Study On The Central Response Characteristics Of Acupuncture Treatment Of Chronic Spontaneous Urticaria

Objective This study was conducted with Chronic Spontaneous Urticaria(CSU)as the experimental object.Based on Blood Oxygen Level Dependent-Functional Magnetic Resonance Imaging(BOLD-f MRI)technology.The Amplitude of Low-Frequency Fluctuation(ALFF)and Functional connection(FC)data analysis methods were used jointly.To further explore the central response characteristics of acupuncture therapy for CSU,and provide a reliable and intuitive research basis for explaining the scientific connotation of acupuncture therapy for CSU.Methods1.A total of 60 CSU patients and 46 healthy subjects were included in this study.Use ALFF data analysis method.Obtain the spontaneous neural activity differences between CSU patients and healthy subjects.Correlation analysis with clinical effect indicators.To explore the characteristics of brain function activity in CSU patients.2.The included 60 CSU patients were randomly divided into acupuncture group(group A)and treated with acupuncture points.In the sham acupuncture group(group B),sham acupuncture was used for non-meridian non-acupoint treatment.Waiting-list group(Group C),the waiting period is not treated.Groups A and B were treated 5 times a week for the first2 weeks and 3 times a week for the next 2 weeks,for a total of 16 treatments.The waiting period for group C is 4 weeks.Clinical effect indicators include urticaria activity score 7(UAS7),pruritus VAS(Visual Analogue Scale,VAS),Dermatology Life Quality Index(DLQI),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and Pittsburgh Sleep Quality Index(PSQI),etc.Clinical efficacy assessment and resting state BOLD-f MRI scanning were performed at the time of enrollment(0 weeks)and at the end of treatment/wait(4 weeks),respectively.Use clinical data analysis and ALFF data analysis methods to complete the following comparisons:(1)Obtain the clinical effect difference of the three groups through comparison before and after treatment/waiting,and comparison between groups.(2)By comparing before and after treatment/waiting,the difference in spontaneous nerve activity of the three groups was obtained(difference=after treatment/waiting-treatment/before waiting).Correlation analysis with clinical effect index improvement value(improvement value = after treatment/waiting-treatment/before waiting).Obtain the different brain areas of each group before and after treatment/waiting.(3)Through the comparison between groups,the differences between the three groups of spontaneous neural activity differences were obtained.Correlation analysis is carried out with the difference of clinical effect index improvement value between groups,and the difference brain area between each group after treatment is obtained.Then we screened out the key brain areas targeted by acupuncture treatment of CSU.3.CSU patients in the acupuncture group were the test subjects.The key brain areas targeted and regulated by acupuncture treatment of CSU are selected as seed points.The FC data analysis method was used to obtain the functional connection difference from the seed point to the whole brain before and after treatment in the acupuncture group.Correlation analysis with clinical effect index improvement value.To explore the effect of acupuncture on the brain function connection of CSU patients.Results1.Case completion and baselineSeven of the 60 CSU patients included were not included in the statistical analysis due to incomplete scan data,excessive head movement,or job transfer.In the end,53 CSU patients(18 in the acupuncture group,18 in the sham acupuncture group,and 17 in the waiting-list group)and 46 healthy subjects were included in the analysis.The baseline is well balanced and comparable.2.Differences in clinical effects among CSU patients(1)Comparison before and after treatment/waiting: Compared with before treatment,the acupuncture group can reduce UAS7,pruritus VAS,DLQI,HAMA,HAMD and PSQI scale scores(p<0.05).The sham acupuncture group can reduce the scores of DLQI,HAMA and HAMD scales(p<0.05),but the scores of UAS7,Pruritus VAS and PSQI scales were not statistically different(p>0.05).Compared with before waiting,the waiting-list group had higher DLQI and HAMA scale scores(p<0.05).However,the scale scores of UAS7,Pruritus VAS,HAMD and PSQI were not statistically different(p>0.05).(2)Comparison between groups: the acupuncture group is superior to the sham acupuncture group and the waiting-list group in reducing the scores of UAS7,pruritus VAS and DLQI scales(p<0.05),and in reducing the scores of HAMA,HAMD and PSQI scales It is better than the waiting-list group(p<0.05),but there is no statistically significant difference from the sham acupuncture group(p>0.05).The sham acupuncture group was superior to the waiting-list group in reducing the scores of the VAS,DLQI,HAMA and HAMD scales for pruritus(p<0.05),but the difference between the UAS7 and PSQI scale scores and the waiting-list group was not statistically significant(p>0.05).3.Characteristics of brain function activity in CSU patientsCompared with healthy subjects,the brain regions with increased spontaneous nerve activity in CSU patients include: left paracentral lobule(BA2),medial superior frontal gyrus(BA10),superior occipital gyrus(BA19),inferior occipital gyrus(BA18),right Lateral bean-shaped putamen,bilateral hippocampal gyrus/para hippocampal gyrus(BA35).The brain areas with reduced spontaneous nerve activity include: left inferior orbital frontal gyrus(BA47),triangular inferior frontal gyrus(BA10),right medial superior frontal gyrus,central anterior gyrus(BA9),middle temporal gyrus(BA21),angular gyrus(BA39),bilateral middle frontal gyrus(BA46),dorsolateral upper frontal gyrus(BA8).The increase of spontaneous nerve activity in the left paracentral lobule was positively correlated with HAMA(r=0.326,p=0.017).The increase of spontaneous nerve activity in the left hippocampal gyrus/parahippocampal gyrus was positively correlated with HAMA and PSQI(r=0.276,p=0.046;r=0.292,p=0.034).The decrease of spontaneous nerve activity in the left inferior frontal gyrus was negatively correlated with UAS7(r=-0.293,p=0.033).The decrease of spontaneous nerve activity in the left dorsolateral superior frontal gyrus was negatively correlated with pruritus VAS(r=-0.280,p=0.043).The decrease of spontaneous nerve activity in the right central anterior gyrus was negatively correlated with DLQI(r=-0.289,p=0.036).The reduction of spontaneous nerve activity in the right angular gyrus was negatively correlated with HAMA(r=-0.303,p=0.027).4.Research on the central response characteristics of acupuncture treatment of CSU4.1 The influence of different treatment methods on the spontaneous nerve activity of CSU patients(1)Comparison before and after treatment/waiting: Compared with before treatment,the spontaneous nerve activity of the left inferior orbital gyrus(BA47),middle frontal gyrus(BA10),and bilateral dorsolateral superior frontal gyrus(BA8)increased in the acupuncture group after treatment.There is no brain area with decreased spontaneous nerve activity.The increase in spontaneous nerve activity in the left inferior frontal gyrus(BA47)was negatively correlated with UAS7 and VAS improvement in pruritus(r=-0.535,p=0.022;r=-0.569,p=0.014).The increase in spontaneous nerve activity in the left middle frontal gyrus(BA10)was negatively correlated with the improvement of HAMA(r=-0.488,p=0.040).The increase of spontaneous nerve activity in the left dorsolateral superior frontal gyrus(BA8)was negatively correlated with the improvement of HAMD(r=-0.570,p=0.014).After treatment in the sham acupuncture group,spontaneous nerve activity increased in the left superior temporal gyrus(BA22)and middle occipital gyrus(BA19).The decrease of spontaneous nerve activity in the left posterior cingulate gyrus(BA31)was positively correlated with the improvement of HAMD(r=0.476,p=0.046).Compared with before waiting,after waiting for the treatment group,the left precuneus(BA7),middle frontal gyrus,middle cingulate gyrus(BA31),right thalamus,caudate nucleus,hippocampus(BA36),and bilateral fusiform gyrus(BA37)spontaneously Increased neural activity.Left superior temporal gyrus(BA22),middle temporal gyrus(BA21),inferior temporal gyrus,inferior frontal gyrus of triangle,inferior frontal gyrus of island cover(BA45),central anterior gyrus,auxiliary motor area(BA6),superior marginal gyrus,Anterior cingulate gyrus,lenticular putamen,and lower spontaneous nerve activity in the right inferior orbital frontal gyrus(BA11).The increase of spontaneous nerve activity in the right thalamus was positively correlated with the aggravation of DLQI(r=0.546,p=0.023).(2)Comparison between groups: Compared with the sham acupuncture group,the spontaneous nerve activity of the left inferior orbital frontal gyrus(BA47)and dorsolateral superior frontal gyrus(BA10)in the acupuncture group were increased.There is no brain area with decreased spontaneous nerve activity.The increase of spontaneous nerve activity in the left inferior frontal gyrus(BA47)was negatively correlated with the difference in UAS7 and DLQI improvement values(r=-0.484,p=0.042;r=-0.536,p=0.022).Compared with the waiting-list group,the spontaneous nerve activity of the left middle frontal gyrus and the inferior frontal gyrus of the triangle in the acupuncture group increased.The decrease of spontaneous nerve activity in the left medial superior frontal gyrus was positively correlated with the difference in the improvement of pruritus VAS(r=0.554,p=0.021).4.2 Acupuncture treatment of key brain areas targeted and regulated by CSU Compared with healthy subjects,the left inferior orbital gyrus(BA47)with decreased spontaneous nerve activity in CSU patients was negatively correlated with UAS7(r=-0.293,p=0.033).After acupuncture treatment,the increase of spontaneous nerve activity in the left inferior orbital gyrus(BA47)was negatively correlated with the improvement of UAS7 and pruritus VAS(r=-0.535,p=0.022;r=-0.569,p=0.014).Compared with the sham acupuncture group,the acupuncture group was more able to increase the spontaneous nerve activity of the left inferior orbital frontal gyrus(BA47),and was negatively correlated with the difference between the UAS7 and DLQI improvement values(r=-0.484,p= 0.042;r=-0.536,p=0.022).4.3 The influence of acupuncture on the brain function connection of CSU patients Take the left inferior orbital frontal gyrus(BA47)as the seed point.Compared with before treatment,the brain functional connection of the left inferior temporal gyrus(BA19),superior marginal gyrus,anterior cuneiform(BA7),right thalamus and superior temporal gyrus of the acupuncture group was enhanced after treatment.Areas of the brain with weakened brain function connections.The enhancement of brain function in the left anterior cuneiform lobe(BA7)was negatively correlated with the improvement of pruritic VAS(r=-0.531,p=0.024).Conclusions1.The clinical effect of acupuncture at acupoints on CSU is better than that of sham acupuncture at non-meridian and non-acupoints and waiting for treatment.2.Compared with healthy subjects,the difference in spontaneous neural activity in CSU patients mainly involves the Default Mode Network(DMN).The spontaneous neural activity changes in DMN-related brain regions may be an important feature of brain function activity in CSU patients.3.Acupuncture treatment can increase the spontaneous nerve activity that is reduced in the disease state of DMN-related brain areas,and enhance the brain function connection between the left inferior orbital gyrus(BA47)and DMN,especially the left precuneus(BA7).Compared with sham acupuncture at non-meridian and non-acupoints and waiting for treatment,part of the central response of acupuncture to treat CSU may be mainly characterized by regulating DMN brain function related to the disease.4.The left inferior orbital frontal gyrus(BA47)may be the key brain area for acupuncture treatment of CSU.