康臨床應(yīng)用及研究進(jìn)展學(xué)習(xí)班論文集[C];2011年

相關(guān)博士學(xué)位論文 前1條

1 卓越;運(yùn)腹通經(jīng)推拿法治療單純性肥胖癥（脾失健運(yùn)證）及對(duì)脂肪代謝影響的機(jī)制研究[D];長(zhǎng)春中醫(yī)藥大學(xué);2014年

相關(guān)碩士學(xué)位論文 前5條

1 陳勇;推拿手法治療脾虛濕阻型單純性肥胖癥的臨床觀察[D];北京中醫(yī)藥大學(xué);2013年

2 姜婉婷;運(yùn)腹推經(jīng)法治療單純性肥胖癥的臨床研究[D];長(zhǎng)春中醫(yī)藥大學(xué);2012年

3 姜濤;健脾祛濕推拿法治療單純性肥胖癥的臨床研究[D];山東中醫(yī)藥大學(xué);2010年

4 喬巧;經(jīng)絡(luò)點(diǎn)穴推拿治療青少年單純性肥胖癥的臨床療效觀察[D];山東中醫(yī)藥大學(xué);2009年

5 張昆;推拿治療單純性肥胖癥的臨床研究[D];山東中醫(yī)藥大學(xué);2004年

，

本文編號(hào)：2464655