基于心脑相关理论的循经取穴针刺治疗心绞痛的心-脑代谢响应特征研究

Relevance theory between heart and brain is the important component of TCM "Zang-xiang" theory. Acupoint selection along meridians is the basic acupoint location method. It has been confirmed in clinical practice that puncturing acupoints along meridians can induce remarkable curative effect in angina patients. However,it still lacks reasonable explanation about its mechanism. The complished NFSC study(NO.30772835)has focused on central responses induced by puncturing acupoints along meridians through fMRI and obtained some finding about central mechanism. Thus, based on previous findings and TCM relevance theory between heart and brain, aimed at the hypothesis of "puncturing acupoints along meridians may arouse specific heart-brain metabolic responses in chronic stable angina patients", this research will be applied to explore heart-brain metabolic responsed induced by puncturing acupoints along meridians in stable angina patients through Magnetic Resonance Spectroscopy Imaging which will be the first time to be used in acupunture study of puncturing acupoints along meridians. It is essentially meaningful that the research results will offer essential support to guide clinical practice, improve the clinical effect of acupuncture and develop acupuncture theory.

心脑相关理论是中医重要的藏象理论，循经取穴是针灸临床最基本的取穴方法，冠心病心绞痛为临床常见的重大疾病，古今临床实践证实循经取穴针刺治疗该病疗效肯定，然而其科学内涵尚未得到全面科学的阐释。已完成的国家自然科学基金课题（NO.30772835）运用fMRI成像技术，从偱经取穴针刺的大脑神经信息响应特征来阐释循经取穴的科学内涵，发现了循经取穴针刺的部分中枢机制。在此基础上，本研究基于中医心脑相关理论，围绕"循经取穴针刺治疗冠心病慢性稳定型心绞痛具有相对特异性的心脑代谢响应特征"的研究假说，以循经取穴针刺疗效确切的慢性稳定型心绞痛患者为载体，从心-脑代谢特征入手，首次将先进的磁共振波谱成像技术应用于循经取穴针刺的机理研究，挖掘循经取穴针刺的心-脑代谢响应特征，进一步揭示循经取穴针刺法特异性的作用机制。其研究成果对指导针灸临床、提高临床疗效、发展针灸理论具有重要的科学意义与临床应用价值。

本研究以慢性稳定性心绞痛患者与健康受试者为载体，采用18F-FDG PET-CT和BOLD-fMRI技术，在观察慢性稳定性心绞痛患者相对于健康受试者脑功能活动的变化特征，明确疾病相关脑区功能变化的基础上，对比观察循经取穴针刺与非循经取穴针刺、非经非穴针刺干预对慢性稳定性心绞痛患者脑区功能活动、脑功能连接网络和血液中白细胞介素-6、CRP和BNP的影响。结果发现，首先，慢性稳定性心绞痛患者与健康受试者相比，存在以自我平衡网络脑区大脑葡萄糖代谢异常，自主神经调控网络脑区大脑功能活动、脑岛功能网络的异常；其次，循经取穴针刺与非循经取穴针刺、非经非穴针刺相比，对患者脑岛等自主神经调控网络脑区的异常活动和血液中白细胞介素-6、CRP和BNP三个代谢指标具有相对特异的调整作用。该研究结果再次证实了穴位相对特异性的存在，也为传统中医心脑相关理论提供了科学的试验依据。