Objective: To observe the changes of functional connectivity of brain pain-emotion regulation region in patients with cervical spondylosis of cervical type by functional magnetic resonance imaging (fMRI).
Methods: Thirty-two subjects were selected. Of them, 16 patients with cervical spondylosis of cervical type were divided into an observation group and 16 healthy subjects into a control group. The patients in the observation group were treated with acupuncture at Tianzhu (BL 10), Jingbailao (EX-HN 15), Jianzhongshu (SI 15) and ashi points for 30 min. The rest-state fMRI data was collected before and after acupuncture in the observation group. The subjects in the control group received no treatment, and the rest-state fMRI data was collected once. The visual analogue scale (VAS) score before and after treatment and the pain catastrophizing scale (PCS) score before treatment in the observation group were recorded. The resting-state brain functional imaging characteristics between the observation group and control group before treatment, between the observation group before and after treatment, were compared. Based on the brain functional connectivity of region of interest (ROI) the changes of functional connectivity in insula and ventral tegmental area (VTA) in emotional regulation brain region were observed, and the correlation between functional connectivity changes and VAS、PCS scores in patients of the observation group was analyzed.
Results: In the observation group, the VAS score was (1.94±1.12) after the treatment, which was lower than (5.62±1.20) before treatment (P<0.05). The PCS score before treatment was (19.18±8.42) in the observation group. Compared with the control group, the areas with increased functional connectivity with insula in the observation group before acupuncture included bilateral dorsolateral prefrontal lobe and right middle cingulate gyrus, and the areas with increased functional connectivity with VTA included right central posterior gyrus and right insula. In the observation group, the connectivity coefficient of left insula and left dorsolateral prefrontal lobe (r=0.438, P<0.05), the connectivity coefficient of right insula and right dorsolateral prefrontal lobe (r=0.483, P<0.05) were positively associated with the VAS score. In the observation group, the connectivity coefficient between the right insula and the right middle cingulate gyrus (r=-0.560, P<0.05), the connectivity coefficient between the right VTA and the right insula (r=-0.525, P<0.05) were negatively associated with the PCS score. After acupuncture, the areas with decreased functional connectivity with insula included bilateral posterior central gyrus, right anterior central gyrus, middle cingulate gyrus and left corpus callosum, while the bilateral suboccipital gyrus and left cerebellum showed increased functional connectivity with right insula. The areas with decreased functional connectivity with VTA included bilateral dorsomedial prefrontal cortex, left anterior cingulate gyrus, right middle temporal gyrus and left anterior cingulate gyrus. After acupuncture in the observation group, the functional connectivity of left VTA left dorsomedial prefrontal cortex and left anterior cingulate cortex (r=-0.548, P<0.05), the functional connectivity of right VTA-bilateral dorsomedial prefrontal cortex and left anterior cingulate cortex (r=-0.547, P<0.05) were negatively associated with the PCS score.
Conclusion: Pain involves the formation and expression of "pain-emotion-cognition". Acupuncture can systematically regulate the brain functional connections between cognitive regions such as dorsal prefrontal lobe and anterior cingulate gyrus and emotional regions such as insula and VTA in patients with cervical spondylosis of cervical type, suggesting that acupuncture has a multi-dimensional and comprehensive regulation effect on pain.
目的：利用功能性磁共振成像（fMRI）技术观察针刺对颈型颈椎病患者疼痛–情绪调控区域的脑功能连接的影响。方法：受试者32例，其中16例颈型颈椎病患者为观察组，16例健康受试者作为对照组。观察组予针刺天柱、颈百劳、肩中俞、阿是穴治疗，留针30 min。观察组患者在针刺治疗前后采集静息态fMRI数据；对照组不进行治疗，仅需采集一次静息态fMRI数据。记录观察组针刺前后视觉模拟量表（VAS）评分及针刺前疼痛灾难化量表（PCS）评分。比较观察组针刺前与对照组、观察组针刺前后静息态脑功能成像特点。基于种子点区域的脑功能连接分析针刺对颈痛患者情绪调节脑区中脑岛（insula）及中脑腹侧被盖区（VTA）功能连接的影响，并分析其功能连接改变与观察组患者VAS、PCS评分的相关性。结果：观察组患者针刺后VAS评分为（1.94±1.12）分，低于针刺前的（5.62±1.20）分（P<0.05）。观察组患者针刺前PCS评分为（19.18±8.42）分。与对照组比较，观察组患者针刺前与insula功能连接增高的区域有双侧背外侧前额叶和右侧中扣带回，与VTA功能连接增高的区域有右侧中央后回和右侧insula。观察组患者左侧insula和左侧背外侧前额叶的连接系数（r=0.438，P<0.05）、右侧insula和右侧背外侧前额叶的连接系数（r=0.483，P<0.05）与VAS评分呈正相关；观察组患者右侧insula和右侧中扣带回的连接系数（r=–0.560，P<0.05）、右侧VTA和右侧insula的连接系数（r=–0.525，P<0.05）与PCS评分呈负关联。针刺后，与insula功能连接降低的区域有双侧中央后回、右侧中央前回、中扣带回、左侧胼胝体，双侧枕下回和左侧小脑与右侧insula功能连接增高；与VTA功能连接降低的区域有双侧背内侧前额叶、左侧前扣带回、右侧颞中回、左侧前扣带回。观察组患者针刺后左侧VTA-左侧背内侧前额叶、左侧前扣带回脑功能连接（r=–0.548，P<0.05）和右侧VTA-双侧背内侧前额叶、左侧前扣带回脑功能连接（r=–0.547，P<0.05）与PCS评分呈负相关。结论：疼痛涉及“痛觉-情绪-认知”的形成和表达。针刺能系统性调节颈型颈椎病患者大脑背侧前额叶和前扣带回等认知区域与insula、VTA等情感区域的脑功能连接，提示针刺对疼痛具有多维度的全面调节作用。.
Keywords: acupuncture; brain functional connectivity; cervical spondylosis of cervical type; emotion regulation; functional magnetic resonance imaging (fMRI); insula; ventral tegmental area (VTA).