Objectives: To explore the clinical effect of Yang's pricking-cupping therapy and its central mechanism in treatment of eczema-induced pruritus using resting-state functional magnetic resonance imaging (rs-fMRI).
Methods: Fifty patients with eczema-induced pruritus were enrolled in the observation group, and 50 healthy subjects were enrolled in the control group. No any intervention was delivered in the control group. Yang's pricking-cupping therapy was operated at Dazhui (GV 14) and bilateral Quchi (LI 11), Xuehai (SP 10) and Sanyinjiao (SP 6), once a week, lasting 6 weeks in the observation group. The scores of the 12-item pruritus severity scale (12-PSS), the eczema area and severity index (EASI), the dermatology life quality index (DLQI), the Pittsburgh sleep quality index (PSQI), and the self-rating anxiety scale (SAS) were compared before and after treatment in the observation group. The rs-fMRI scanning was conducted and the regional homogeneity (ReHo) analysis performed in all of the participants before and after treatment in the observation group, as well as at the time of subject enrollment in the control group. The correlation was analyzed between ReHo values in the different areas of the brain and the scores of the above scales.
Results: Compared with those before treatment, the scores of 12-PSS, EASI, DLQI, PSQI, and SAS were reduced after treatment in the observation group (P<0.01, P<0.05). ReHo values were increased in the right caudate nucleus, the right middle temporal gyrus, the right orbitofrontal gyrus, the right thalamus and the left angular gyrus before treatment in the observation group when compared with those in the control group (P<0.001); and ReHo values in the above areas of the brain were decreased after treatment when compared with those before treatment in the observation group (P<0.001). In comparison with the control group, ReHo values were reduced in the left middle temporal gyrus, the left superior parietal lobule and the left supplementary motor area in the observation group before treatment (P<0.001); while when compared with those before treatment, ReHo values in the above areas of the brain were elevated after treatment in the observation group (P<0.001). Before treatment, ReHo value in the left supplementary motor area was positively correlated with 12-PSS score (r=0.432, P=0.004), and the value in the right orbitofrontal gyrus was negatively correlated with PSQI score (r=-0.318, P=0.04) in the observation group. After treatment, ReHo value in the left superior parietal lobule was positively correlated with 12-PSS score (r=0.384, P=0.012) in the observation group.
Conclusions: The abnormal cerebral functional activities are exhibited in multiple areas of the brain involved in stimulus response, emotional regulation, behavior control and attention in the patients with eczema-induced pruritus. Yang's pricking-cupping therapy can effectively relieve the pruritus symptoms and skin lesions of the patients, which may be related to reversing the abnormal cerebral functional activities induced by pruritus.
目的: 采用静息态功能磁共振成像（rs-fMRI）技术探究杨氏絮刺火罐治疗湿疹瘙痒的临床疗效和中枢机制。方法: 50例湿疹瘙痒患者纳入观察组，50名健康受试者纳入对照组。对照组不行任何干预；观察组于大椎及双侧曲池、血海、三阴交行杨氏絮刺火罐治疗，每周1次，共治疗6周。比较观察组治疗前后12项瘙痒严重程度评估量表（12-PSS）、湿疹面积及严重程度（EASI）、皮肤病生活质量指数（DLQI）、匹兹堡睡眠质量指数（PSQI）和焦虑自评量表（SAS）评分。观察组治疗前后及对照组入组时均接受rs-fMRI扫描并进行局部一致性（ReHo）分析，将差异脑区ReHo值与上述量表评分进行相关性分析。结果: 与治疗前比较，观察组治疗后12-PSS、EASI、DLQI、PSQI、SAS评分均降低（P<0.01，P<0.05）。与对照组比较，观察组治疗前右侧尾状核、右侧颞中回、右侧眶部额上回、右侧丘脑、左侧角回ReHo值增高（P<0.001）；与治疗前比较，观察组治疗后上述脑区ReHo值下降（P<0.001）。与对照组比较，观察组治疗前左侧颞中回、左侧顶上小叶、左侧补充运动区ReHo值下降（P<0.001）；与治疗前比较，观察组治疗后上述脑区ReHo值增高（P<0.001）。治疗前，观察组左侧补充运动区ReHo值与12-PSS评分呈正相关（r=0.432，P=0.004）；右侧眶部额上回ReHo值与PSQI评分呈负相关（r=-0.318，P=0.04）。治疗后，观察组左侧顶上小叶ReHo值与12-PSS评分呈正相关（r=0.384，P=0.012）。结论: 湿疹瘙痒患者多个参与刺激反应、情绪调节、行为控制、注意力等功能的脑区存在活动异常。杨氏絮刺火罐能有效改善湿疹患者瘙痒症状和皮肤损害，其作用机制可能和逆转瘙痒所导致的脑区功能活动异常有关。.
Keywords: eczema; functional magnetic resonance imaging (fMRI); pricking-cupping; pruritus; regional homogeneity (ReHo).