偏头痛共病焦虑抑郁的脑功能活动改变及针刺对其调节作用机制：fMRI研究的Meta分析

Changes in brain functional activity in migraine with anxiety and depression and the mechanism of acupuncture on its regulation：a Meta-analysis of fMRI studies

关键词:  偏头痛  共病  焦虑  抑郁  针刺  功能磁共振成像  系统评价

Key words:  migraine  comorbidity  anxiety  depression  acupuncture  functional magnetic resonance imaging  systematic evaluation

摘要:

[目的] 评价偏头痛共病焦虑抑郁患者脑功能活动的改变及针刺治疗对其脑功能活动的影响。[方法] 检索国内外数据库，时间从各数据库建库至2022年6月。系统收集以脑功能磁共振成像为观察指标的针刺治疗无先兆偏头痛文献，筛选出有偏头痛共病焦虑抑郁患者的临床脑功能影像研究，汇总针刺治疗对偏头痛共病焦虑抑郁脑功能影像数据，影像指标要求包含激活脑区的蒙特利尔神经学研究所或Talairach空间坐标，采用差异映射分析（SDM）软件进行体素Meta分析，得出其脑功能变化的特点及针刺治疗该疾病引起脑功能改变的一般规律。[结果] 共检索到文献186篇，10篇文献符合纳入标准，共纳入418例患者及160例健康对照，对10项研究进行体素Meta分析后，结果显示偏头痛共病焦虑抑郁患者左尾状核的脑功能较健康对照受试者活跃，双侧枕中回及右侧枕上回脑区较健康对照活跃度降低；针刺治疗升高右额中回的脑功能（P＜0.005）。[结论] 针刺可通过增加偏头痛共病焦虑抑郁患者的右侧额中回功能活动来减轻患者的疼痛及焦虑抑郁相关症状；共病患者大脑的脑功能活动改变可能与偏头痛的慢性化及先兆症状相关。

Abstract:

[Objective] To evaluate the changes of brain function in migraine patients with anxiety and depression and the effects of acupuncture on brain function. [Methods] Domestic and foreign databases were searched from the establishment of each database to June 2022. The literature on acupuncture treatment of migraine without aura using functional magnetic resonance imaging（fMRI） as the observation index was systematically collected，and the clinical brain functional image studies of migraine patients with anxiety and depression were screened out，and the brain functional image data of acupuncture treatment on migraine with anxiety and depression were summarized. Image indicators were required to include MNI（Montreal Neurological Institute） or Talairach spatial coordinates of activated brain regions，and voxel Meta-analysis was performed using Seed-based d Mapping（SDM） software. The characteristics of brain function change and the general rule of brain function change caused by acupuncture treatment of this disease were obtained. [Results] A total of 186 literatures were retrieved，10 of which met the inclusion criteria，including 418 patients and 160 healthy controls. Voxel Meta-analysis of the 10 studies showed that the brain function of the left caudate nucleus in migraine with anxiety and depression was more active than that in the healthy control，and the activity of the bilateral middle occipital gyrus and right suproccipital gyrus was less active than that in the healthy control. Acupuncture decreased the brain function in the right middle frontal gyrus（P＜0.005）. [Conclusion] Acupuncture could reduce pain and anxiety-depression-related symptoms of migraine patients by increasing the functional activity of right middle frontal gyrus. The changes of brain functional activity in comorbidities may be related to the chronic and aura symptoms of migraine.