A Bold-fMRI Study Of Acupuncture At ST25for Regulating Intestinal Motility Bidirectionally

Aim:To explore the central mechanism of puncturing on the ST25(Tianshu) for regulating intestial motility bidirectionally.Methods:40functional constipation patients,18functional diarrhea patients and50health controls (HC) who met the inclusion criteria were collected. Both constipation patients and diarrhea patients were treated by acupuncture on the ST25points for10times. Functional magnetic resonance imaging (fMRI) was performed on patients and healthy subjects in resting state. The characteristics of resting-brain activities in functional constipation patients and functional diarrhea patients were obtained by comparing the regional homogeneity (ReHo) in functional constipation patients or functional diarrhea patients with those in HC respectively. fMRI was performed on functional constipation patients and functional diarrhea patients after10times treatment. The characteristics of cerecral responses to punctureing on the ST25were obtained by comparing the changings in ReHo of functional constipation patients and functional diarrhea patients respectively. Then, anlyze the correlation between clinical improvement and ReHo values changes pre and post acupuncture treatment. Finally, explore the functional connectivity characteristics of functional constipation patients and functional diarrhea patients by analyzing the brain network pre and post the treatment.Results:1. The results of the clinical efficacy evaluation of acupuncture for functional constipation and functional diarrhea:(1) The defecation times of one week show the functional constipation patients’ defecation times increased significantly (P<0.01), while the defeaction times of functional diarrhea decreased significantly(P<0.01). The Bristol stool form score was drecreased in the functional constipation patients (P<0.05) and increased in the functioanl diarrhea patients (P<0.05).(2) Acupuncture could improve the score of short-form36of constipation patients in gernal healthy (P<0.01), and emotion role (P<0.05); while for the diarrhea patients could improve the bady pain, general healthy and vatility (P<0.05).(3) Acupuncture could induce the score of SAS and SDS of functioanl constipaiton patients, but not improve the score of diarrhea patients.2. The characters of ReHo in functional bowel disease patients(1) The difference in ReHo between functioal constipation patients and HC: Compared with the HC, the functioanl constipation patients showed that increased ReHo in left posterior central gyrus (BA3), superior temporal gyrus(BA21,22), right inferior temlporal gyrus (BA20), temporal pole (BA36), MCC (BA23), parahippocampal gyrus (BA34), bilateral superior frontal gyrus (BA11), and middle temporal gyrus (P<0.005), and decreased ReHo in left angular gyrus (BA39), thalamus, right inferior frontal gyrus (BA45), pallidum and bilateral orbit frontal coetex (BA47)(P<0.005).(2) The difference in ReHo between functioal diarrhea patients and HC: Compred to the HC, the functioanl diarrhea patients showed increased ReHo in left supplementary motor area (BA6), middle frontal gyrus(BA46), inferior parietal gyrus (BA7), lingual gyrus (BA17), insula (BA13), MCC (BA24), right superior parietal gyrus (BA7), precuneus (BA7), bilateral anterior cntral gyrus (BA6,4) posterior central gyrus (BA3), paracentral louble (BA6), superior pariteal gyrus (BA10), middle temporal gyrus (BA21)(P<0.005); and decreased in left orbit cortex (BA47), parahippocampal gyrus (BA35), right middle frontal gyrus (BA10), orbit cortex (BA10), temporal pole (BA21) and midbrain (P<0.005).3. The change of ReHo in functional bowel disease patients after acupuncture(1) The changes of functional constipation patients:The change Compared to pre-treatment, the functioanl constipation patients showed that increased ReHo in left inferior parietal gyrus (BA40), angular gyrus (BA39), right inferior frontal gyrus (BA44), bilateral precuneus (BA7), middle frontal gyrus (BA44,46)(P<0.005); decreased in left superior parietal gyrus(BA5), temporal pole(BA21), fusiform gyrus (BA37), thalamus, right supplementary motor area (BA6), orbit frontal cortex (BA10), superior parietal gyrus (BA19), inferior temporal gyrus(BA20), bilateral middle^occipital gyrus (BA18), anteior central gyrus (BA6,4), posterior central gyrus (BA3), paracentral louble (BA6), lingual gyrus (BA18), superior tempoarl gyrus (BA22), inferior frontal gyrus (BA45,48)(P<0.005).(2) The changes of functional diarrhea patients:The change Compred to pre-treatment, the functioanl diarrhea patients showed increased ReHo in left angular gyrus (BA39), inferior frontal gyrus (BA46), inferior temporal gyrus (BA20), ACC (BA32), right superior parietal louble (BA7), middle occipiatal gyrus (BA19), bilateral precuneus(BA7), middle frontal gyrus(BA9,46)(P<0.005); decreased in left anterior central gyrus (BA6), putman, thalamus, right posterior central gyrus (BA3), fusiform gyrus (BA37), bilateral paracentral lobe (BA6), lingual gyrus (BA18) and middle temporal gyrus (BA21)(P<0.005).(3) The key regions which might be closely related to the effect of acupuncture: The decreased ReHo value in thalamus showed a very siginificant correlation with the incereased defecation times in functional constipation patients (P<0.01). The incereased ReHo value in ACC and middle occipital gyrus showed a significant correlation with the decreased defecation times in diarrhea patients (P<0.05), and decreased ReHo values in middle temporal gyrus showed a significant correlation with the decreased defection (P<0.05).4. The results of functional connectivity after treatment by acupuncture(1) The functional connectivity with left thalamus of funcitonal constipation patients decreased in left superior frontal gyrus (BA11), medical frontal gyrus (BA9), orbit frontal gyrus (BA11), ACC (BA32), insual (BA13), right amygdala (BA48), bilateral thalamus after acupuncture treatment(P<0.001).(2) The functional bonnectivity with left ACC of funcitonal diarrhea patients decreased in supplementary motor area (BA6), insual(BA13), right inferior frontal gyrus (BA45), orbit frontal gyrus (BA11), caduate, bilateral thalamus after acupuncture treatment(P<0.001). Conclusion:1. Acupuncture could change the defecation times and stool form both in functional constipation patients and functioal diarrhea patients. This shows acupuncture could mudulate instestinal motility bidirectionally.2. ReHo had significant differences in resting brain activities among functional constipation patients, diarrhea patients and HC. The change of limbic system-cerebral cortex should be the common characteristic of brain activities in constipation and diarrhea patients.3. The cerebral responsed to puncture at ST25for constipation and diarrhea might be characterized by inducing extensive changes of functional activities in limbic sytstem-cerebral cortex. Left thalamus and ACC might be the core regions that closely relate to purge and antidiarrheal effect of acupuncture respectively. Acupuncture also could regulate the functional connectivity of the homeostasis afferent processing network.