牛　璇^1,2，孙传铸¹，王　姗¹，王晓翠¹，曹洁莉¹，陈　震¹，,劳力行^3,4，白丽君¹

（1西安交通大学生命科学与技术学院生物信息工程重点实验室，陕西西安710049；2西安交通大学第一附属医院影像科，陕西西安 710061；3香港大学中医药学院，香港；4马里兰大学医学院综合医学中心，美国 ）

摘要：研究目的：临床上，针刺内关穴（PC6）被广泛用于预防药物治疗或手术引起的恶心呕吐等副反应，大量证据表明针刺在镇吐方面疗效显著，但其潜在的神经机制尚不清楚。本研究旨在探索针刺内关穴位（PC6），相较于同经络穴位大陵（PC7）以及视觉相关穴位光明（GB37）在恶心图片刺激任务所引发的大脑不同激活响应模式。研究方法：48名健康被试随机分入4组：（1）PC6治疗组，（2）PC7治疗组，（3）GB37治疗组，（4）恶心图片刺激组。在磁共振扫描过程中，治疗相继接受不同的穴位刺激，以及从国际情绪图片系统筛选的恶心图片构成的恶心诱发刺激；恶心刺激组只接受单纯的诱发恶心的刺激任务。在扫描结束后，采集所有被试在针刺得气感、恶心感觉及焦虑方面的评分。研究结果：相较于恶心诱发刺激组，针刺PC6组在恶心感觉评分有显著的降低（P＜0.05）。相比较，针刺PC7组表现出比恶心诱发刺激组在焦虑评价得分上显著的降低(P＜0.05)，针刺GB37与恶心诱发刺激组相比，在恶心感觉与焦虑评价得分均无明显的统计学差异 (P＞0.05)。在大脑fMRI BOLD信号激活响应方面，相较于恶心诱发刺激组，针刺PC6组在前额叶与小脑蚓部具有更强的信号减弱；针刺PC7可产生对旁海马脑区更强的信号抑制作用；针刺GB37产生BOLD信号减弱的部位位于枕上小叶。结论：结果表明，针刺PC6可特异性的通过调节小脑-额部神经环路参与对呕吐反应的治疗作用。并且，针刺PC7可产生对情感处理加工相关的脑区，如旁海马区域的调节，推测这可能与其在心理相关疾病的疗效密切相关。针刺GB37对枕叶脑区的调控作用也进一步阐明其在治疗视觉相关疾病方面的潜在神经机制。本研究进一步表明相较于对照组，PC7（与PC6位于同一经络穴位）及与GB37（治疗视觉相关疾病的穴位），针刺PC6在镇吐方面具有特异性的神经调节机制，其大脑激活效应模式揭示小脑-额部神经环路可能参与针刺PC6穴位在镇吐中的神经调节作用。 

关键词：针刺镇吐作用；PC6穴位特异性；恶心图片诱发刺激；大脑激活响应模式

Neural mechanism of acupoint specificity underlying the antiemetic efficacy: an fMRI study.

NIU Xuan1,2, SUN Chuanzhu1, WANG Shan1, WANG Xiaocui1, CAO Jieli1, CHEN Zhen1, LAO Lixing3,4, BAI Lijun1

(1 Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi’ an Jiaotong University, Shanxi Xi'an 710049；2 Department of Medical Imaging, the First Affiliated Hospital of Medical College, Xi’ an Jiaotong University, Shanxi Xi'an 710061；3 School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong；4 Center for Integrative Medicine, School of Medicine, University of Maryland, 520 W. Lombard Street, Baltimore, MD 21201, USA)

Abstract: Objective: Acupuncture is particularly effective for preventing nausea and vomiting after drug treatments and surgery. Furthermore, the antiemetic efficacy of acupuncture, especially the acupointNeiguan, pericardium 6 (PC6), has been widely used in clinical settings. However, the mechanismby which acupuncture stimulation at PC6 achieves its therapeutic effects is unclear. We aimed to investigate the activity patterns of different acupoints such as PC6, with the same meridian acupoint PC7 and vision-related acupoint GB37, comparing with the disgust-induced group without treatment. Methods: Forty- eight subjects were randomly divided into four groups. The digust-induced group was used as a blank control to observe brain signal activation and affective assessments (disgust sensations and anxiety scales) evoked by pictures from the International Affective Picture System (IAPS). Three acupuncture treatment groups performed on different acupoints and experienced the disgust stimuli as conducted in disgust-induced group. Psychophysical responses (deqi sensations) were also assessed after acupuncture treatments. Results: In the comparison of PC6 acupuncture and disgust-induced group, disgust sensations showed significant decreased (P＜0.05). By contrast, PC7 group presented significant decrease of anxiety scores compared with disgust-induced group (P＜0.05), and GB37 did not produce significant statistical differences on disgust sensations and anxiety scores. Neuroimaging studies showed that PC6 reduce the signal changes in the inferior prefrontal gyrus and vermis. Moreover, there was a less range of signal changes in response to disgust stimulation after PC7 acupuncture, mainly deactivations in the parahippocampal gyri. In contrast, GB37 can induce decreased signal changes mainly in the superior occipital gyrus. Conclusions:The results indicated that PC6 can specifically modulate disgust-induced nausea and vomiting，further suggested by the involvements of the cerebellar-frontal neural circuit. In addition, acupuncture at PC7 produce the affective- process brain area such as parahippocampal gyri, which can be a mechanism underlying its function for mental-related disorders. The brain regions activation after GB37 located at the vision-related cortex (superior occipital gyrus) elucidating the effects of GB37 in vision-related disorders. These findings demonstrated that acupuncture at different acupoints may exert heterogeneous modulatory effects on the brain activity patterns.

Key words: Antiemetic efficacy of acupuncture, Disgust-inducedstimuli, Brain activity pattern