| Background:dizziness is one of the most common clinical manifestations in diagnosis and treatment,but it is difficult for patients to describe properly and doctors to judge accurately because of its subjectivity.The causes of dizziness are various,and the proportion of psychosocial dizziness in clinic is increasing.PPPD is a newly established clinical diagnosis in recent years,and it is also the most common clinical mental dizziness.Although there are many examination methods for dizziness,fMRI is considered to be the first choice to study the pathogenesis of the disease.Although traditional Chinese medicine has formed a unique diagnosis and treatment system for the treatment of vertigo in the process of long-term medical practice,there are still differences between PPPD and vertigo in the traditional sense.whether there is a correlation between the different syndrome characteristics of traditional Chinese medicine and the research views of modern medicine remains to be explored.Objective:To study the TCM syndrome characteristics of liver depression and yin deficiency in PPPD;To observe the resting state functional magnetic resonance imaging characteristics between PPPD liver depression group and yin deficiency group;And to observe the resting state functional magnetic resonance imaging characteristics of PPPD patients.Methods:a total of 16 patients with PPPD were included.There were 7 males and 9 females,aged from 24 to 64 years old,with an average age of 42 years.A total of 16 healthy volunteers were selected in the control group,including 6 males and 10 females,aged from 23 to 62 years old,with an average age of 38 years.A total of 23 patients with Meniere's disease(including acute and remission)were selected in the Meniere's disease group,including 10 males and 13 females,aged from 27 to 67 years old,with an average of 54 years old.All subjects received HADS scale,DHI scale score and TCM syndrome scale,and routine whole brain magnetic resonance imaging(T1-WI),T2-WI sequence scanning and resting functional magnetic resonance(rs-fMRI)imaging were performed.The MRI data were statistically analyzed by AFNI software,and the differences of hippocampal functional connections between groups were compared by independent sample t-test.The collection results of TCM syndrome scale of patients with PPPD were dialectically scored according to the diagnostic criteria of traditional Chinese medicine,and the characteristics of TCM syndromes were explored.SPSS20.0 software was used for statistical analysis.Results:a total of 16 patients with persistent postural perceptual dizziness were included in this study,including 7 males and 9 females,including 6 patients in the liver depression group and 8 patients in the yin deficiency group.2 patients in the yin deficiency group were excluded from the group because the image was not clear due to the excessive range of head movement during fMRI.Finally,14 patients with persistent postural perceptual dizziness were included,including liver depression group(N=6)and yin deficiency group(N=8).There were 16 cases of healthy control group and 23 cases of Meniere's disease control group.There was no significant difference in age and sex among the three groups(P>0.05).(1)the TCM syndrome characteristics of PPPD patients are mainly heart yin deficiency in 8 cases(57.2%)and liver qi stagnation in 6 cases(42.8%),and both of there TCM syndrome score>20 points,and spleen deficiency and dampness syndrome in 5 cases,cold and dampness in 5 cases,spleen deficiency and qi entrapment syndrome in 4 cases,spleen yang deficiency syndrome in 4 cases,heart qi deficiency syndrome in 4 cases and kidney yang deficiency syndrome in 2 cases(TCM syndrome score is between 14 and 20 points).(2)the baseline level of age and sex in each group:there was no significant difference in age and sex between PPPD group and normal control group,PPPD group and MD group,PPPD group and Yin deficiency group.There was a significant difference in the course of disease between the liver depression group and the yin deficiency group,according to the average value of the two groups,the liver depression group was 12.83 months,and the yin deficiency group was 41.75 months,so the course of disease in the yin deficiency group was longer than that in the liver depression group.(3)the HADS score in the PPPD group and the normal control group showed that the HADS score in the PPPD group was significantly higher than that in the normal control group.(4)there was no significant difference in HADS score between liver depression and yin deficiency group and liver depression group in PPPD group(P>0.05);(5).There was significant difference in DHI-P score between Neiyin deficiency group and liver depression group in PPPD group,and no significant difference in DHI-E and DHI-F scores was found in Neiyin deficiency group and liver depression group(P>0.05).(6)the fMRI of PPPD patients showed that the functional connections of right lingual gyrus,left cuneate lobe,right cuneate lobe and right cerebellum(hot color)were enhanced,while the functional connectivity of left inferior parietal lobule,left middle frontal gyrus,left putamen and left precentral gyrus was decreased.(7)the functional connections of right cingulate gyrus,left anterior wedge lobe and left middle frontal gyrus(hot color)were enhanced in fMRI of PPPD patients compared with those of MD patients,while the connectivity of right superior temporal gyrus,right cerebellum,left superior frontal gyrus,left superior temporal gyrus,right inferior temporal gyrus,right parahippocampal gyrus,right precentral gyrus and left inferior temporal gyrus decreased.(8)the hippocampal connections in the left inferior parietal lobule and the right superior frontal gyrus in the Neiyin deficiency group were significantly higher than those in the liver depression group,while the hippocampal connections in the right postcentral gyrus,left precentral gyrus,left inferior frontal gyrus,right precentral gyrus and left posterior cingulate gyrus were significantly decreased in fMRI.Conclusion:1.The development of TCM syndromes in PPPD patients was characterized by stagnation of liver Qi as early as possible,and deficiency of heart Yin as the main symptom in the later stage of the disease;2.Compared with the patients in the liver depression group,the patients in the PPPD yin deficiency group showed more connected areas connecting visual and emotional processing,while fewer connections between the related areas involved in physical exercise,which may provide a relevant imaging basis for the dialectical syndrome of liver depression and yin deficiency in TCM.3.Compared with the normal control group,the connecting area of visual and emotional processing in PPPD patients increased,while the connection between the areas involved in multi-sensory vestibular processing and spatial cognition decreased.The functional connection pattern of this brain region may become an imaging marker for PPPD diagnosis.4.Compared with Meniere's disease group,PPPD showed increased regional connectivity related to emotional processing,while decreased connectivity between audio processing and body movement-related regions,which may be the brain functional basis of typical symptoms of PPPD. |
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