An FMRI Study Of Acupuncture Improve Vasomotorial Symptoms At Perime Nopausal Syndrome For The Central Response Characteristics

Purpose:The study is to observe the difference on the brain function activities of patients with PMS after acupuncture Meridian acupoint and non acupoint therapy with the Blood Oxygenation Level Dependent-functional oxygen Magnetic Resonance Imaging ?BOLD-fMRI? technology, to extract the changes of PMS patients'brain function feature compared with that of healthy human, then to find the "core area " where the acupuncture therapeutic effect works in the integration of neural network, and then finally to explain the central regulation mechanism of vasomotor symptoms improvement which appears through the acupuncture treatment on PMS patients, providing a scientific basis for further clinical application of the acupuncture treatment on PMS.Method:In this study,35 cases of PMS patients are randomly divided into meridian acupoint group and non acupoint group. Meridian acupoint group:selecting acupoints named Guanyuan, Zigong, Sanyinjiao, Zusanli as needling treatment for 20 times; Non acupoint group:receiving the non acupoint as needling treatment for the same time. Clinical evaluation and resting state fMRI scan were performed before and after the treatment in two groups. Image data uses regional homogeneity ?ReHo? and amplitude of tow frequency fluctuations ?ALFF? method to complete the following analysis;1.two groups are compared on the scores in Menopause rating Scale?MRS?, integral of mean hot flushes, Menopause-specific quality-of-life?MENQOL?,Self-rating Depression Scale?SDS?, Self-rating Anxiety Scale?SAS?, Pittsburgh sleep quality index?PSQI?, and the differences of the clinical efficacy will be analyzed;2.Comparing two groups during resting state, the differences of ALFF and ReHo will be found to feature the brain functional activity characteristics of PMS patients;3. Comparing two groups after the therapy, the differences of ALFF and ReHo will be found again to analysis the similarities and differences of the brain functional change between the acupuncture meridian acupoints and non acupoints treatment;Result:1.The Meridian acupoint group:needling on the acupoints named Zusanli, Sanyinjiao and Guanyuan, Zigong can effectively improve a variety of clinical symptoms of PMS patients, and reduce the scores on MRS, integral of mean hot flushes, MENQOL, SDS, SAS ?P< 0.05?. But the PSQI improvement is not so obvious after treatment ?P>0.05?.2. Non acupoint group:needling on non acupoint can improve the overall quality of PMS patients, but the improvement of the symptoms of hot flashes, sleep, and mood is not obvious. The MRS and MENQOL of PMS patients changed significantly ?P< 0.05?, and the integral of mean hot flushes, PSQI, SDS, SAS have no significant change ?P> 0.05?.3. The clinical effect contrast analysis between two groups:the meridian acupoint group is better than non acupoint one in reducing MRS, integral of mean hot flushes, MENQOL, SDS, and SAS?P< 0.05?, but there is no difference on the PSQI change?P> 0.05?.4. The characteristics of PMS patients'brain functional activity:Compared with healthy subjects, PMS patients ReHo is higher in the brain regions including Cerebelum_6R, Cerebelum_Crusz2_L, Cuneus_L, Linqual_R, Occipital_Mid_L, and Temporal_Mid_R, PMS patients ALFF is higher in the brain regions including Angular_R, Parietal_Inf_R, and Precuneus_R; PMS patients ALFF is lower in the brain regions including Cerebelum₇b_R, Cerebelum_8L, Cerebelum_8R, Frontal_Sup_Medial_L, and Frontal_Sup_Medial_R.5. after the acupuncture treatment, PMS patients' brain activity changes include the following:After acupuncture, the ReHo is different in the brain area named Cerebelum_Crusz2_L 2, while the ALFF is different in the brain areas named Cerebelum_9R,Cerebelum_8R,Cerebelum_Crusz2_L in the two groups.Conclusion:1.Compared with non acupoints group, improvements have a significant advantage in Meridian acupoints group on the hot flashes, MAS score, MENQL score, negative emotions ?depression, anxiety?.2.REHO and ALFF are significantly different between PMS patients and healthy subjects during resting state. Cerebellum-frontal-temporal lobe function abnormal brain activity may be the brain functional activity features of PMS patients PMS symptoms-related brain regions.3.Acupuncture can significantly reduce PMS patients'brain regions where REHO is increased, and can well-adjust the amplitude of low frequency vibration of brain local neurons in patients with PMS. The core area of the change of the brain function is the cerebellum by acupuncture meridian point, It is speculated that acupuncture meridian point may affect the function of up and down autonomic nervous network, or by strengthening the connection between the cerebellum and brain stem, spinal cord and stimulating the neuroendocrine function, eventuallyaffect autonomic nervous system sympathetic and parasympathetic excited and suppressed so as to improve PMS vasomotor symptoms of hot flashes.Therefore, acupuncture can regulate the cerebellum-frontal-temporal lobe function, the brain has connection and feedback with various brain region, and that may be the central response characteristics of the whole regulation effect of acupuncture to PMS.