目的以丘脑为种子点观察无先兆偏头痛(MwoA)患者接受针刺前后丘脑动态功能连接(dFC)变化,并以治疗前dFC差异脑区为特征构建机器学习(ML)模型以预测MwoA患者对针刺治疗的反应。方法搜集50例确诊为MwoA的患者,根据治疗前后临床指标变化分为针刺应答组(AR)30例与非应答组(NR)20例。使用3.0 T MRI采集其T 1WI和BOLD-fMRI图像,通过梯度提升(GBM)、支持向量机(SVM)及随机森林(RF)机器学习算法对其dFC进行分析。结果AR组针刺前丘脑与枕中回、眶内额上回、颞下回动态功能连接较NR组强,中央沟盖、颞中回、距状裂周围皮层、梭状回动态功能连接较NR组弱;与治疗前相比,治疗后丘脑与岛盖部额下回、颞横回、额中回动态功能连接增强;丘脑与背外侧额上回、颞中回、中央前回动态功能连接减弱;训练集中GBM表现较好,权重绝对值排名前三的脑区为眶内额上回、颞中回、左侧距状裂周围皮层。结论调节丘脑与默认模式网络(DMN)、感觉运动环路的dFC是针刺治疗MwoA的可能作用机制;基线状态丘脑与DMN、视觉通路的功能连接强度可能是针刺效果的关键,是针刺疗效的潜在预测因子。
本研究采用前瞻性、随机、对照的临床研究方法,对92例CKD 3~4期诊断为脾肾气虚、湿浊瘀阻证的患者进行观察。随机分为“西医一体化治疗基础方案”对照组和“西医一体化治疗基础疗法结合热敏灸疗法”治疗组,每组46例患者,治疗周期为12周。对照组患者予以西医一体化治疗方案,治疗组患者在对照组治疗方案的基础上予以双侧膈俞穴、脾俞穴、三焦俞穴、肾俞穴和命门穴热敏灸治疗。治疗前后记录两组患者一般情况及热敏灸气感维持时间,并检测患者Scr、Cysc、eGFR、BUN、UA、IL-6、TNF-α、NLR等指标,评价两组临床疗效和中医证候疗效。A prospective, randomized, controlled clinical study was conducted to observe 92 patients diagnosed with spleen kidney qi deficiency, dampness turbidity and blood stasis syndrome in CKD 3~4 stage. They were randomly divided into a control group of “Western medicine integrated treatment basic plan” and a treatment group of “Western medicine integrated treatment basic therapy combined with thermal moxibustion therapy”, with 46 patients in each group and a treatment period of 12 weeks. The control group patients were treated with a Western medicine integrated treatment plan, while the treatment group patients were treated with bilateral thermal moxibustion on the basis of the control group treatment plan at the points of Geshu, Piyu, Sanjiao Yu, Shenshu, and Mingmen. Before and after treatment, the general condition of two groups of patients and the duration of thermal moxibustion gas sensation were recorded, and measure indicators such as Scr, Cysc, eGFR, BUN, UA, IL-6, TNF-α, and NLR were detected to evaluate the clinical efficacy and traditional Chinese medicine syndrome efficacy of the two groups.
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