Research On Characteristics Of Brain-target Organ Interaction In Acupuncture Treating Primary Dysmenorrhea

Objective: Primary dysmenorrhea(PDM)participants and healthy subjects were enrolled in this study.We use the arterial spin labeling magnetic resonance imaging(ASL-MRI)technique and three-dimensional Color Doppler Ultrasonography(3D-CDU)technique to monitor the blood perfusion characteristics of the brain-target organ in real time,and to explore the characteristics of acupuncture treatment of PDM brain-target organ linkage response,and further explore the internal mechanism of acupuncture treatment of PDM.Methods: 1.We included 40 PDM participants and 36 age-,education level-matched healthy subjects.All subjects' demographic data,vital signs,emotional status and living quality were collected on the menstrual period.At the same time,brain ASL-MRI scan and uterine 3D-CDU examination were conducted.By comparing analysis,the abnormal brain regions of cerebral blood perfusion and the characteristics of uterine perfusion in patients with PDM were combed.2.Using a randomized,controlled study design,40 PDM participants were assigned into acupuncture treatment and waiting treatment groups by using a computer-generated random number table,20 in each group.Subjects in the acupuncture treatment group underwent acupuncture treatment for three menstrual cycles,acupuncture treatment started 5 days before menstruation,once a day,until the arrival of the menstruation,a total of 15 sessions.Subjects in the waiting treatment group received no treatment during the study and received the same treatment as the acupuncture treatment group after the study.Using the visual analogue scale(VAS)to evaluate pain degree of dysmenorrhea and COX dysmenorrhea symptom scale to evaluate simultaneous phenomenon of dysmenorrhea,the emotional state of subjects was assessed by using the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),the living quality of the subjects was assessed using the MOS 36-item Short Form Health Survey(SF-36).The above indicators were evaluated before intervention and menstrual period after treating 3 months.The second ASL-MRI scan and uterine 3D-CDU examination were conducted at the menstrual period after the end of the treatment.Results: 1.The baseline comparison results were comparable between PDM participants and the healthy subjects(p>0.05).Analysis of cerebral blood flow(CBF)characteristics and uterine blood perfusion characteristics found: compared with healthy subjects,PDM participants had significantly increased CBF in the left inferior parietal gyrus,left superior parietal gyrus,left postcentral gyrus,left middle frontal gyrus.PDM participants had significantly decreased CBF in the right middle temporal gyrus,right superior temporal gyrus,right temporal pole middle temporal gyrus,left anterior cingutate gyrus,left middle orbital-frontal gyrus,left hippocampus,left parahippocampal gyrus.The uterine artery hemodynamic parameters of PDM participants are significantly different from those healthy subjects.The uterine blood perfusion is characterized by "low speed and high resistance".In terms of systole/diastole rate(S/D),resistance index(RI)and pulsatility index(PI),PDM participants were significantly higher than healthy subjects(p<0.05).We found that the CBF of the left inferior parietal gyrus was positively correlated with the SAS scores in PDM participants(r=0.334,p=0.035),and the CBF of the left inferior parietal gyrus was negatively correlated with the velocity of mean(VM)in PDM participants(r=-0.424,p=0.006),and the CBF of the left middle frontal gyrus was negatively correlated with the VM in PDM participants(r=-0.359,p=0.023),and the CBF of the left middle frontal gyrus was positively correlated with the PI in PDM participants(r=0.391,p=0.013).2.The baseline comparison results were comparable between two groups PDM participants(p>0.05).(1)Clinical efficacy: In the acupuncture treatment group,the VAS scores and COX scores were significantly improved after the treatment(p<0.05).And the bodily pain(BP)scores of the living quality was significantly improved after the treatment(p<0.05).Comparison between groups after treatment,the VAS scores and COX scores of PDM participants in the acupuncture treatment group were significantly better than in the waiting treatment group(p<0.05).The SDS scores of PDM participants in the waiting treatment group were significantly better than in the acupuncture treatment group(p<0.05).(2)CBF: In the acupuncture treatment group,comparison between after treatment with before treatment,PDM participants had significantly increased CBF in the right superior occipital gyrus,right middle occipital gyrus,right middle temporal gyrus,bilateral precuneus,left hippocampus,left parahippocampal gyrus.PDM participants had significantly decreased CBF in the left thalamus,left posterior cingutate gyrus,left middle frontal gyrus,left inferior parietal gyrus,left angular gyrus,right middle orbital-frontal gyrus,right superior orbital-frontal gyrus.(3)Uterine blood perfusion: In the acupuncture treatment group,the S/D and RI were significant reduction after the treatment(p<0.05).And the velocity of diastole(VD)was significantly increased after the treatment(p<0.05).Comparison between groups after treatment,the S/D of PDM participants in the acupuncture treatment group were significantly lower than in the waiting treatment group(p<0.05).(4)Correlation analysis: We found that the CBF improvement value of the left inferior parietal gyrus was negatively correlated with the improvementr atio of SDS scores in PDM participants of the acupuncture treatment group(r=-0.513,p=0.029),and the CBF improvement value of the left inferior parietal gyrus was positively correlated with with the improvementr atio of mental health(MH)scores in PDM participants of the acupuncture treatment group(r=0.489,p=0.040),and the CBF improvement value of the left middle frontal gyrus was negatively correlated with the improvementr atio of VD in PDM participants of the acupuncture treatment group(r=-0.589,p=0.010).Conclusions: 1.PDM participants have abnormal changes in CBF of brain regions and uterine blood perfusion.Moreover,the pathological changes of brain-target organ perfusion abnormalities are significantly correlated.2.Acupuncture can improve the pain degree and dysmenorrhea accompanying symptoms in PDM participants,and can change the blood perfusion of PDM participants with abnormal CBF changes in brain regions,and can change the "low speed and high resistance" characteristics of the uterine blood perfusion.3.Acupuncture can simultaneously improve the blood perfusion of the brain and target organs of PDM participants,and there is a significant correlation between brain and target organs.It indicates that acupuncture treatment of PDM can adjust the blood perfusion of the brain and target organs.And acupuncture has a holistic therapeutic effect.