Objectives: To explore the effect of acupuncture for Ningshen Tongqiao (tranquilizing the spirit and unblocking the orifices) on the functional connectivity (FC) between the anterior cingulate cortex (ACC) and the whole brain in the patients with subjective tinnitus using the resting-state functional magnetic resonance imaging (fMRI).
Methods: Forty patients with subjective tinnitus and 40 healthy subjects were recruited. The patients with subjective tinnitus were treated with acupuncture for Ningshen Tongqiao at Yamen (GV 15) and Baihui (GV 20), as well as Tinggong (SI 19), Touqiaoyin (GB 11) and Shuaigu (GB 8) on the affected side; and Tinggong (SI 19) and Touqiaoyin (GB 11) were attached to the electric acupuncture apparatus and stimulated with disperse-dense wave and 2 Hz/50 Hz in frequency. Acupuncture was operated once daily, 3 times a week and 10 treatments were required. Before and after treatment, the scores of tinnitus evaluation questionnaire (TEQ), tinnitus handicap inventory (THI) and tinnitus visual analogue scale (VAS) were evaluated; and the clinical therapeutic effect was assessed. Separately, the patients with subjective tinnitus received one time of fMRI within 2 days before and after treatment, and the healthy subjects underwent one time of fMRI after enrollment. The bilateral ACC was taken as the region of interest (ROI). Using matlab R2017b software, FC between ACC and the whole brain was calculated.
Results: After treatment, the scores of THI, TEQ and VAS were reduced in the subjective tinnitus patients compared with those before treatment (P<0.01); and the total effective rate was 92.5% (37/40). Before treatment, compared with the healthy subjects, FC between the right ACC and the left middle temporal gyrus, the left superior temporal gyrus and the left superior frontal gyrus decreased in the subjective tinnitus patients. FC between the right ACC and the left middle frontal gyrus and the bilateral angular gyrus was dropped, while that between the left ACC and the left middle frontal gyrus, the left thalamus, the left angular gyrus and the left middle temporal gyrus was decreased in the subjective tinnitus patients when compared with the healthy subjects after treatment. Compared with those before treatment, FC between the right ACC and the left lingual gyrus and the left thalamus were declined, and that between the left ACC and the right middle frontal gyrus and the right superior frontal gyrus was decreased in the subjective tinnitus patients after treatment.
Conclusions: Acupuncture can effectively relieve the clinical symptoms of subjective tinnitus patients, and promote the functional re-construction of the auditory regions (temporal lobe, frontal lobe and thalamus) and the emotion-related brain regions.
目的: 采用静息态功能磁共振成像（fMRI）探究宁神通窍法针刺对主观性耳鸣患者前扣带回（ACC）与全脑功能连接的影响。方法: 招募40例主观性耳鸣患者和40例健康受试者。主观性耳鸣患者予宁神通窍法针刺治疗，穴取哑门、百会及患侧听宫、头窍阴、率谷，听宫、头窍阴连接电针仪，使用疏密波，频率2 Hz/50 Hz。隔日针刺1次，每周针刺3次，共治疗10次。分别于治疗前后观察主观性耳鸣患者耳鸣评价量表（TEQ）、耳鸣残疾评估量表（THI）、耳鸣视觉模拟量表（VAS）评分，并评定临床疗效。主观性耳鸣患者分别在治疗前后2 d内进行1次fMRI扫描，健康受试者纳入后进行1次fMRI扫描。将双侧ACC作为感兴趣区域（ROI），采用matlab R2017b软件计算ACC和全脑之间的功能连接（FC）。结果: 治疗后，主观性耳鸣患者TEQ、THI、VAS评分均较治疗前降低（P<0.01），总有效率为92.5%（37/40）。治疗前，与健康受试者比较，主观性耳鸣患者右侧ACC与左侧颞中回、左侧颞上回、左侧额上回FC降低。治疗后，与健康受试者比较，主观性耳鸣患者右侧ACC与左侧额中回、双侧角回FC降低；左侧ACC与左侧额中回、左侧丘脑、左侧角回、左侧颞中回FC降低。与治疗前比较，主观性耳鸣患者治疗后右侧ACC与左侧舌回、左侧丘脑FC降低；左侧ACC与右侧额中回、右侧额上回FC降低。结论: 针刺可有效改善主观性耳鸣患者临床症状，促进颞叶、额叶、丘脑等听觉及情绪相关脑区功能重组。.
Keywords: Ningshen Tongqiao (tranquilizing the spirit and unblocking the orifices); acupuncture; functional connectivity; functional magnetic resonance imaging (fMRI); subjective tinnitus.