The Influence Of Acupuncture And Polyethylene Glycol Treatment On Cerebral Functional Activity Of Patients With Functional Constipation: A FMRI Study

Objective: To explore the characteristics of central nerve system response to acupuncture treating for Functional Constipation(FC)by functional Magnetic Resonance Imaging(f MRI),so as to provide scientific evidence for clinical acupuncture treatment of FC.Methods: A total of 36 FC patients were recruited in this study,and randomly divided into acupuncture group(Group A)and Polyethylene glycol(PEG)group(Group B)with the ratio of 1: 1.The patients in acupuncture group received 10 times manual acupuncture treatment,once a day,five times per week for 2 weeks.The patients in PEG group were treated with PEG powder,once a day,once a packet for10 g,five times per week for 2 weeks.The Spontaneous Bowel Movements(SBMs),Cleveland Constipation Score(CCS)and Patient Assessment of Constipation Symptom(PAC-SYM)were used to evaluate the improvement of clinical symptoms of FC patients after two kinds of interventions.The classic resting-state f MRI technique was used to obtain changes of brain functional activity before and after treatment in FC patients.In statistical analysis,first,the ALFF method was used to observe the effect of two interventions on local spontaneous brain activity in FC patients;then,the brain regions with differences in local spontaneous brain activity after these two interventions was used as the region of interest(ROI)for further ROI-FC analysis to investigate the effect of different treatments on the synchronization from ROI to global brain functional activity in FC patients;finally,the correlation analysis between the improvement of clinical outcomes and the changes in cerebral activity was conducted to explored the effects of acupuncture and medication on the brain function in patients with FC.Result:1.Clinical efficacy of acupuncture and PEG treatment for FC patients:(1)The baseline demographic data and disease-related data of FC patients in two groups showed no significant difference(p> 0.05).(2)After treatment,the SBMs in both groups increased significantly(p<0.01),while CCS scores and PAC-SYM scores in both groups decreased significantly(p<0.01).There was no significant difference between two groups in the changes of the SBMs,CCS scores and PAC-SYM scores(p >0.05).2.The change of local spontaneous brain activity elicited by different interventions for FC patients:(1)After acupuncture treatment,ALFF values of multiple brain areas in the Default Mode Network(DMN),such as right hippocampus and left superior parietal gyrus,and Salience Network(SN),such as the right anterior insula and left anterior cingulate gyrus(ACC)increased.While ALFF values in the DMN such as left superior parietal gyrus,right superior temporal gyrus,left middle temporal gyrus and left supramarginal gyrus decreased.After PEG treatment,the areas in the DMN,including left hippocampus and left precuneus showed increased value of ALFF;while areas distributing in the left superior parietal gyrus of the DMN,showed decreased value of ALFF.(2)After treatment in acupuncture group,the decreased ALFF values in left superior parietal gyrus of FC patients was significantly postively correlated with the improvement of CCS(r=0.626,p=0.007).(3)Compared to PEG group,FC patients after acupuncture treatment showed significant increased ALFF values in the left Posterior Cingulate Gyrus(PCC).Therefore,left PCC was selected as ROI to perform the further ROI-Functional Connectivity Analysis.3.The change of functional connectivity by acupuncture and PEG treatment for FC patients:(1)After acupuncture treatment,the functional connectivity between the left PCC with the DMN areas,including right precuneus,left temporal pole,left parahippocampal gyrus,left middle frontal gyrus of FC patients increased,and areas with reduced functional connectivity were not shown.After PEG treatment,the functional connectivity of left PCC with left thalamus and left angular gyrus in FCpatients increased;while the functional connectivity between the left PCC with right ACC and the DMN areas such as left temporal pole,left superior temporal gyrus,right frontal lobe,right middle temporal gyrus decreased.(2)Compared to PEG group,FC patients after acupuncture treatment showed increased functional connectivity between the left PCC with left angular gyrus and left thalamus;decreased functional connectivity between the left PCC with DMN areas including left temporal pole,right superior temporal gyrus and right interior temporal gyrus,as well as the right exterior cerebellum and right precentral gyrus decreased.Conclusion1.Both acupuncture and PEG treatment can effectively improve the clinical symptoms of FC patients.2.Both acupuncture and PEG treatment can affect the central activity in the DMN of FC patients.However,acupuncture treatment can more significantly regulate the functional connectivity between PCC with DMN,as well as regulate functional activity of SN core region with insula and ACC.Synergistic regulation of DMN and SN may be an important central characteristic of acupuncture treatment for FC.