A Study On The PAG Brain Function Connect Network In Primary Dysmenorrhea Patients Based On Resting State FMRI

Objective:In this study,Functional Magnetic Resonance Imaging(fMRI)was used as the research method,Primary Dysmenorrhea(PDM)as the research carrier,periaqueductal gray matter of midbrain as the seed point,to explore the central mechanism of acupuncture in the treatment of PDM from the perspective of affecting the brain functional connection network of PAG.Methods:In this study,36 PDM subjects were randomly divided into acupuncture group(group A)and waiting treatment group(group B).Acupuncture group received three menstrual cycles of acupuncture treatment,waiting for the treatment group did not receive any treatment.All PDM subjects were required to have Visual Analogue Scale(VAS),The Cox Menstrual Symptom Scale(CMSS),Self-rating Anxiety Scale(SAS)score,Self-rating Depression Scale(SDS)score,Pittsburgh sleep quality index(PSQI)score and fMRI scan in the baseline period and the first menstrual cycle after the completion of the trial.Spss25.0 was used to analyze the differences of clinical scales(VAS,CMSs,SAS,SDS and PSQI)before and after treatment in acupuncture group,so as to evaluate whether acupuncture can improve pain and accompanying symptoms(anxiety,depression and sleep quality).Using the analysis method of resting state functional connection,taking PAG as the seed point,by comparing the fMRI images of the subjects in the acupuncture group and the waiting group after the experiment,the characteristics of the adjustment of acupuncture on the abnormal PAG brain functional connection network in PDM patients were analyzed.The correlation between PAG forebrain island,VAS and PAG amygdala / hippocampus and total attack time of Cox dysmenorrhea was analyzed by Pearson correlation analysis(? = 0.05).Results:1.There was no significant difference in baseline demographic characteristics(age,height,weight,etc.)and condition data(VAS,CMSS,SAS,SDS,PSQI scores)between groups A and B,and there was comparability between groups.2.Compared with before acupuncture treatment,the scores of VAS,CMSS and PSQI of PDM patients in group A decreased after acupuncture treatment(P < 0.05),while the scores of SAS and SDS decreased,but the difference was not statistically significant(P > 0.05).There was no significant difference in VAS and CMSS scores before and after the test in group B PDM patients(P > 0.05),and the scores of SAS,SDS and PSQI decreased(P < 0.05).After the test,there were significant differences in VAS,CMSS and PSQI scores between the two groups(P < 0.05),but no significant differences in SAS and SDS scores(P > 0.05).3.After treatment,compared with group B,the FC was higher than that PAG of right Prefrontal cortex,left Precuneus,right Precuneus and left Amygdala(AMY)/ Hippocampus(HIP);the FC was lower than that PAG of right middle occipital gyrus,left cerebellum and right Anterior insula(AI).4.After treatment,there was a significant negative correlation between PAG-AI functional connection and VAS score in group A(P < 0.05);there was a significant positive correlation between PAG-AMY/HIP functional connection and total attack time of COX dysmenorrhea symptoms in group A(P < 0.05).Conclusions:1.Acupuncture at Sanyinjiao and Guanyuan can significantly improve the degree of dysmenorrhea pain,clinical symptoms of dysmenorrhea and sleep conditions in PDM patients,but the improvement of anxiety and depression in PDM patients is not obvious.2.Acupuncture can change the functional connection network between PAG and Prefrontal cortex,limbic system,Precuneus,insula and cerebellum.The increase of the functional connection network between PAG,limbic system and Precuneus may be the main central mechanism of acupuncture in the treatment of PDM.3.The enhancement of PAG-AMY/HIP functional connection may be related to the improvement of the total pain attack time of patients with PDM by acupuncture.The enhancement of PAG-AI functional connection may be related to the improvement of the pain degree of PDM by acupuncture.