针刺对颈椎病颈痛患者默认模式网络的影响：一项功能磁共振成像研究*

The Impact of Acupuncture on the Default Mode Network in Patients with Cervical Spondylosis Neck Pain: A Functional Magnetic Resonance Imaging Study

摘要:

目的：基于功能磁共振成像探讨针刺治疗颈椎病（Cervical Spondylosis, CS）颈痛的部分中枢起效机制。方法：2023年3月至2024年5月于山西中医药大学、山西省针灸医院招募40例 CS患者（治疗组、对照组各20例）进行2周6次治疗，同时招募健康受试者 40例进行3.0t功能磁共振扫描。采用视觉模拟评分（Visual Analog Scale, VAS）在治疗前、后进行疗效评价，采用分数低频振幅（fractional Amplitude of Low Frequency Fluctuations, fALFF）和功能连接（Functional Connectivity, FC）分析方法表征健康受试者和颈痛患者的中枢病理特征及两组患者针刺治疗前及结束后的中枢响应特征。结果：与健康受试者相比，CS患者右侧额中回（Middle Frontal Gyrus, MFG）fALFF值增高，且和VAS评分呈正相关。与治疗前相比，针刺后治疗组VAS评分显著降低，右侧MFG到左侧楔前叶、枕中回等FC增高；对照组VAS评分改善不明显，右侧MFG到左侧MFG、眶部额下回等FC降低。结论：针刺可能通过调节默认模式网络的异常功能连接缓解疼痛，而假针刺的镇痛作用则可能与针刺所引发的安慰剂效应相关联。

Abstract:

Objective: Exploring the Central Efficacy Mechanisms of Acupuncture Treatment for Cervical Spondylosis (CS) Neck Pain Using Functional Magnetic Resonance Imaging. Method: From March 2023 to May 2024, 40 patients with CS were recruited at Shanxi University of Chinese Medicine and Shanxi Provincial Hospital of Acupuncture and Moxibustion (20 cases in the treatment group and 20 cases in the control group) for 6 treatments over 2 weeks. Additionally, 40 healthy subjects were recruited for 3.0T functional magnetic resonance imaging scans. The Visual Analog Scale (VAS) was used to evaluate the efficacy before and after treatment. The fractional Amplitude of Low Frequency Fluctuations (fALFF) and Functional Connectivity (FC) analysis methods were used to characterize the central pathological features of healthy subjects and patients with neck pain, as well as the central response characteristics before and after acupuncture treatment in both groups. Results: Compared to healthy subjects, CS patients showed increased low-frequency amplitude in the right Middle Frontal Gyrus (MFG), which was positively correlated with VAS scores. Following acupuncture treatment, the true acupuncture group exhibited a significant decrease in VAS scores, along with increased FC from the right MFG to the left Precuneus and Posterior Cingulate Cortex. In contrast, the sham acupuncture group showed less improvement in VAS scores and decreased FC from the right MFG to the left MFG and Inferior Frontal Orbital Gyrus. Conclusion: True acupuncture may alleviate pain by modulating abnormal functional connectivity in the default mode network, while sham acupuncture may be associated with the placebo analgesic effect induced by acupuncture.