| ObjectiveAccording to Chinese medicine,amblyopia belongs to the categories of "visionfaintness","undefined eyes","children’s green blindness","children’s eyes",etc.,which are mainly caused by liver and kidney loss and passive divine light.Acupuncture therapy can effectively treat amblyopia,but its mechanism has not been clarified.It is generally believed that acupuncture can improve the cerebral cortex function of amblyopia patients,but there is still a lack of simple and fast evaluation methods and related indicators.FNIRS is a new brain functional imaging technology that can detect the hemodynamic changes of the visual cortex in real time.The previous fNIRS study of our team found that acupuncture at Hegu point can improve the blood oxygen level of the visual cortex.This study intends to use the method of fNIRS to detect the hemodynamic response of visual cortex in children with amblyopia,study the brain function mechanism of amblyopia,explain the mechanism of action of acupuncture therapy,and provide new ideas for clinical diagnosis,treatment and efficacy evaluation.Methods1.Subject inclusion: Under the premise of the informed consent of the subject’s guardian,normal children and amblyopia children aged 7-12 years were recruited from December2018 to June 2019,including 38 normal children;Children with amblyopia were monocular anisometropia,that is,BCVA≥0.8 in the sound eye and two or more rows higher than BCVA in the affected eye(12 cases).Review the patients with amblyopia who received initial diagnosis,treatment ≥3 months and return visit on time from June 2019 to December 2019.22 cases were treated by acupuncture plus conventional western medicine.The amblyopia subjects who received acupuncture were included,with no age limit,and the remaining criteria were the same,a total of 15 cases.2.Treatment planRoutine treatment: wearing glasses,covering,training therapy.Acupuncture treatment: Acupuncture points: main points: Chuanzhu,Sizhukong Taiyang,Hegu;Match acupoints: Guangming,Tongziliao,Taichong,choose 2-5acupoints.Acupuncture method: select the acupuncture needle with less pain,select 2～5acupuncture points in total according to the individual situation,and retain the needle for30 minutes.3.FNIRS detection method: Hitachi ETG-4000 near-infrared brain function imager was used to detect the blood oxygen level of the subjects’ occipital,and they received visual tasks synchronously,including baseline and stimulus period.The baseline was black screen,and the stimulus period was divided into 1° and 15 ’black and white checkerboard reversed.4 Data analysis and statistics: The above fNIRS data was processed using NIRS＿SPM software based on MATLAB(R2013a).According to the known hemodynamic response function(HRF)and general linear model(GLM)assumptions create model,forecast HRF matrix and practical measured data matrix in fNIRS linear fitting,through parameter estimation and fitting coefficient,namely the beta,positive/negative beta value represents the activation degree of positive/negative correlation.SPSS17.0 was used to analyze the values of single channel and multi-channel mean.Results1.Comparison of the degree of blood oxygen activation in visual cortex between amblyopia and normal children(1)Comparison of activation range: The single channel P-value was screened out according to baseline/stimulus paired T-test for activation and significant activation channels.Among a total of 22 channels,the number of activation channels in the healthy control group was more than that in the amblyopia healthy eye and the affected eye under low-spatial frequency checkerboard flipping;In the healthy group,the activated channels were the most,followed by amblyopia and amblyopia.(2)Comparison of visual cortex activation at baseline and stimulus: Comparison between the three groups at baseline and stimulus alone showed that the value of amblyopia patients under high spatial frequency checkerboard flip was lower than that of amblyopia healthy eyes and healthy subjects,and no difference was observed between amblyopia healthy eyes and healthy subjects.There was no statistical difference among the groups at low spatial frequencies.A paired comparison of high/low spatial checkerboard stimuli in the same group showed that amblyopia had significantly lower activation at high frequencies than at low frequencies.(3)blood oxygen activation values more: Δ beta stage = stimulus beta-baseline beta.Compared with each group under the same spatial frequency,amblyopia patients under the stimulation of low spatial frequency were higher than amblyopia healthy eyes and control group.High spatial frequency stimuli Δ beta no statistical difference between the three groups.In the same group,the value of the high spatial frequency visual task was lower than that of the low spatial frequency visual task.(4)Region of Interest(ROI)mean comparison: Through pairwise comparison of three groups,it was found that no matter the ROI was selected as channels 10-22 or 1-22,there was a statistical difference between amblyopia patients in receiving checkerboard flip stimulation at high spatial frequency/low spatial frequency,and visual cortex activation at high spatial frequency was significantly lower than that at low spatial frequency.2.Efficacy evaluation of acupuncture treatment for amblyopiaThe total effective rate was 56.00% in the control group and 81.82% in the acupuncture group.The total effective rate in the acupuncture group was higher than that in the control group,with statistical difference.There were significant differences between amblyopia patients and normal controls before acupuncture at the high spatial frequency checkerboard turnover visual task stimulation period.The value of the anterior visual cortex was increased during acupuncture compared with that of the anterior visual cortex during high spatial frequency checkerboard flipping,and there was no statistical difference in baseline.Conclusions1.The activation range of visual cortex of amblyopia patients was smaller than that of healthy subjects,and the blood oxygen response of visual cortex of amblyopia patients at baseline and high frequency stimulation stage was weaker than that of healthy eyes and normal people,but there was no significant difference between baseline and stimulation stage.This suggests that the visual cortex function may be impaired in children with amblyopia.2.Compared with western medicine alone,acupuncture combined with Traditional Chinese and Western medicine can effectively improve the vision of amblyopia patients and improve the visual cortex hemodynamic response immediately. |
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