| Objective: T2DM patients were taken as the research subjects,and "Adjust Zang Dredge Meridian" electroacupuncture therapy was used as the intervention means,and a prospective randomized control was adopted as the research method to observe the improvement of clinical symptoms in T2DM patients.Comprehensively applying multimodal brain imaging techniques to reveal the changes in brain function of T2DM patients,and elaborating on the brain imaging effect and mechanism of "Adjust Zang Dredge Meridian" electroacupuncture to improve T2DM.Methods: 1.Retrieve clinical controlled studies on functional connectivity in patients with T2DM from CNKI,Wanfang,VIP,Pub Med,Web of Science and Embase databases from the time of database construction to February 2024,screen the literature based on the nerfing criteria,extract the corresponding data in the included literature,and use the SDMPSI software package to conduct separate resting-state functional differences voxel metaanalysis.2.Healthy subjects and T2DM subjects were enrolled,and clinical information of the subjects was collected,while rs-fMRI,MRS detection technology was applied to collect brain image data of the subjects.The structural images of the two groups of included subjects were analyzed to derive the brain regions that produced structural changes,and the differential brain regions were used as seed points to analyze the changes in brain functional connectivity in the two groups;in addition,metabolite metabolism was observed to characterize metabolites in the anteriorly connected regions of the white matter.3.The T2DM subjects were randomly grouped into "Adjust Zang Dredge Meridian" electroacupuncture group and sham electroacupuncture group,and the sparse and dense waves with a frequency of 2Hz/100 Hz and current intensity in the range of 0.1～1.0MA(to the extent that the patients felt comfortable).Taking sparse and dense wave,frequency2Hz/100 Hz,current intensity in the range of 0.1～1.0MA(to the extent that the patient feels comfortable),electroacupuncture stimulation was performed.In the sham electroacupuncture group,the wires of the electroacupuncture instrument were cut before the intervention,and after the completion of the needling operation,and the parameters of electroacupuncture were set up as before.The clinical indicators and imaging data of the two groups were collected to analyze the clinical symptoms and brain imaging changes of T2DM with the electroacupuncture method of " Adjust Zang Dredge Meridian ".Results: 1.A total of 16 studies were included in the Meta-analysis.Enhanced activity in patients with T2DM was mainly concentrated in the bilateral thalamus,left insula,hemispheric lobule VIII of the right cerebellum,right precentral gyrus,left inferior frontal gyrus,and left supra-frontal gyrus;diminished activity was found in the hemispheric lobule VI and Crus I regions of the left cerebellum,the right mid-occipital gyrus,the left precentral gyrus,and the right suboccipital gyrus.2.Results of changes in clinical indicators,brain structure,function and intracerebral metabolites in T2DM subjects and healthy subjects:(1)Results of changes in clinical indicators: FPG,GA,Hb A1 c,FINS,HOMA-IR and TG were significantly increased in the T2DM group compared with the HC group,and the differences were statistically significant(P<0.05,P<0.001);The rest of the demographic information was not statistically significant when comparing the two groups(P>0.05);(2)Results of brain structural changes: the T2DM group showed a statistically significant difference in gray matter volume reduction in the right middle temporal gyrus and right cerebellar Crus II region compared with the HC group(P<0.01);In the T2DM group,compared with the HC group,the cortical thickness was thinner in the left orbital middle frontal gyrus,the right postcentral gyrus,and the right middle temporal gyrus,and the difference was statistically significant(P<0.001);The T2DM group had a thickened cortical thickness in the right insula compared to the HC group,and the difference was statistically significant(P <0.001);The T2DM group had increased sulcus depth in the left lingual gyrus and right middle prefrontal cortex compared with the HC group,and the difference was statistically significant(P<0.001);The T2DM group showed a statistically significant difference in reduced cortical folds in the right middle prefrontal,right insula,right supramarginal gyrus,and right lateral occipital cortex compared with the HC group(P<0.001);(3)The results of the changes in brain function: in the T2DM group compared with the HC group,the functional connectivity of the right postcentral gyrus with the right medial superior frontal gyrus and the frontal pole was enhanced;the functional connectivity of the right middle temporal gyrus with the right middle frontal gyrus was enhanced;and the left lingual gyrus was enhanced by the functional connectivity of the left lingual gyrus with the right orbito-corbital middle frontal gyrus,the right medial superior frontal gyrus,and the right middle frontal gyrus.In the T2DM group,compared with the HC group,the functional connectivity of the right middle prefrontal gyrus with the right middle frontal gyrus was weakened;the functional connectivity of the right postcentral gyrus with the right middle occipital gyrus and the right supraoccipital gyrus was weakened;the functional connectivity of the right middle temporal gyrus with the right supratemporal gyrus was weakened;and the functional connectivity of the right cerebellar Crus II area with the right middle frontal gyrus was weakened;(4)Results of changes in metabolic substances in the brain: the concentrations of GABA/Cr+PCr,NAA/Cr+PCr,and Glu/Cr+PCr were reduced in the T2DM group compared with the HC group,and the difference was statistically significant(P<0.05).3.Improvement of clinical indicators and brain imaging results of T2DM by electroacupuncture of "Adjust Zang Dredge Meridian" :(1)Comparison of the general conditions of the subjects in the DM＿A and DM＿SA groups showed no statistical difference(P>0.05);(2)FPG,Hb A1 c,GA,FINS and HOMA-IR were reduced in the DM＿A group after electro-acupuncture treatment with "regulating the organs and collaterals",and the differences were statistically significant compared with those before the treatment(P<0.05,P<0.01);There was no statistically significant difference in the clinical indexes before and after treatment of the subjects in the DM＿SA group(P>0.05);FPG,Hb A1 c,GA,FINS,and HOMA-IR of the subjects in the DM＿A group were reduced after treatment compared with those of the subjects in the DM＿SA group,and the difference was statistically significant(P<0.05);The difference between the remaining indicators before and after treatment was not significant(P>0.05);(3)Resting-state functional connectivity results: In the DM＿A group,the functional connectivity of the right lateral occipital cortex with the right caudate nucleus and the right orbital middle frontal gyrus was enhanced after treatment compared with before treatment;the functional connectivity of the right supramarginal gyrus with the left supratemporal gyrus was enhanced;the functional connectivity of the left lingual gyrus with the left inferotemporal gyrus was diminished;and the functional connectivity of the right middle temporal gyrus with the left medial supratentorial frontal gyrus and the right precuneus was weakened;There was no statistically significant difference in the comparison of resting-state functional connectivity in the DM＿SA group after treatment compared to before treatment;Results of the main effect difference between the HC group,DM＿A and DM＿SA resting-state functional connectivity change profiles: Enhanced functional connectivity of the right middle temporal gyrus with the limbic lobe;Analysis of changes in resting-state functional connectivity in DM＿A and DM＿SA RESULTS: The right middle temporal gyrus of DM＿A had enhanced functional connectivity with the inferior lobe,the right brainstem,and the gray matter of the temporal lobe when compared with the DM＿SA group;(4)GABA/Cr+PCr,NAA/Cr+PCr and Glu/Cr+PCr ratios of the subjects in DM＿A group were significantly higher after electroacupuncture treatment of "Adjust Zang Dredge Meridian" compared with that before the treatment,and the difference was statistically significant(P<0.01);GABA/Cr+PCr of the subjects in DM＿A group was significantly higher after the treatment compared with that of those in DM＿SA group(P<0.05).GABA/Cr+PCr was significantly higher after treatment compared with that after treatment,and the difference was statistically significant(P<0.05).Conclusion: 1.Meta-analysis showed that changes in T2DM brain function were dominated by functional alterations in the cerebellum,insula and visual cortex.2.Patients with T2DM have alterations in brain structure,function and neurotransmitter metabolism in the brain,including cerebellum,temporal lobe,frontal lobe and other regions.Among them,the right middle temporal gyrus was reduced in gray matter volume and cortical thickness compared with healthy per capita,and there were also abnormalities in functional connectivity between the middle temporal gyrus and other brain regions.Abnormalities of the structure of middle temporal gyrus and the connectivity of the brain’s functional network may be the key to the alterations of the brain centers in T2DM.In addition,neurotransmitter levels in the anterior white matter connective area were reduced compared with healthy individuals.3."Adjust Zang Dredge Meridian" electroacupuncture can improve clinical symptoms such as blood glucose and insulin resistance,regulate the brain functional connectivity network,and improve the metabolism of neurotransmitters in the brain in T2DM subjects,among which the improvement of the functional connectivity abnormality between the middle temporal gyrus and the whole brain may be a potential mechanism of action.Improving the functional connection between the middle temporal gyrus and the whole brain may be a potential mechanism of "Adjust Zang Dredge Meridian" electroacupuncture to regulate the central brain changes in T2DM patients. |
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