“治鸣六穴”治疗脾胃虚弱型耳鸣患者的临床疗效观察及脑效应机制研究

doi:10.6040/j.issn.1673-3770.0.2023.099

摘要/Abstract

摘要： 目的观察“治鸣六穴”治疗脾胃虚弱型耳鸣患者的临床疗效,并运用静息态功能性磁共振(functional magnetic resonance imaging, fMRI)对针刺治疗耳鸣进行纵向研究,探讨其脑效应机制。方法选取上海中医药大学附属岳阳中西医结合医院耳鼻咽喉科2020年8月~2022年1月接诊的慢性、中重度(THI≥38分)且中医辨证为脾胃虚弱型的耳鸣患者65例,随机分成观察组(“治鸣六穴”治疗组)和对照组(基础治疗组),基础治疗为交流解惑、声治疗,观察组在基础治疗上增加“治鸣六穴”针刺治疗(2次/星期,持续5星期),两组在治疗结束后及随访期(治疗结束后1个月、3个月)采用耳鸣残疾量表(tinnitus handicap inventory, THI)、匹兹堡睡眠质量指数量表(pittsburgh sleep quality index, PSQI)评估两组患者临床症状改善情况。二组患者治疗前后进行静息态fMRI扫描,以低频振幅(the amplitudeof low-frequency fluctuations, ALFF)、局部一致性(regional homogeneity, ReHo)、功能连接(functional connectivity, FC)为数据分析方法,比较脾胃虚弱型耳鸣患者在“治鸣六穴”针刺前后脑功能活动变化,探讨其脑效应机制。结果观察组较对照组更能显著降低慢性耳鸣患者的THI、PSQI评分(P<0.05);与治疗前相比,观察组和对照组治疗后均能显著降低THI、PSQI评分(P<0.05),治疗结束时、结束4星期、结束12周的观察组的总有效率分别为90.63%、87.50%、87.50%,对照组的总有效率分别为75.76%、72.73%、66.67%,观察组临床疗效更加显著;观察组针刺治疗后耳鸣患者的右侧壳核、右侧脑岛ALFF值降低;右侧梭状回、右侧舌回ReHo值降低;功能连接分析显示以右侧壳核为种子点时,治疗后右侧壳核与右侧额上回、右侧角回、左侧中央旁小叶的功能连接强度降低;以右侧舌回为种子点时,治疗后右侧舌回与左侧内侧额上回、左侧额上回功能连接强度降低;观察组中,右侧壳核的ALFF值变化与PSQI评分呈正相关(P<0.001)。结论 “治鸣六穴”针刺治疗对改善耳鸣患者严重程度、降低耳鸣响度、缓解伴随症状疗效更加显著。针刺治疗后壳核、舌回与前额叶皮层的功能连接降低可能是“治鸣六穴”针刺治疗脾胃虚弱型耳鸣患者的重要中枢调节机制。

关键词: 耳鸣, 针刺, 静息态功能性磁共振, 治鸣六穴, 脾胃虚弱型

Abstract: Objective We first observe the clinical effect of “Six acupoints for treating tinnitus” in the treatment of tinnitus patients with spleen and stomach deficiency, and then adopt a longitudinal study on the treatment of tinnitus with acupuncture by using fMRI which investigates their brain effect mechanism. Methods We select 65 tinnitus patients that were diagnosed with chronic, moderate to severe tinnitus(THI≥38 points)and have spleen and stomach deficiency according to TCM syndrome differentiation. These patients were admitted to the Department of Otorhinolaryngology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese medicine from August 2020 to January 2022. In addition, patients were randomized into an observation group(the “Six acupoints for treating tinnitus” treatment group)and a control group(the basic treatment group). The former group was receiving communication puzzle-solving and acoustic therapy. The latter group was treated with acupuncture at “Six acupoints for treating tinnitus”(twice a week, for five weeks)in addition to the basic treatment. After treatment and follow-up period(two-time points: 1 month and 3 months after the treatment), we employ THI and PSQI to assess the improvement of clinical symptoms in these two groups. Finally, we make a comparison study by adopting ALFF, ReHo, and FC as data analysis methods to compare the changes in brain functional activities before and after acupuncture at “Six acupoints for treating tinnitus” in tinnitus patients with spleen and stomach deficiency. Results Compared with control group, the scores of THI and PSQI in patients with chronic tinnitus in observation group were significantly reduced(P<0.05). Compared with those before treatment, the scores of THI and PSQI in both groups were significantly decreased after treatment(P<0.05). The total effective rates at the end of treatment, 4 weeks, and 12 weeks after treatment in observation group were 90.63%, 87.50%, and 87.50%, respectively. Nevertheless, those in control group were 75.76%, 72.73%, and 66.67%, respectively. To put it differently, the clinical efficacy in observation group was more significant than that in control group. The ALFF values in the right putamen nucleus and right insula, and the ReHo values of the right fusiform gyrus and the right lingual gyrus were decreasing after acupuncture treatment of tinnitus patients in the observation group. Functional connectivity analysis showed that the functional connectivity between the right putamen nucleus and the right frontal gyrus, the right angular gyrus, and the left paracentral lobular decreased after treatment when the right putamen nucleus was set as the seed point. Similarly, the functional connection strength between the right lingual gyrus and the left medial superior frontal gyrus or left superior frontal gyrus decreased after treatment when the right lingual gyrus was used as the seed point. In observation group, the change of ALFF value in the right putamen nucleus was positively correlated with PSQI score(P<0.001). Conclusion “Six acupoints for treating tinnitus” acupuncture treatment has a more significant effect on improving the severity of tinnitus patients, reducing tinnitus loudness, and relieving concomitant symptoms. The decrease in the functional connection between the putamen nucleus, the lingual gyrus, and the prefrontal cortex after acupuncture treatment may be the important central regulation mechanism of “Six acupoints for treating tinnitus” acupuncture in the treatment of tinnitus patients with spleen and stomach deficiency.

Key words: Tinnitus, Acupuncture, Functional magnetic resonance imaging, Six acupoints for treating tinnitus, Spleen and stomach deficiency

中图分类号:

R276.1

刘广宇,谭君颖,霍岩,张剑宁,李明. “治鸣六穴”治疗脾胃虚弱型耳鸣患者的临床疗效观察及脑效应机制研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 53-61.

LIU Guangyu, TAN Junying, HUO Yan, ZHANG Jianning, LI Ming. Clinical observation of “Six acupoints for treating tinnitus”in the treatment of patients with spleen and stomach deficiency and study of brain effect mechanism[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(4): 53-61.

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