从2024年1期起，广大读者朋友可以在本公众号经典栏目“《世界针灸杂志》选粹”中全文免费翻阅世界针联会刊《世界针灸杂志》啦！每一期的“《世界针灸杂志》选粹”栏目不仅会推送一篇最新研究摘要，还会附上整期电子刊阅读链接，此阅读链接永久有效，可自由阅览《世界针灸杂志》的学术论文！
Effect of acupuncture for anisometropic amblyopia: A randomized clinical trial and potential mechanism
针刺治疗屈光参差性弱视：一项随机对照试验及其潜在起效机制
Cui MA（马翠）a，Jing JIA（贾静）a，Yu-juan YE（叶钰娟）a，Yan SUN（孙燕）b，Xing-ke YAN（严兴科）a
a College of Acupuncture-Moxibustion and Tuina, Gansu University of Chinese Medicine, Lanzhou 730000, China（甘肃中医药大学针灸推拿学院，兰州 730000，中国）
b Gansu Provincial Hospital Rehabilitation Center, Lanzhou 730000, China（甘肃省康复中心医院，兰州 730000，中国）
Objective: To evaluate the effect of acupuncture on anisometropic amblyopia (AA) and explore its potential mechanism for children with AA. Methods: Seventy-six children with monocular AA were randomized into a conventional treatment group and a combined treatment group of acupuncture and conventional treatment, with 38 patients in each group. In the conventional treatment group, on the base of patching regimen, the red flashing, grating and visual stimulation were delivered. Each approach lasted for 5 min per session and was given once every two days, three times a week, for 4 consecutive weeks. In the acupuncture-combined treatment group, on the base of the regimen of conventional treatment group, acupuncture was applied to Jingming (BL1), Cuanzhu (BL2), Fengchi (GB20) and Guangming (GB37), with needles retained for 20 min per session, once every two days, three times of intervention a week and for 4 consecutive weeks. Before and after treatment, the best corrected vision acuity (BCVA) was observed to evaluate the clinical effect in the two groups. Before treatment started, 15 patients with AA on left side were randomized selected from each group and the resting-state functional magnetic resonance imaging (rs-fMRI) was operated before and after treatment. Simultaneously, eight healthy children with normal visual acuity were recruited to be the normal control group and received one-time rs-fMRI scanning. Based on the activation likelihood estimation (ALE), the visual “what” pathway network was constructed. By analyzing the amplitude of low frequency fluctuation (ALFF) and the regional homogeneity (ReHo), the differences in the regional autonomous function activities in the key brain areas of the “what” pathway were compared among the three groups.Results: (1) Clinical effect: After treatment, BCVA was (0.6 [0.5, 0.6]), higher than that (0.4 [0.3, 0.5]) before treatment, presenting the statistical difference (P < 0.05) in the conventional treatment group. BCVA was (0.6 [0.6, 0.8]), higher than that (0.4 [0.4, 0.5]) before treatment, presenting the statistical difference (P < 0.05) in the acupuncture-combined treatment group. BCVA in the acupuncture-combined treatment group was higher than that of the conventional treatment group (P < 0.05) after treatment. The total effective rate was 86.1% in the acupuncture-combined treatment group, higher than that (65.8%) of the conventional treatment group (P < 0.05). (2) Mechanism: ① ALFF: In comparison with the healthy control group, the ALFF in the primary visual cortex of the “what” pathway for AA children was reduced significantly (P < 0.05), and ALFF in the right fusiform gyrus and the right inferior temporal gyrus increased significantly when compared with the healthy children (P < 0.05). Compared with that before treatment, there was no significant difference in the brain areas of the “what” pathway after treatment in the conventional treatment group (P > 0.05). In the acupuncture-combined treatment group, ALFF in the right inferior occipital gyrus and the right fusiform gyrus of the “what” pathway increased after treatment when compared with that before treatment (P < 0.05). After treatment, in comparison with the conventional treatment group, there was no significant difference in the brain areas of “what” pathway in the acupuncture-combined treatment group (P > 0.05). ② ReHo: ReHo in the right inferior occipital gyrus, the right fusiform gyrus and the right inferior temporal gyrus in the “what” pathway was elevated significantly in AA children when compared with that in the healthy control group (P < 0.05). ReHo of the left inferior occipital gyrus and the left fusiform gyrus increased significantly after treatment when compared with that before treatment in the conventional treatment group (P<0.05). ReHo of the right inferior occipital gyrus, the left and the right fusiform gyrus increased significantly after treatment when compared with that before treatment in the acupuncture-combined treatment group (P < 0.05). After treatment, ReHo of the right inferior temporal gyrus in the “what” pathway in the acupuncture-combined treatment group was significantly higher than that of the conventional treatment group (P < 0.05).Conclusion: The acupuncture combined with conventional treatment improves BCVA and the total effective rate of AA children. The changes in the regional function activity of the brain areas within the “what” pathway were dominated by the compensatory increase of the autonomous activity in the occipital lobe (inferior occipital gyrus) and the temporal lobe (inferior temporal gyrus) in AA children. Both conventional treatment and acupuncture can enhance the intensity of autonomous function activities in the occipital lobe (inferior occipital gyrus) and the temporal lobe (fusiform gyrus / inferior temporal gyrus) in the “what” pathway so as to relieve visual impairment. ReHo in the inferior temporal gyrus in the acupuncture-combined treatment group was higher than that of the conventional treatment group and it suggests that the inferior temporal gyrus may be the key brain area to the improvement of visual function in the “what” pathway.目的：评价针刺治疗屈光参差性弱视（Anisometropic amblyopia，AA）患儿的临床疗效，并探讨针刺治疗AA患儿潜在的起效机制。方法：将76例单眼AA患儿随机分为常规治疗组和常规治疗联合针刺组，每组各38例。常规治疗组给予在配镜遮盖的基础上，接受红闪、光栅和视刺激治疗，每项每次持续干预5 min，隔日进行1次，一周3次，共4周。常规治疗联合针刺组在常规治疗的基础上，采用针刺干预，穴取睛明、攒竹、风池和光明，每次留针20 min，隔日治疗1次，一周3次，共治疗4周。分别于治疗前后观察两组患儿最佳矫正视力以评判临床疗效。在治疗开始前从两组中随机抽取15例左眼AA患儿，于治疗前后分别进行静息态功能磁共振成像（Resting-state functional magnetic resonance imaging, rs-fMRI）扫描，同时招募8例视力正常的健康儿童为正常对照组，并于入组时进行一次rs-fMRI扫描。基于激活似然估算法（Activation Likelihood Estimate，ALE）构建视觉what通路网络，运用低频振荡振幅（Amplitude of low frequency fluctuations，ALFF）和局部一致性（Regional homogeneity，ReHo）分析方法比较三组what通路关键脑区局部自主功能活动差异。结果：（1）临床疗效：治疗后，常规治疗组最佳矫正视力为0.6（0.5,0.6）高于治疗前的0.4（0.3,0.5），差异具有统计学意义（P＜0.05）；常规治疗联合针刺组最佳矫正视力为0.6（0.6,0.8）高于治疗前的0.4（0.4,0.5），差异具有统计学意义（P＜0.05）。治疗后，常规治疗联合针刺组最佳矫正视力高于常规治疗组（P＜0.05）。常规治疗联合针刺组总有效率86.1%，高于常规治疗组的65.8%（P＜0.05）。（2）起效机制：①ALFF结果：AA患儿与正常对照组比较：与正常儿童相比，AA患儿what通路内初级视皮层ALFF值显著降低（P＜0.05），右侧梭状回和右侧颞下回的ALFF值显著升高（P＜0.05）。常规治疗组治疗前后比较：与治疗前相比，常规治疗组治疗后what通路内无显著性差异脑区（P＞0.05）。常规治疗联合针刺组治疗前后比较：常规治疗联合针刺组治疗后what通路内右侧枕下回、右侧梭状回的ALFF值较治疗前升高（P＜0.05）。两组患儿治疗后比较：治疗后，与常规治疗组相比，常规治疗联合针刺组what通路内无显著性差异脑区（P＞0.05）。②ReHo结果：AA患儿与正常对照组比较：与正常儿童相比，AA患儿what通路内右侧枕下回、右侧梭状回、右侧颞下回ReHo值升高（P＜0.05）。常规治疗组治疗前后比较：与治疗前相比，治疗后常规治疗组左侧枕下回和左侧梭状回ReHo值显著升高（P＜0.05）。常规治疗联合针刺组治疗前后比较：常规治疗联合针刺组右侧枕下回、左侧梭状回和右侧梭状回ReHo值显著升高（P＜0.05）。两组患儿治疗后比较：常规治疗联合针刺组what通路内右侧颞下回ReHo值显著高于常规治疗组（P＜0.05）。结论：常规联合针刺治疗可改善AA患儿最佳矫正视力，提高总有效率。AA患儿what视神经通路内脑区局部功能活动的改变以枕叶（枕下回）、颞叶（颞下回）自发活动的代偿性增加为主。常规治疗和针刺都可增强what通路内枕叶（枕下回）与颞叶（梭状回/颞下回）自发活动强度，从而改善患儿的物体特征视觉功能障碍。其中，常规治疗联合针刺组的颞下回ReHo值高于常规治疗组，表明颞下回可能是针刺通过影响what通路改善视功能的核心关键脑区。
|
|
◆“中医针灸，世界针灸”重装上线。全球最新、最快、最全的针灸第一时间有态度、负责任的呈现给您。
![]()
针灸 【经络 穴位 中医 养生 健康】
世界针灸学会联合会简介： ►是世界卫生组织非政府组织机构（NGO in official Relations with WHO）。
►是国际标准化组织中医药技术委员会（ISO/TC249）A级联络组织。 ►现有团体会员272个，代表着70个国家和地区40多万名针灸工作者。 ►促进世界针灸界之间的了解和合作，加强国际间的学术交流，进一步发展针灸医学，不断提高针灸医学在世界卫生保健工作中的地位和作用，为人类的健康做出贡献。 I 版权声明：本文由世界针灸学会联合会整理发布。尊重知识与劳动，转载请保留版权信息。本平台所发布内容的版权属于相关权利人所有，如存在不当使用的情况，请随时与我们联系协商。
I 投稿邮箱：admin@wfas.org.cn 欢迎广大针灸工作者进行原创投稿，一经采纳，必有重酬。 I 编辑微信号：ChinaJin 请在添加好友中注明微信投稿字样。
I 责任编辑：刘晋 ![]()
![]() 猛戳“阅读原文”获取更多针灸信息
![]()
|
