Central Response To Acupuncture At Combination Of Back-Shu And Front-Mu Points Of Stomach Of Functional Dyspepsia Based On Resting State Functional Magnetic Resonance Imaging

ObjectiveTo analyze the amplitude of low-frequency fluctuation(ALFF),the regional homogeneity(ReHo)and the functional connectivity(FC)from resting-state functional magnetic resonance imaging(rs-fMRI),and investigate the central response to acupuncture at combination of Back-Shu and Frontal-Mu points of stomach of functional dyspepsia(FD),thus providing experimental evidence for elucidating the scientific connotation of combination of Back-Shu and Frontal-Mu points.MethodsThirty-seven patients of FD were randomly divided into a combined-point group(19 cases)and a non-acupoint group(18 cases).The groups were treated with acupuncture at combined Weishu(BL21)and Zhongwan(RN12)or the non-acupoints separately.Each group was given acupuncture for 10 times.Functional dyspepsia index(FDI),nepean dyspepsia index(NDI),electrogastrogram(EGG),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were selected as a clinical evaluation index for FD patients.The rs-fMRI scan and clinical evaluation were performed before and after treatment.At the same time,19 healthy subjects were recruited as the control group,and the following analysis were completed:1 The changes of clinical indicators were observed before and after acupuncture in each group,as well as among the groups.Additionally,evaluated the therapeutic effect of acupuncture treatment of FD patients.2 The differences in ALFF and ReHo between FD patients and healthy subjects were compared,and explored the regional brain functional characteristics of FD patients.The effects on the ALFF values and ReHo values of FD patients with acupuncture were analyzed.Additionally,the correlation analysis between the obviously changes of clinical indicators and regional brain functional activity were conducted before and after acupuncture,and selected targeted brain regions for acupuncture treatment of FD as regions of interest(ROI).3 The functional connection(FC)of ROI and other brain regions of the whole brain was analyzed,and the changes of brain functional connection network of two groups before and after acupuncture were compared.Results1 The clinical effects of acupuncture treatment as follows:(1)The aspect of indigestion symptoms: The score of FDI and NDSI of FD patients could be reduced by acupuncture at combination of BL21 and RN12(P<0.01,P<0.05),and it could be reduced by acupuncture at the non-acupoints(both P<0.05)There was a difference between the groups in NDSI after acupuncture.(2)The aspect of life quality: The score of NDLQI of FD patients were higher than before acupuncture treatment in both groups(both P<0.05).(3)The aspect of the statement of emotion: The score of SAS and SDS were lower than before the acupuncture treatment in the combined-point group,and only the score of SAS was lower than before in the non-acupoint group.(4)The aspect of the EGG: After acupuncture treatment,both the amplitude and the frequency of EGG in the combined-point group were increased(P<0.01,P<0.05)The amplitude of EGG in the non-acupoint group was increased(P<0.01),and the frequency was not significantly different as compared with the conditions before acupuncture(P>0.05).2The influences of the regional brain functional characteristics by acupuncture at combination of BL21 and RN12 of FD patients(1)The difference of regional brain functional activity between FD patients and healthy subjects.Compared with healthy subjects,the ALFF values of FD in the left anterior cingulate gyrus,left supramarginal gyrus,right middle cingulate gyrus,left precuneus,right superior temporal gyrus,left superior frontal gyrus and other brain regions were abnormal.And the ReHo values of FD in the left middle frontal gyrus,right cerebellum posterior lobe,right cerebellum anterior lobe,left posterior cingulate gyrus,right insula,right middle temporal gyrus and other brain regions were unusual.(2)The influences of ALFF values by acupuncture at combination of BL21 and RN12 of FD patientsAfter acupuncture at combination of BL21 and RN12,the ALFF values of the right parahippocampa gyrus,right inferior temporal gyrus,right insula,left posterior cingulate gyrus and other brain regions were enhanced,and the ALFF values of the left inferior temporal gyrus,right inferior frontal gyrus,bilateral precuneus and other brain regions were reduced.After acupuncture at the non-acupoints,the ALFF values of the right cerebellum posterior lobe,bilateral inferior temporal gyrus and other brain regions were enhanced,the ALFF values of the right middle temporal gyrus,bilateral angular gyrus and other brain regions were reduced.Compared with the non-acupoint group,the ALFF values of the left middle temporal gyrus,left temporal pole of the middle temporal gyrus,right insula,left anterior cingulate gyrus and other brain regions of the combined-point group were enhanced,and the ALFF values of the left inferior temporal gyrus,left postcentral gyrus,right middle frontal gyrus and other brain regions were reduced.(3)The influences of ReHo values by acupuncture at combination of BL21 and RN12 of FD patients.After acupuncture at combination of BL21 and RN12,the ReHo values of the left fusiform gyrus,right inferior frontal gyrus,left posterior cingulate gyrus,left precuneus and other brain regions were enhanced,and the ReHo values of the left cerebellum anterior lobe,right hippocampus gyrus,left anterior cingulate gyrus,right caudate nucleus and other brain regions were reduced.After acupuncture at the non-acupoints,the ReHo values of the right cerebellum posterior lobe,right precuneus and other brain regions were enhanced,the ReHo values of the the right middle frontal gyrus of orbital part,left middle frontal gyrus and other brain regions were reduced.Compared with the non-acupoint group,the ReHo values of the left middle temporal gyrus,bilateral posterior cingulate gyrus and other brain regions of the combined-point group were enhanced,and the ReHo values of the right parahippocampa gyrus and right lenticular nuclues were reduced.(4)The correlation analysis in the combined-point group indicated that the changes of the ALFF values in the left posterior cingulate gyrus,and right insula were positively correlated to the changes of the EGG amplitudes,and the change of the ReHo value in the left posterior cingulate gyrus was positively correlated to the change of the EGG amplitude,and the change of the ReHo value in the left anterior cingulate gyrus was positively correlated to the changes of FDI.3The functional connectivity between the region of interest and other brain regions of FD patients.(1)After acupuncture at combination of BL21 and RN12,the functional connectivity of anterior cingulate gyrus to bilateral middle occipital gyrus,bilateral middle frontal gyrus and left precuneus were increased,the functional connectivity of anterior cingulate gyrus to left inferior temporal gyrus and right inferior occipital gyrus were decreased.After acupuncture at the non-acupoints,the functional connectivity of anterior cingulate gyrus to right precuneus were increased,the functional connectivity of anterior cingulate gyrus to right insula,right middle frontal gyrus and left precentral gyrus were decreased.Compared with the non-acupoint group,the functional connectivity of anterior cingulate gyrus to right lingual gyrus and right middle frontal gyrus of the combined-point group were increased,and the functional connectivity of anterior cingulate gyrus to right superior frontal gyrus were decreased.(2)After acupuncture at combination of BL21 and RN12,the functional connectivity of insula to left middle temporal gyrus,left middle cingulate gyrus and left inferior parietal gyrus were increased,the functional connectivity of insula to left calcarine,right supplementary motor area and precentral gyrus were decreased.After acupuncture at the non-acupoints,the functional connectivity of insula to left parahippocampa gyrus,left middle temporal gyrus,left precuneus and right postcentral were increased,the functional connectivity of insula to left middle occipital gyrus and bilateral precentral gyrus were decreased.Compared with the non-acupoint group,the functional connectivity of insula to right supplementary motor area,left postcentral and right superior parietal lobule of the combined-point group were increased,and the functional connectivity of insula to right inferior temporal gyrus,bilateral middle cingulate gyrus and right middle frontal gyrus were decreased.(3)After acupuncture at combination of BL21 and RN12,the functional connectivity of posterior cingulate gyrus to bilateral insula,left rolandic operculum and left precentral gyrus were increased,the functional connectivity of posterior cingulate gyrus to right inferior temporal gyrus,left middle frontal gyrus,left superior frontal gyrus and left angular gyrus were decreased.After acupuncture at the non-acupoints,the functional connectivity of posterior cingulate gyrus to right superior parietal lobule,left precentral gyrus and left superior parietal lobule were increased,the functional connectivity of posterior cingulate gyrus to bilateral postcentral gyrus were decreased.Compared with the non-acupoint group,the functional connectivity of posterior cingulate gyrus to right angular gyrus and bilateral superior frontal gyrus of the combined-point group were increased,and the functional connectivity of posterior cingulate gyrus to left middle frontal gyrus,left superior occipital gyrus and bilateral precuneus were decreased.Conclusions1 The symptoms of dyspepsia,quality of life,state of emotion and gastric motility of FD patients could be effectively improved by acupuncture at combination of BL21 and RN12.2 Compared with healthy subjects,there were multiple brain regions of FD patients with irregular values of ALFF and ReHo,and they could be regulated by acupuncture at combination of BL21 and RN12.And the range of brain regions regulated in combined-point group is more extensive than that of non-acupoint group.The anterior cingulate gyrus,insula,and posterior cingulate gyrus are the key brain regions for the targeted adjustment of FD in acupuncture treatment.3 Acupuncture effect of puncturing at combination of BL21 and RN12 to FD patients might be achieved through benign regulation of emotional network,cognitive network,default network and gastrointestinal sensory matrix.