基于双模拟设计的针刺治疗KOA下行疼痛调控系统网络整合机制研究

Knee osteoarthritis (KOA) is a major concern of the health in the elderly, which is also a major social public issues in the aging society in China. A large number of clinical randomized controlled trails report that acupuncture treatment is effective and safe for KOA, but the underlying mechanism remains unclear, which restricts its clinical application. It is now well accepted that the abnormity of the descending pain modulatory system in KOA is one of the key pathophysiology for the complex pain symptom in KOA patients. Based on the traditional Chinese medicine (TCM) theory “knee is the converge of Jin, while Yanglingquan acupoint is the coverge of Jin”, Yanglingquan is one of the most frequently used acupoints for KOA and also a good breakthrough point for acupunture treatment for KOA research. Based on the above, this study is projected to integrate neuroscience, computer science, neuroimage and psychology with TCM. Multiple mode neuroimaging techniques (BOLD-fMRI + ASL), advanced complex network analysis method and double dummy design will be combined to investigate the different descending pain modulatory system brain network modulation characteristic between puncturing Yanglingquan acupoint and classic non-steroid anti-inflammatory drug (celecoxib) for KOA treatment, for the sake of providing scientific evidence for acupuncture treatment for KOA.

膝骨关节炎（KOA）严重影响中老年人群健康，是老龄化中国社会的重要公共社会问题。大量临床研究显示针刺治疗KOA安全有效，但其作用机制尚不明确，限制了其临床应用和推广。目前研究发现KOA患者大脑下行疼痛调控系统的功能异常，是导致KOA患者临床疼痛症状复杂性的关键病理因素之一。根据“膝为筋之府，筋会阳陵泉”理论，阳陵泉是针刺治疗KOA的经典常用取穴，也是针刺治疗KOA的良好切入点。基于此，本课题将在中医理论的指导下，综合中医学、神经科学、计算机、影像学、心理学等多学科，采用多模态神经成像技术（BOLD-fMRI+ASL）交互印证，使用先进的复杂网络分析方法，引入双模拟设计，从下行疼痛调控系统脑网络整合机制切入，研究针刺阳陵泉对比经典非甾体类抗炎药（塞来昔布胶囊）治疗KOA患者的中枢脑网络整合机制差异，为针刺治疗KOA提供科学依据。

本项目以膝骨性关节炎为研究载体，采用BOLD-fMRI，3DT1和DTI扫描成像技术，观察针刺相对于塞来昔布和等待治疗对膝骨性关节炎患者脑区功能活动、脑功能连接网络的影响。结果发现，在临床效应方面，相较于塞来昔布组及等待治疗组，针刺能有效的改善膝骨性关节炎患者的疼痛、僵硬、功能障碍等临床症状，调节患者的焦虑、抑郁情绪，提高患者的生活质量。其次，在脑功能活动方面，与塞来昔布及等待治疗相比，针刺治疗后KOA患者脑功能活中央前回功能活动增加，壳核、楔前叶功能活动降低，前扣带回与海马功能连接增加，前扣带回与额下回、额中回、角回、脑岛功能连接降低。塞来昔布组及等待治疗组患者中央后回功能活动增加，额中回功能活动降低。该研究结果表明相对于塞来昔布治疗与等待治疗，针刺治疗对膝骨性关节炎患者大脑功能活动的影响模式不同，主要为表现在对疼痛情感、感觉和认知以及疼痛下行调控通路相关脑区的调整模式不同。本研究为针刺治疗KOA的部分中枢作用机制提供了科学试验依据。