| Aim:To investigate the central mechanism of acupuncture treatment for chronic fatigue syndrome (CFS), multimodel magnetic resonance technology (fMRI and MRS) was used to evaluate acupuncture effects on improving fatigue and cognitive function from aspects of brain function and central neural biochemistry.Methods:1.17 CFS patients who matched inclusion criteria and 9 healthy subjects (Group C) were collected.17 patients were randomly allocated into Acupuncture Group (Group A) and Sham-acupuncture Group (Group B). All patients were treated during 17:00 to 19:00 for 5 sessions in first 2 weeks and 3 sessions in last 2 weeks,16 sessions in total. Checklist for Individual Strength (CIS) was primary outcome measure, Somatic and Psychological Health Report (SPHERE) and Short Form-36 Health Survey (SF-36) were secondary outcome measures. Clinical evaluation and multi-model magnetic resonance were administrated before and after treatment.2. Based on BOLD-fMRI, applying block design of task to obtain PVSAT and image data. Comparing PVSAT data, such as response time and correct rate of healthy subjects and CSF patients to evaluate the extent of cognitive impairment in CFS; Comparing fMRI data of healthy subjects and CSF patients to explore the central traits of cognitive impairment in CFS. Comparing PVSAT data, such as response time and correct rate of CSF patients before and after acupuncture or sham-acupuncture to evaluate the curable effects of acupuncture on cognitive impairment in CFS; Comparing fMRI data of CSF patients after acupuncture or sham-acupuncture to explore central response differences between two groups.3. Regions of interest located at right frontal lobe and bilateral occipital lobe were scanned applying 1H-MRS. Comparing effects of acupuncture and sham-acupuncture on brain metabolites to discuss central mechanism of acupuncture. Analyzing correlations between metabolite changes after acupuncture or sham-acupuncture and clinical alterations, to explore biomarkers of acupuncture effects, discuss central mechanism discrepancies between acupuncture and sham-acupuncture.Results:1. Clinical results of acupuncture for CFS:(1) CIS score, SPHERE score and SF-36 score in CFS patients were significantly differ from healthy subjects, presenting as higher Total CIS score, CIS fatigue score, CIS concentration score, CIS motivation score, CIS activity score and SPHERE score, lower SF-36 score (PCS, MCS, RP, Ⅵ and RE) (P<0.05).(2) After acupuncture, clinical manifestations including CFQ score, Total CIS score, CIS fatigue score, CIS concentration score, CIS motivation score, CIS activity score of Group A were significantly improved and superior to Group B (P<0.05); SPHERE score and SF-36 (Ⅵ, MCS) score of Group A were significantly improved although there was no statistic difference compared with Group B (P>0.05).2. Central response traits of acupuncture for CFS(1) Compared with healthy subjects, CFS patients had longer response time, lower correct rate, higher wrong rate and lost rate without significance (P>0.05). After acupuncture, all parameters of PVSAT were improved without significance (P>0.05) and there was no obviously difference between groups (P>0.05).(2) At baseline, less activity in supracalcarine cortex, intracalcarine cortex, lingual gyrus, occipital pole, cuneal cortex were observed in CFS patients undergoing PVSAT compared with healthy subjects (P<0.05). After acupuncture, frontal lobe, temporal lobe, parietal lobe and occipital lobe were activated obviously undergoing PVSAT in both GroupA and B, though without significance compared with baseline. There were no significant difference between Group A and Group B (P>0.05).3. Central neural biochemistry mechanism of acupuncture for CFS:(1) Baseline analysis showed that GPC+PCh level in right occipital lobe was significant lower in CFS patients compared with healthy subjects (P＜0.05), other metabolites in both ROI were not obviously different between two kinds of populations.(2) After acupuncture, GPC+PCh level in right occipital lobe was raised to the normal level of healthy subjects, although no significant difference compared with baseline level. NAA+NAAG content in occipital lobe was significant higher (P＜0.05). After sham-acupuncture, metabolites in right frontal lobe and occipital lobe were not changed obviously.4. Correlation analysis results between MRS changes and clinical alterations:(1) At baseline, Glu+Gln in right frontal lobe positively correlated with CIS activity score; GPC+PCh in occipital lobe negatively correlated with CIS fatigue score; NAA in occipital lobe positively correlated with CIS motivation score; Cr in occipital lobe negatively correlated with CIS motivation score.(2) After acupuncture, GPC+PCh in right frontal lobe significantly correlated with CIS activity score, correct ratio of PVSAT; Ins and GSH in right frontal lobe positively correlated with CIS concentration score. GPC+PCh in occipital lobe negatively correlated with CIS total scores; Glu+Gln in occipital lobe significantly correlated with CIS motivation, activity, correct ratio of PVSAT; NAA+NAAG in occipital lobe negatively correlated with CIS activity; Asp in occipital lobe positively correlated with CIS total scores and CIS activity.(3) After sham-acupuncture, GPC+PCh positively correlated with SF-36 (MH, GH), Ins and GSH in right frontal lobe negatively correlated with SF-36 (MH); GPC+PCh and Glx in occipital lobe positively correlated with SF-36 (RP, SF, MH); Asp in occipital lobe positively correlated with CIS activity.Conclusions:1. Fatigue manifestations of CFS include physical and mental fatigue, cognitive impairment of CFS is mild, charactered as reduced attention and motivation. Acupuncture can effectively ameliorate fatigue symptoms and improve cognitive function of CFS.2. Neural metabolic abnormalities were observed in right frontal lobe and occipital lobe, depressed activation of occipital lobe was main alteration of CFS brain function. Acupuncture can modify central neural metabolism of CFS, activate cognition related cerebral regions including occipital lobe, which is probably potential central mechanism of acupuncture for treating CFS and improving cognitive function.3. Compared with sham-acupuncture, acupuncture is more effective in improving metal fatigue, and brain metabolite changed induced by acupuncture correlate closely with clinical improvements, its curable effects is more specific to CFS. |
PDF Full Text Request