Effect Of Acupuncture-rehabilitation Therapy On BOLD-fMRI And Serum Biomarkers In Cognitive Dysfunction After Ischemic Stroke Patients

ObjectiveTo observe the effect of Acupuncture-rehabilitation therapy on brain function and serum biomarkers in non-dementia patients with cognitive impairment after ischemic stroke,and to elucidate the central and peripheral mechanisms of Acupuncture-rehabilitation therapy in promoting cognitive function recovery in patients with cognitive impairment after ischemic stroke.Materials and methods1.30 patients with ischemic PSCIND(experimental group)and 27 healthy volunteers were scanned by BOLD-f MRI.The differences in Re Ho and ALFF between the two groups between experimental group and healthy volunteers were calculated and analyzed by MATLAB platform and corresponding software package pretreatment.2.30 patients with ischemic PSCIND in the experimental group were divided into Acupuncture-rehabilitation group and control group according to random number table method.The control group was given routine medical treatment,and the Acupuncture-rehabilitation group was given Acupuncture-rehabilitation therapy(scalp cluster needling + dual task execution function training)on the basis of the control group.Neuropsychological scales(MMSE,Mo CA,LOTCA,FIM,TMT-A,TMT-B),BOLD-f MRI scanning and serum biological markers(Hcy,hs-CRP,IL-1β,IL-6,TNF-a,IL-4,IL-10,TGF-β1)were assessed before and 4 weeks after treatment in both groups.Relevant software was used to analyze the evaluation and test results.Result1.Neuropsychological Scale test results: Mo CA,LOTCA,FIM scores in the Acupuncture-rehabilitation group were higher than those in the control group(P < 0.05),and the time and error number in the connection test were less than those in the control group(P< 0.05).2.BOLD-f MRI findings:(1)Comparison between the experimental group and healthy volunteers: in the experimental group,the Re Ho values of right inferior frontal gyrus,left middle temporal gyrus and bilateral superior temporal gyrus decreased,and left superior frontal gyrus increased(P<0.05,FDRc=96);the ALFF values of left inferior temporal gyrus,anterior cingulate gyrus,angular gyrus and central anterior gyrus decreased,and the ALFF values of bilateral superior frontal gyrus and right middle temporal gyrus increased(P<0.05,FDRc=27).(2)Comparison of Acupuncture-rehabilitation group and control group:Before treatment,Re Ho and ALFF did not show significant difference between the two groups(P < 0.001,without FDRc correction).After 4 weeks of treatment,the Re Ho values of left parahippocampal gyrus,right temporal polar region and right middle frontal gyrus increased,bilateral inferior frontal gyrus and left posterior central gyrus decreased(P<0.05,FDRc=124),and ALFF values of right inferior frontal gyrus,right middle frontal gyrus and right middle temporal gyrus increased,while ALFF values of left dorsolateral superior frontal gyrus decreased(P<0.05,FDRc=54)in the control group.The Re Ho values of right anterior central gyrus,left parahippocampal gyrus,right temporal polar region,left middle temporal gyrus increased,bilateral inferior frontal gyrus and right inferior temporal gyrus decreased(P < 0.05,FDRc = 124),right triangular inferior frontal gyrus,left parahippocampal gyrus,angular gyrus and cingulate gyrus increased(P < 0.05,FDRc = 41),and there was no brain area with decreased ALFF values in Acupuncture-rehabilitation group.Compared with the control group,the Re Ho values in the right inferior temporal gyrus and inferior frontal gyrus increased(P<0.05,FDRc=97),but there was no reduction of Re Ho values in the brain area;the ALFF values in the right fusiform gyrus,parahippocampal gyrus,putamen,dorsolateral prefrontal lobe,inner olfactory cortex and middle frontal gyrus increased,and the ALFF values in the bilateral anterior central gyrus decreased(P<0.05,FDRc=49)in Acupuncture-rehabilitation group.3.The results of serum biological markers test: compared with the control group,Acupuncture-rehabilitation group could better inhibit the release of IL-1β,IL-6 and TNF-a,reduce the level of Hcy(P < 0.05),and promote the release of IL-4,IL-10 and TGF-β1(P <0.05),but the two groups had no significant effect on hs-CRP(P > 0.05).4.Correlation analysis results: the right frontal gyrus and the inferior temporal gyrus were positively correlated with the Mo CA scale(r=0.365/0.387,P=0.047/0.035);the right fusiform gyrus and the right dorsolateral prefrontal cortex were positive with the LOTCA scale.Correlation(r=0.448/0.361,P=0.013/0.05),the right inferior temporal gyrus was negatively correlated with TMT-A(r=-0.394,P=0.031).Right middle frontal gyrus was positively correlated with TGF-β1(r=0.434,P=0.017);Right infratemporal gyrus was negatively correlated with TNF-α and Hcy(r=-0.533/-0.441,P=0.002/0.015);Right inferior frontal gyrus was positively correlated with IL-10(r=0.376,P=0.041),and negatively correlated with TNF-α and Hcy(r=-0.412/-0.454,P=0.024/0.012).Conclusion1.Re Ho values of right inferior frontal gyrus,left middle temporal gyrus and bilateral superior temporal gyrus,ALFF values of left inferior temporal gyrus,anterior cingulate gyrus,angular gyrus and central anterior gyrus in ischemic PSCIND patients were significantly lower than those in healthy volunteers,suggesting that brain function was impaired and cognitive function was impaired.2.The Acupuncture-rehabilitation therapy can improve the scores of Mo CA,LOTCA and FIM in patients with ischemic PSCIND,shorten the time of connection test,reduce the number of errors,and improve the cognitive function of patients with ischemic PSCIND.3.The Acupuncture-rehabilitation therapy can increase the Re Ho value of right inferior temporal gyrus and inferior frontal gyrus and ALFF value of right spindle gyrus,parahippocampal gyrus,putamen,dorsolateral prefrontal lobe,internal olfactory cortex and middle frontal gyrus in patients with ischemic PSCIND,and enhance the spontaneous functional activities of local brain areas,thereby improving the brain function of patients with ischemic PSCIND.4.The Acupuncture-rehabilitation therapy can promote the release of IL-4、IL-10、TGF-β1 in patients with ischemic PSCIND,inhibit the release of IL-1β 、 IL-6 、 TNF-a,reduce the level of Hcy and improve cognitive function in patients with ischemic PSCIND.