| Objective:The study on primary dysmenorrhea as a carrier of the disease, the use of resting-state functional magnetic resonance imaging technology to explore the possible mechanism of acupuncture in the treatment of PD.Methods:1.12 patients with primary dysmenorrhea who matched the inclusion criteria were randomly divided into the real acupuncture group (Group A,SP6) and the sham acupuncture group (Group B.sham acupoint) in the proportion of 1:1.each group consisting of 6 case. Both groups received treatment 7 days before menstruation,once per day,.Each time retaining the needles for 30 minutes.and till the menses.They received treatment for 3 menstrual cycles continuously.Respectively before treatment and after each treatment in the subjects of pain on the visual simulation (VAS) and after three cycles of continuous treatment of dysmenorrhea symptom score (CMSS), self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) were evaluated. The collected data using statistical software spss21.0 carries on the statistical analysis.2. The subject will be two rs-fMRI scans before and after the continuous treatment of acupuncture therapy three courses and two scans were performed in menstruation 1-3 days of pain.The amplitude of low frequency fluctuation was used to compare the fMRI images of the acupuncture group and the group, and the differences of brain function in resting state between the group and the group after acupuncture treatment in PD patients were observed.Results:1. The baseline data of VAS,CMSS,SAS,SDS before treatment and age, weight, height, course of disease, menstrual cycle, the number of menstruating days were consistent (P> 0.05).2. Evaluating the therapeutic effect of acupuncture stimulation at SP6 versus sham acupuncture in patients with primary dysmenorrhea:(1) The VAS scores of the two groups after each course of treatment were lower than before treatment,and the tendency of the third course< the second course< first course was found..After third courses of treatment is compared before treatment were significantly reduced (P<0.05). Between the two groups after treatment no significant difference (P> 0.05), but the mean group a< B group. Indicating that the two groups can improve the symptoms of dysmenorrhea by acupuncture.,and group A than in group B.(2) The CMSS scores of two groups were decreased after acupuncture stimulation.and Group A difference was more obvious (P< 0.05).), there was statistical significance; Group B had no statistical significance (P> 0.05),the difference between the two groups was not significant (P> 0.05), but the mean A group< B group. It showed that the two groups could improve the symptoms of dysmenorrhea (P> 0.05)., but the improvement of A group was more significant.(3) The two groups after treatment SDS score and SAS score than before treatment were decreased, the difference is statistically significant (P< 0.05).After treatment, the difference between the two groups was not significant (P> 0.05). It show that acupuncture can improve the PD subjects of anxiety and depression, acupuncture stimulation at SP6 versus sham acupuncture in PD patients’ mood regulation does not have significant difference.3. Different effects of acupuncturing sanyinjiao and sham acupuncture on the brain function of primary dysmenorrhea subjects(1) Acupuncturing Sanyinjiao (Group A) before and after the resting-state fMRI data comparison results demonstrate:ALFF apparently increased in the left superior frontal gyrus (BA6), the left middle frontal gyrus (BA6), the left inferior frontal gyrus (BA9), left anterior cingulate gyrus (bA33), left posterior central gyrus (BA7), left cuneus(BA7), right precuneus (BA7), the left superior temporal gyrus (BA41), left superior temporal gyrus (BA9), on the right superior parietal lobule (BA7), the left uncus (BA36). ALFF decreased in the cerebellum brain regions of the right front lobe, right middle frontal gyrus (BA47), the left cerebellar tonsil and right insula (BA13), right thalamus.(2) Compared with resting-state functional magnetic resonance imaging before and after acupuncture at sham acupuncturet (Group B).The results show:Increased ALFF was detected in the left brain area putamen, the left middle temporal gyrus (BA21). Decreased ALFF was observed in the right occipital lobe brain regions lingual gyrus (BA18), the left putamen, the left inferior parietal lobule (BA40).(3) Sanyinjiao and sham acupuncture after resting-state functional magnetic resonance imaging contrast results show:After acupuncture,the left lobe cuneus (BA7),the left postcenter (BA7) and the right superior parietal lobule (BA7) activated higher in Group A than Group B,while in the left middle frontal (BA47), left anterior limbic cingulate gyrus (BA32), left side of the cerebellar vermis, the right superior frontal gyrus (BA9),the right Medial frontal (BA8) and left paracentral(BA8)Conclusions:1. There is positive significance of acupuncture in improving PD in subjects with pain and its related symptoms, but few samples showed only A of group B was superior to the trend, need further research.2. Acupuncture can improve the anxiety and depression state of PD subjects (P< 0.05), but the positive regulation does not have obvious difference (P> 0.05). This result indcated that acupuncture at sanyinjiao and sham acupuncture could activate different brain regions.3. Group A and Group B in getting Qi in acupuncture with significant difference (P< 0.05), which in the expansion of sense significantly (P< 0.05), while in acid, hemp, weight, pain, anxiety, and other sensory no statistical difference (P> 0.05). The two groups were different in acupuncture.4. Group A not only activate the prefrontal and central gyrus, thalamus and pain perception and transduction related brain regions, but also activates the anterior cingulate gyrus, insula and pain sensation, emotion and cognition related to the limbic system, thus we hypothesized that Acupuncture Sanyinjiao (SP 6) for the treatment of PD may activate multiple and pain related brain areas, through integration and analgesia of the synergy between them.5. Group B activates the lentiform nucleus, the superior temporal gyrus, lingual gyrus and inferior parietal lobule, main and responsible brain regions of the emotional regulation,, indicating that acupuncture without the non acupoint after PD by improvement of symptoms may and placebo effect is related to the existence.6. Between the two groups comparison it was found that Acupuncture Sanyinjiao can target in pain regulation, cognitive, memory, emotion regulation, etc. primary dysmenorrhea of abnormal brain regions, indicating that Acupuncture Sanyinjiao (SP 6) different from non acupoint acupuncture, which may be due to the specificity of acupoint. Therefore, we speculate that acupuncture acupoint and non acupoint may be regulated by different brain regions to alleviate the symptoms of PD. |
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