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| 由rs-fMRI探讨电针对原发性骨质疏松症腰背痛的影响 |
| Effects of electroacupuncture on the low back pain in primary osteoporosis based on rs-fMRI |
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| DOI：10.3969/j.issn.1006-7108.2025.07.007 |
| 中文关键词: 电针 原发性骨质疏松症 腰背痛 静息态功能磁共振成像 |
| 英文关键词:electroacupuncture primary osteoporosis back pain resting-state functional magnetic reasoning imaging |
| 基金项目:江苏省中医药科技发展计划重点项目(ZD202313）；江苏省研究生实践创新计划（SJCX23_0895）；江苏省中管局项目（MS2022021）；江苏省中医院重点病种项目（YZJ2404） |
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| 中文摘要: |
| 目的 采用静息态功能磁共振成像（resting state functional magnetic resonance imaging， rs-fMRI）技术探究电针治疗原发性骨质疏松症腰背痛的临床疗效和中枢机制。方法 纳入25例原发性骨质疏松症腰背痛患者作为观察组，招募性别、年龄相匹配的20名健康志愿者作为健康对照组。观察组予电针治疗，每周3次，共治疗4周。比较治疗前后视觉模拟评分（visual analogue scale，VAS）、简式McGill疼痛问卷(short-form of McGill pain questionnaire，SF-MPQ)、腰椎功能障碍指数（oswestry disability index，ODI）。观察组治疗前后及健康对照组入组时均接受rs-fMRI扫描，比较观察组与健康受试者脑功能活动局部一致性值（regional homogeneity，ReHo）的差异；观察电针治疗前后观察组ReHo值的变化；并将ReHo变化值与VAS改善值进行相关性分析。结果 与治疗前比较，观察组治疗后VAS、SF-MPQ、ODI评分降低（P＜0.01）。观察组治疗前与健康对照组相比，共有7个脑区ReHo值发生改变，降低的脑区包括右侧楔前叶、右侧额下回、右侧角回、左侧角回、枕下小叶，增强的脑区有左侧颞上回和右侧脑干。与治疗前比较，治疗后上述7个脑区的ReHo值中，左侧颞上回、右侧脑干明显下降（P＜0.05），右侧楔前叶和右侧额下回明显增强（P＜0.05）。相关性分析显示，治疗前后右侧楔前叶ReHo变化值与VAS改善差值呈负相关（r=-0.548，P=0.015）。结论 电针治疗可改善原发性骨质疏松症患者腰背部疼痛，右侧楔前叶脑区自发性脑活动改变可能是电针起效的中枢机制之一。 |
| 英文摘要: |
| Objective Resting state functional magnetic resonance imaging (rs-fMRI) was used to investigate the clinical effect and central mechanism of electroacupuncture in the treatment of low back pain in primary osteoporosis. Methods Twenty-five patients with primary osteoporosis low back pain were included as the observation group, and 20 healthy volunteers matched in gender and age were recruited as the healthy control group. There was no intervention in the healthy control group. Patients in the observation group received electroacupuncture 3 times a week for 4 weeks, with a total of 12 times. Visual analogue scale (VAS), short-form of McGill pain questionnaire (SF-MPQ), Oswestry disability index (ODI) were compared before and after the treatment. Patients in the observation group and those in the healthy control group received rs-fMRI scanning before and after treatment. The difference of local consistency value of brain functional activity between the patients with primary osteoporosis and the healthy subjects was compared. The changes of local consistency values in patients with low back pain of primary osteoporosis were observed before and after electroacupuncture treatment. The correlation between the local consistent change value and the VAS improvement value was analyzed. Results Compared to those before the treatment, VAS, SF-MPQ, and ODI in the observation group decreased after the treatment (P<0.01). Compared to those in the healthy control group before the treatment, the local consistency values of 7 brain regions in the observation group changed. The decreased brain regions included the right anterior cuneus, the right inferior frontal gyrus, the right angular gyrus, the left angular gyrus, and the suboccipital lobules. The enhanced brain regions included the left superior temporal gyrus and the right brain stem. Compared to those before the treatment, the local consistency values of the above 7 brain regions decreased significantly in the left superior temporal gyrus and right brainstem (P<0.05), and increased significantly in the right anterior cuneus and right inferior frontal gyrus after the treatment (P<0.05). Correlation analysis showed that the local consistent changes of the right anterior cuneus before and after treatment were negatively correlated with the difference in VAS improvement (r=-0.548, P=0.015). Conclusion Electroacupuncture treatment effectively relieves the low back pain in patients with primary osteoporosis. The degree of pain relief is negatively correlated with the local consistency in the right precuneus brain region. The spontaneous changes in brain activity in this brain region may be one of the central mechanisms of electroacupuncture analgesia. |
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