1、转化医学杂志 2022年12月 第11卷 第6期Translational Medicine Journal,Vo1.11 NO.6,Dec 2022振腹法治疗寒凝血瘀型痛经患者的疗效及ALFF分析研究耿楠,吕桃桃,万纪雷,王伟新 摘要 目的 证实振腹法的临床疗效，探讨振腹法对寒凝血瘀型原发性痛经（primary dysmenorrhea,PD）患者脑区的影响。方法以寒凝血瘀型PD患者为研究对象开展小样本临床试验观察，观察振腹法治疗该病的临床疗效。共纳入20例患者参加振腹法治疗，由于5例患者未能规律接受治疗导致脱落，最终确定15例有效数据纳入统计。观察寒凝血瘀型PD患者经过振腹法治疗后疼痛程度
2、评分量表（Visual analogue scale,VAS）评分、COX痛经症状量表（Cox Menstrual Symptom Scale,CMSS）。受试者在第0月经周期（基线期）和第1个月经周期的前3天内各扫描一次静息态功能磁共振成像（resting state functional magnetic resonance imaging,rs-fMRI），第二次扫描时与振腹法治疗同步进行。采用两样本t检验分析寒凝血瘀型PD患者低频振幅（Amplitude of low frequency fluctuation,ALFF）的差异。结果振腹法治疗寒凝血瘀型PD患者VAS评分结果显示：振腹
3、法治疗前和第1、2、3次治疗后均有明显差异（P0.01）；第1次治疗后与第2次治疗后有差异（P0.05），与第3次治疗后有明显差异（P0.01）；第2次治疗后和第3次治疗后无差异（P0.05）。CMSS总发作时间结果显示：振腹法治疗前与第1次治疗后有差异（P0.05），与第2次和第3次治疗后有明显差异（P0.01）；第1次治疗后与第2次治疗后无差异（P0.05），与第3次治疗后有差异（P0.05）；第2次治疗后与第3次治疗后无差异（P0.05）。CMSS平均严重程度结果显示：振腹法治疗前与第1次治疗后有差异（P0.05），与第2次和第3次治疗后有明显差异（P0.01）；第1次治疗后与第2次和第
4、3次治疗后有差异（P0.05）；第2次治疗后和第3次治疗后无差异（P0.05）。振腹法治疗后，PD患者右侧壳核、左侧岛叶、右侧小脑脚1区存在组间差异，ALLF值升高。结论振腹法临床疗效明确，可刺激寒凝血瘀型痛经患者相关脑区的脑神经元活动，为今后的中枢调控机制研究奠定基础。关键词 ALFF；寒凝血瘀型；痛经；振腹法 中图分类号 R271.13 文献标志码 A 文章编号 2095-3097（2022）06-0392-05doi:10.3969/j.issn.2095-3097.2022.06.015Efficacy of abdomen vibrating method in the treatm
5、ent of dysmenorrhea with coldcoagulation and blood stasis,and its ALFF analysisGENG Nan1，LV Taotao2，WAN Jilei1，WANG Weixin1（1.Dongfang Hospital Beijing University of Chinese Medicine,Beijing 100078,China;2.Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China）Abstract
6、 Objective To confirm the clinical efficacy of the abdomen vibrating treatment and the effect on resting-state functional magnetic resonance imaging(RS-fMRI)of brain in patients with cold coagulation and blood stasisdysmenorrhea.MethodsA small sample clinical trial was conducted on PD patients with
7、cold coagulation and bloodstasis to observe the clinical efficacy abdomen vibrating treatment.A total of 20 patients were included in the method,and 5 patients fell off because they failed to receive regular treatment.Finally,valid data of 15 patients were included inthe statistics.Then,the pain sca
8、le(VAS)score and COX Dysmenorrhea symptom Scale(CMSS)of PD patients withcold coagulation and blood stasis after treatment of abdomen vibrating treatment were analysed.Subjects were scannedwith RS-fMRI once during menstrual cycle 0(baseline)and once during the first 3 days of menstrual cycle 1.The se
9、cond scan was performed at the same time as abdominal vibration treatment.Paired t-test was used to analyze the difference of amplitude of low frequency(ALFF)in PD patients with cold coagulation and blood stasis,with FWE(family-wise Error)correction.ResultsThe VAS scores of PD patients with cold coa
10、gulation and blood stasis treated by abdominal vibration method showed that there were significant differences between before and after the first,second andthird treatment(P0.01).There was a significant difference between the first treatment and the second treatment(P基金项目 国家自然科学基金项目（No.81904315）作者单位
11、 100078 北京，北京中医药大学东方医院（耿楠，万纪雷，王伟新）；100029 北京，北京中医药大学第三附属医院（吕桃桃）；通讯作者 王伟新，E-mail： 392转化医学杂志 2022年12月 第11卷 第6期Translational Medicine Journal,Vo1.11 NO.6,Dec 20220.05),and between the third treatment and the first treatment(P0.01).There was no difference between the secondtreatment and the third treatm
12、ent(P0.05).The total onset time of CMSS showed that there was a significant difference between before and after the first treatment(P0.05),and after the second and third treatment(P0.01).Therewas no difference between the first treatment and the second treatment(P 0.05),but there was a difference be
13、tweenthe first treatment and the third treatment(P0.05).There was no difference between the second treatment and the thirdtreatment(P0.05).The average severity of CMSS showed that there was a significant difference between before andafter the first treatment(P0.05),and after the second and third tre
14、atment(P0.01).There were significant differencesbetween the first treatment and the second and third treatment(P0.05).There was no difference between the secondtreatment and the third treatment(P0.05).After abdominal vibration treatment,there were inter-group differences inthe right putamen,left ins
15、ula,and right cerebellar crus 1 region of PD patients,and the ALLF value increased.Conclusion The clinical effect of the method of vibrating the abdomen is clear,which can stimulate the activity of brain neurons in related brain regions of patients with cold coagulation and blood stasis dysmenorrhea
16、,and lay the foundation forthe future research of central regulatory mechanism.Key words ALFF;Cold coagulation syndrome dysmenorrhea model;Dysmenorrhea;Vibrating abdomen method原发性痛经（primary dysmenorrhea,PD）是指女性在月经前、间、后，特别是月经期间出现的以少腹胀痛或腰骶部酸痛为主要症状的疾病，病情严重者可导致昏厥、呕吐等症状1-2。现代医学手段治疗PD 通常通过服用镇痛药物缓解疼痛感，但停药后症状易反复，远期效果不佳且具有一定副作用3-5。原发性痛经中以寒凝血瘀证为常见证型，其主要症状是以经期或经前小腹冷痛为主，遇温则痛减，经量少偶有血块为主要临床表现。腹部是人体的第二大脑，腹脑与大脑具有相似性及作用相关性，在振腹推拿的研究中，rs-fMRI成像技术的引入为振腹法治疗原发性痛经的中枢机制研究提供了安全可靠的技术手段。低频振幅（Amplitude of low frequency flu