Clinical Medical School of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of CM, Guangzhou 510405, Guangdong Province, China.
Second School of Clinical Medicine, Guangzhou University of CM, Guangzhou 510120, Guangdong Province.
Zhongguo Zhen Jiu. 2023 Sep 1;43(11):1239-1245. doi: 10.13703/j.0255-2930.20230420-k0003.
OBJECTIVES: To compare the effects of electroacupuncture (EA) with different time intervals on corticospinal excitability of the primary motor cortex (M1) and the upper limb motor function in healthy subjects and observe the after-effect rule of acupuncture. METHODS: Self-comparison before and after intervention design was adopted. Fifteen healthy subjects were included and all of them received three stages of trial observation, namely EA group (received one session of EA), EA group (received two sessions of EA within 1 day, with an interval of 6 h) and EA group (received two sessions of EA within 3 days, with an interval of 48 h). The washout period among stages was 1 week. In each group, the needles were inserted perpendicularly at Hegu (LI 4) on the left side, 23 mm in depth and at a non-acupoint, 0.5 cm nearby to the left side of Hegu (LI 4), separately. 's acupoint nerve stimulator (HANS-200A) was attached to these two needles, with continuous wave and the frequency of 2 Hz. The stimulation intensity was exerted higher than the exercise threshold (local muscle twitching was visible, and pain was tolerable by healthy subjects, 1-2 mA ). The needles were retained for 30 min. Using the single pulse mode of transcranial magnetic stimulation (TMS) technique, before the first session of EA (T0) and at the moment (T1), in 2 h (T2) and 24 h (T3) after the end of the last session of EA, on the left first dorsal interosseous muscle, the amplitude, latency (LAT), resting motor threshold (rMT) of motor evoked potentials (MEPs) and the completion time of grooved pegboard test (GPT) were detected. Besides, in the EA group, TMS was adopted to detect the excitability of M1 (amplitude, LAT and rMT of MEPs) before the last session of EA (T0*). RESULTS: The amplitude of MEPs at T1 and T2 in the EA group, at T0* in the EA group and at T1, T2 and T3 in the EA group was higher when compared with the value at T0 in each group separately (<0.001). At T1, the amplitude of MEPs in the EA group and the EA group was higher than that in the EA group (<0.001, <0.01); at T2, it was higher in the EA group when compared with that in the EA group (<0.01); at T3, the amplitude in the EA group and the EA group was lower than that of the EA group (<0.001). The LAT at T1 was shorter than that at T0 in the three groups (<0.05), and the changes were not obvious at the rest time points compared with that at T0 ( > 0.05). The GPT completion time of healthy subjects in the EA group and the EA group at T1, T2 and T3 was reduced in comparison with that at T0 (<0.001). The completion time at T3 was shorter than that at T0 in the EA group (<0.05); at T2, it was reduced in the EA group when compared with that of the EA group (<0.05). There were no significant differences in rMT among the three groups and within each group (>0.05). CONCLUSIONS: Under physiological conditions, EA has obvious after-effect on corticospinal excitability and upper limb motor function. The short-term interval protocol (6 h) blocks the after-effect of EA to a certain extent, while the long-term interval protocol (48 h) prolongs the after-effect of EA.
目的：比较不同时间间隔电针对健康受试者初级运动皮层（M1）皮质脊髓兴奋性和上肢运动功能的影响，并观察针刺的后效规律。
方法：采用干预前后自身对照设计。纳入 15 名健康受试者，均接受 3 个阶段的试验观察，即电针组（单次电针）、电针组（1 日内 2 次电针，间隔 6 h）和电针组（3 日内 2 次电针，间隔 48 h）。各阶段之间的洗脱期为 1 周。在每组中，将针垂直插入左侧合谷（LI4），深度 23mm，在左侧合谷（LI4）附近非穴位处，深度 0.5cm。将“穴位神经刺激仪（HANS-200A）”连接到这两个针上，采用连续波，频率为 2Hz。刺激强度高于运动阈（局部肌肉抽搐可见，健康受试者可耐受的疼痛，1-2mA）。针保留 30min。采用经颅磁刺激（TMS）技术的单次脉冲模式，在左侧第一背间骨间肌上，在电针第一次治疗前（T0）和结束时（T1）、结束后 2 小时（T2）和 24 小时（T3），检测运动诱发电位（MEPs）的振幅、潜伏期（LAT）、静息运动阈值（rMT）和槽钉板测试（GPT）完成时间。此外，在电针组中，在最后一次电针治疗前（T0*），采用 TMS 检测 M1 的兴奋性（MEPs 的振幅、LAT 和 rMT）。
结果：电针组 T1 和 T2 时，电针组 T0*时和电针组 T1、T2 和 T3 时，MEPs 的振幅高于各组 T0 时（均<0.001）。T1 时，电针组和电针组的 MEPs 振幅高于电针组（均<0.001，<0.01）；T2 时，电针组高于电针组（<0.01）；T3 时，电针组和电针组低于电针组（均<0.001）。三组 T1 时 LAT 较 T0 时缩短（均<0.05），与 T0 时相比，其余时间点变化不明显（均>0.05）。电针组和电针组 T1、T2 和 T3 时健康受试者的 GPT 完成时间较 T0 时缩短（均<0.001）。电针组 T3 时的完成时间较 T0 时缩短（<0.05）；T2 时，电针组低于电针组（<0.05）。三组 rMT 比较差异均无统计学意义（均>0.05）。
结论：在生理状态下，电针对皮质脊髓兴奋性和上肢运动功能有明显的后效。短期间隔方案（6h）在一定程度上阻断了电针的后效，而长期间隔方案（48h）延长了电针的后效。
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