利用神经影像学技术预测针刺治疗腕管综合征远期效果【BRAIN，IF=10】

JenniferZhan

转载自：针灸最前沿     作者：陈波


Abstract

Carpal tunnel syndromeis the most common entrapment neuropathy, affecting the median nerve at thewrist. Acupuncture is a minimally-invasive and conservative therapeutic option,and while rooted in a complex practice ritual, acupuncture overlaps significantlywith many conventional peripherally-focused neuromodulatory therapies. However,the neurophysiological mechanisms by which acupuncture impacts acceptedsubjective/psychological and objective/physiological outcomes are not wellunderstood. Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6years) were enrolled and randomized into three intervention arms:分三组 (i)verum electro-acupuncture ‘local’ to the more affected hand; 一组局部取真穴(ii) verum electro-acupuncture at‘distal’ body sites, near the ankle contralesional to the more affected hand; 一组远端取真穴and(iii) local sham electro-acupuncture using non-penetrating placebo needles另外组局部用安慰针.Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston CarpalTunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms atbaseline, following therapy and at 3-month follow-up. Nerve conduction studiesassessing median nerve sensory latency and brain imaging data were acquired atbaseline and following therapy. Functional magnetic resonance imaging assessedsomatotopy in the primary somatosensory cortex using vibrotactile stimulationover three digits (2, 3 and 5). While all three acupuncture interventionsreduced symptom severity, verum (local and distal) acupuncture was superior tosham in producing improvements in neurophysiological outcomes,神经病理指标真穴（局部或远端）都优于安慰 both local to the wrist (i.e. median sensory nerve conductionlatency) and in the brain (i.e. digit 2/3 cortical separation distance).Moreover, greater improvement in second/third interdigit cortical separationdistance following verum acupuncture predicted sustained improvements insymptom severity at 3-month follow-up. We further explored potentialdifferential mechanisms of local versus distal acupuncture using diffusiontensor imaging of white matter microstructure adjacent to the primarysomatosensory cortex. 进一步比较了局部取穴与远端取穴机制差异，Compared to healthy adults (n = 34,28 female, 49.7 ± 9.9 years old), patients with carpal tunnel syndromedemonstrated increased fractional anisotropy in several regions and, for theseregions we found that improvement in median nerve latency was associated withreduction of fractional anisotropy near (i) contralesional hand areafollowing verum, but not sham, acupuncture; 真针刺（局部或远端），非安慰针，同侧手区激活(ii) ipsilesional hand area followinglocal, but not distal or sham, acupuncture;局部针刺，非远端或安慰针，对侧手区激活 and (iii) ipsilesional leg areafollowing distal, but not local or sham, acupuncture.远端针刺，非局部或安慰针 对侧下肢区域激活 As these primarysomatosensory cortex subregions are distinctly targeted by local versus distalacupuncture electrostimulation, acupuncture at local versus distal sitesmay improve median nerve function at the wrist by somatotopically distinctneuroplasticity in the primary somatosensory cortex following therapy.针刺局部与远端比较，可能提供了腕部正中神经功能 Our study further suggests that improvementsin primary somatosensory cortex somatotopy can predict long-termclinical outcomes for carpal tunnel syndrome. 研究表明初级躯体感觉皮层投射增强可以预测针刺治疗腕管综合征具有较好的长期临床效应。