Acupunture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Sichuan, China.
Am J Gastroenterol. 2012 Aug;107(8):1236-47. doi: 10.1038/ajg.2012.53. Epub 2012 May 29.
Acupuncture is a commonly used therapy for treating functional dyspepsia (FD), although the mechanism remains unclear. The objectives of this study were to investigate the differences in cerebral glycometabolism changes evoked by acupuncture and sham acupuncture and to explore the possible correlations between brain responses and clinical efficacy.
In all, 72 FD patients were randomly assigned to receive either acupuncture or sham acupuncture treatment for 4 weeks. Ten patients in each group were randomly selected for fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography scans to detect cerebral glycometabolism changes. The Nepean Dyspepsia Index (NDI) and Symptom Index of Dyspepsia (SID) were used to evaluate the therapeutic effect.
(i) The clinical data showed that after treatment the decrease in SID score in the acupuncture group was significantly greater than that in the sham acupuncture group (P<0.05). The increase in NDI score between the two groups did not differ (P>0.05), and only the improvement in NDI score in the acupuncture group was clinically significant. (ii) The neuroimaging data indicated that after treatment the acupuncture group showed extensive deactivation in cerebral activities compared with the sham acupuncture group. In the acupuncture group, the deactivations of the brainstem, anterior cingulate cortex (ACC), insula, thalamus, and hypothalamus were nearly all related to the decrease in SID score and the increase in NDI score (P<0.05, corrected). In the sham acupuncture group, the deactivations of the brainstem and thalamus tended to be associated with the increase in NDI score (P<0.1, corrected).
Acupuncture and sham acupuncture have relatively different clinical efficacy and brain responses. Acupuncture treatment more significantly improves the symptoms and quality of life of FD patients. The more remarkable modulation on the homeostatic afferent network, including the insula, ACC, and hypothalamus, might be the specific mechanism of acupuncture.
针刺是治疗功能性消化不良（FD）的常用疗法，但作用机制尚不清楚。本研究旨在观察针刺与假针刺治疗后大脑糖代谢变化的差异，并探讨脑反应与临床疗效的可能相关性。
共纳入 72 例 FD 患者，随机分为针刺组和假针刺组，分别接受 4 周的治疗。每组各有 10 例患者随机接受氟-18 氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描，以检测大脑糖代谢变化。采用 Nepean 消化不良指数（NDI）和消化不良症状指数（SID）评价疗效。
（i）临床数据显示，治疗后针刺组 SID 评分下降较假针刺组更显著（P<0.05）。两组 NDI 评分的增加无差异（P>0.05），且只有针刺组 NDI 评分的改善具有临床意义。（ii）神经影像学数据表明，治疗后针刺组与假针刺组相比，大脑活动的广泛去激活。在针刺组中，脑干、前扣带回皮质（ACC）、岛叶、丘脑和下丘脑的去激活与 SID 评分的降低和 NDI 评分的增加均密切相关（P<0.05，校正）。在假针刺组中，脑干和丘脑的去激活趋势与 NDI 评分的增加相关（P<0.1，校正）。
针刺和假针刺具有相对不同的临床疗效和脑反应。针刺治疗更显著地改善 FD 患者的症状和生活质量。针刺可能通过调节包括岛叶、ACC 和下丘脑在内的自主传入网络发挥其特异性作用机制。
