| Objective:Regarding the liver-qi stagnation type psychological ED as the research object,the limbic system functional network as the research focus,the cingulate gyrus as the seeds,using BOLD-f MRI technique and analyzed with functional connectivity,to explore the influence of anterior cingulate cortex(ACC)and its correlation with three interventions.Based on the correlation with the effectively of the Chaihu-Shugan Powder,tadalafil and placebo for the treatment of psychological ED,which was under the guidance of the theory of "Liver governs the tendons".To explain partially and scientifically the central mechanisms on the theory of "Liver governs the tendons".Method:1.Sixty three liver qi stagnation type psychological ED patients were recruited in the outpatient andrology department in the hospital of Chengdu University of Traditional Chinese Medicine,and forty healthy subjects(HS)were enrolled in campus recruitment in Chengdu University of Traditional Chinese Medicine.In addition to common disease data collection,Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were used to evaluate the emotions of all subjects.The Traditional Chinese Medicine(TCM)Syndrome Score,international index of erectile function questionnaire(IIEF-5),quality of erection questionnaire(QEQ),erection hardness score(EHS)and self-esteem and relationship questionnaire(SEAR)were used to evaluate the erectile function of Liver-qi Stagnation type psychological ED patients.Blood Oxygenation level-dependent functional magnetic resonance imaging(BOLD-f MRI)was used to the resting state scan in Liver-qi Stagnation type p ED patients and HS.The brain function imaging data were analyzed with the seed-based functional connectivity(seed-based FC)and the regional homogeneity(Re Ho).The ACC functional connectivity under resting state were compared between p ED patients and HC,as well as the association with Liver-qi Stagnation type p ED symptoms,so as to certify the significance of ACC in the central pathological changes of Liver-qi Stagnation type p ED.2.The randomized,double-blind controlled clinical trial was taken,63 patients with liver qi stagnation type p ED enrolled from the hospital of Chengdu University of Chinese Medicine p ED and computed-randomized into three groups: the Chaihu-Shugan powder group(CHSG),the tadalafil group,and the placebo group.Each group of subjects intervened according to the prescribed intervention program.The TCM Syndrome Score,IIEF-5,QEQ,EHS,SEAR,SDS and SAS were used as clinical measurements.Use SPSS25.0 statistical analysis system to analyze the effect of clinical treatment evaluation of liver qi stagnation p ED patients before and after treatment,and compare the differences in the treatment effects of the three groups,so as to observe the influence of CHSG on the p ED therapeutic effect.3.The brain function imaging data of three groups: the CHSG group(n=20),the tadalafil group(n=21)and the placebo group(n=20)were scanned and analyzed the same as the first part.The ACC rs FC of the three groups before and after treatment will be compared,also be compared with the abnormality of ACC rs FC of p ED patients in the first part,so as to invested the influence of CHSG powder on the changes of the clinical symptoms related ACC rs FC in p ED patients.To explain partially and scientifically the central mechanisms on the theory of "Liver governs the tendons".Result:1.The abnormal changes in Brain function associated with abnormal ACC-function connectivity-related brain areas in patients with liver qi stagnation type psychological ED.(1)Baseline comparison between psychological ED patients and HS:there was statistically significant of scores in IIEF-5,EHS,SEAR,QEQ,SDS and SAS(p<0.05),but no significant difference in age,height and weight(p>0.05).(2)Brain functional activity characteristics: compared with HS,the increased ACC rs FC regions of liver-qi-stagnation type psychological ED patients were the right cerebellum,right anterior cingulate cortex(BA24)and right caudate nucleus,left fusiform gyrus(BA19),left hippocampus(BA20)and the left temporal lobe(BA20),bilateral orbital frontal cortex(BA11),bilateral middle cingulated cortex(BA23),bilateral supplementary motor area(BA32),bilateral insula(BA47)(p<0.005).The decreased ACC rs FC regions of liver-qi-stagnation type psychological ED patients including the right inferior parietal lobule(BA7),right precuneus(BA7),right superior temporal gyrus(BA22),left brain stem,left middle temporal gyrus(BA21),the bilateral postcentral gyrus(BA4),bilateral paracentral lobule(BA4),bilateral thalamus and lateral cerebellum(p<0.005).2.The effects of three different treatment regimens on the clinical effect of patients with psychological ED with liver-qi stagnation.(1)There was no difference in baseline comparison between the Chaihu-Shugan powder group,the tadalafil group,and the placebo group,which were comparable.(2)The results of IIEF-5,EHS,QEQ,SEAR,TCM syndrome scores,SDS and SAS scores showed:Compared with before treatment,the Chaihu-Shugan powder group,tadalafil group,and placebo group were effective in improving patients' IIEF-5,EHS,QEQ,and SEAR scores,and the differences were statistically significant(p<0.05).Compared with tadalafil group,Chaihu-Shugan San has advantages in improving SEAR,TCM syndrome scores,SDS and SAS scores of Liver-qi Stagnation-type Psychological ED patients.Tadalafil has advantages in improving patients' IIEF-5,EHS,and QEQ scores.Compared with placebo group,Chaihu-Shugan Powder has advantages in patients' IIEF-5,QEQ,SEAR,TCM syndrome scores,SDS and SAS scores.3.The effects of Chaihu-Shugan powder on ACC Functional Connectivity of brain function in Patients with liver-qi stagnation-type Psychological ED.(1)Compared with before treatment,the patients who has been treated by the Chaihu-Shugan powder showed increased ACC rs FC regions in the bilateral brain stem,bilateral cerebellum,right hippocampus(BA27),right insula(BA48),right thalamus,right paracentral lobule(BA4),right middle cingulate gyrus(BA23),superior temporal gyrus(BA22),inferior temporal gyrus(BA20),left hippocampus(BA20),left supplementary motor area(BA6),left middle temporal gyrus(BA39)and left fusiform gyrus(BA37)(p<0.005).The decreased regions include the bilateral putamen,bilateral medial frontal gyrus(BA10),right middle frontal gyrus(BA45),right temporal lobe(BA38),right caudate,right orbital frontal cortex(BA47),right anterior cingulated cortex(BA23),right posterior cingulated cortex(BA30),right middle temporal gyrus(BA21),right cuneus,left middle frontal gyrus(BA10),left temporal lobe(BA20),left inferior frontal gyrus(BA9)and left inferior temporal gyrus(BA22)(p<0.005).(2)Compared with tadalafil group,the patients who has been treated by the Chaihu-Shugan powder showed increased ACC rs FC regions in the bilateral cerebellum,bilateral insula(BA48),bilateral pallidum,bilateral parahippocampus(BA20),bilateral orbital frontal cortex(BA11),bilateral supplementary motor area,bilateral middle cingulate cortex(BA23),bilateral superior temporal gyrus(BA21),right putamen,left caudate and left paracentral lobule(BA4)(p<0.005).The decreased regions include the bilateral brain stem,bilateral precentral gyrus(BA6),bilateral precuneus(BA7),right cerebellum,right paracentral lobule(BA4),right middle cingulated cortex(BA23),right posterior cingulate cortex,right superior parietal lobule(BA05),right superior temporal gyrus(BA22),left medial frontal cortex(BA10)and left postcentral gyrus(BA22)(p<0.005).(3)Compared with placebo group,the patients who has been treated by the Chaihu-Shugan powder showed increased ACC rs FC regions in the bilateral brain stem,bilateral cerebellum,bilateral hippocampus(BA20),right insula(BA11),right caudate,right orbital frontal cortex(BA6),right middle cingulate cortex(BA23),right posterior cingulated cortex(BA23),right precuneus(BA7),right fusiform gyrus(BA18,BA37),left orbital frontal cortex(BA11),left middle cingulate cortex(BA24),left middle temporal gyrus(BA22)and left fusiform gyrus(BA19)(p<0.005).The decreased regions including the bilateral cerebellum,bilateral postcentral gyrus(BA3),bilateral precuneus(BA7),right medial frontal cortex(BA8),right paracentral lobule(BA4),right temporal lobe,left putamen,left medial frontal cortex(BA10),left superior frontal gyrus(BA9),left precentral gyrus(BA6)and left paracentral lobule(BA6)(p<0.005).Conclusion:1.Compared with HS,Liver-qi Stagnation-type Psychological ED patients have abnormal resting state brain activities especially in ACC-brainstem,ACC-cerebellum and limbic systems including cingulate cortex and hypothalamus compared to HS.2.The central mechanism of Chaihu-Shugan Powder for the treatment of liver-qi stagnation-type psychological ED and the changes in the cerebellum,limbic system,and central brain are the functional activities of the main brain areas to improve erectile function.3.Compared with tadalafil and placebo,the central mechanism of Chaihu-Shugan Powder for the treatment of liver-qi stagnation-type psychological ED patients have different resting state cerebral activities.Most of the different cerebral regions pertain to cognition and emotion related regions. |
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