| ObjectiveTo explore the neuroimaging characteristics of resting central nervous system in responsive patients with chronic knee pain caused by knee osteoarthritis treated with acupuncture.Methods1.72 KOA patients with chronic knee pain were randomly divided into acupuncture point group(n = 36)and non-acupuncture point group(n = 36).Patients in the two groups received acupuncture treatment once a day for 30 minutes each time,and rested for 2 days after completing 5 treatments for a total of 10 treatments.Before treatment,a resting-state BOLDf MRI scan was performed.Visual score scale(VAS),Western Ontario and Mc Master Universities Osteoarthritis index(WOMAC)and Mc Gill Pain Questionnaire(MPQ)were used to evaluate the clinical efficacy before and after treatment.Self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to evaluate patients’ emotional and psychological state.12-Item Short Form Survey(SF-12)were used to evaluate patients’ quality of life.The minimal clinically important difference(MCID)(VAS improved value ≥2 points or more than40.8%,and WOMAC function score improved value ≥6 points or more than 26%)was used as the standard to distinguish whether acupuncture is clinically responsive or not in patients with KOA chronic knee pain.2.The brain resting-state BOLD-f MRI data of acupuncture responsive patients compared with unresponsive patients were analyzed by whole brain level fractional amplitude of low-frequency fluctuation(fALFF)and Regional Homogeneity(ReHo).Furthermore,the overlapping brain regions of fALFF and ReHo,which are significantly different between acupuncture responsive patients and unresponsive patients,are taken as seed points,and the seed-based functional connectivity(Seed-based FC)analysis is performed to explore the characteristics of brain functional network in acupuncture responsive patients.Results1.Screening of clinically responsive patients with acupuncture treatment of KOA chronic knee pain.(1)There was no significant difference in the improvement values of VAS,WOMAC and MPQ as well as SAS,SDS and SF-12 between acupuncture point group and non-acupoint group after treatment in KOA chronic knee pain patients(p > 0.05).Therefore,acupuncture acupoints group and non-acupoints group were combined with KOA patients with chronic knee pain to expand the sample size for clinical screening of patients with responsive acupuncture.(2)Taking the minimum clinical important difference(MCID)as the demarcation standard for the responsive and unresponsive with acupuncture treatment.The responsive rate of acupuncture treatment for KOA was 50.77%,and there was no difference in the responsive rate of acupuncture between the acupoint and non-acupoint groups.2.Results of brain function and brain function network characteristics of patients with chronic knee pain responsive in the treatment of KOA(1)fALFF resultCompared with unresponsive patients,responsive patients showed increased fALFF values in bilateral medial orbital gyrus(OFC BA11),right medial superior frontal gyrus(BA11),right gyrus rectus(BA11),right posterior cingulate gyrus(BA23)and right precuneus(BA23).(2)ReHo resultCompared with unresponsive patients,responsive patients showed increased ReHo values in bilateral OFC(BA11),right gyrus rectus(BA11),right superior frontal gyrus(BA6),left middle frontal gyrus(BA46),right medial cingulate gyrus(BA11),right putamen(BA11)and right caudate(BA47).(3)FC resultThe overlapping brain regions of fALFF and ReHo that are significantly different between responsive patients and unresponsive patients are the right OFC(peak MNI coordinates,x=12,y=48,z=-21,voxel size=15)and the left OFC(peak MNI coordinates,x=-15,y=24,z=-21,voxel size=33).Both fALFF and ReHo values showed increased in bilateral OFC.Compared with unresponsive patients,responsive patients showed increased FC values in the bilateral superior parietal lobules(BA7/BA19),bilateral supramarginal gyrus(BA40),right cuneus(BA19),right fusiform gyrus(BA37),left gyrus rectus(BA11),left middle frontal gyrus(BA9),right OFC(BA11),right inferior medial frontal gyrus(BA11),and right parahippocampus gyrus(BA20)with the right OFC.Compared with unresponsive patients,responsive patients showed increased FC values in bilateral lingual gyrus(BA30),right fusiform gyrus(BA37),left superior lobe(BA40),left angular gyrus(BA40),bilateral OFC(BA11),bilateral gyrus rectus(BA11),right superior frontal gyrus(BA8),left middle frontal gyrus(BA9),right posterior cingulate gyrus(BA27),left thalamus(BA27),right cerebellum,and the brain stem with the left OFC.Conclusions1.The increase of fALFF and ReHo in bilateral OFC may be one of the central characteristics of responsive patients with KOA chronic knee pain treated by acupuncture.2.The increase of rs-FC in OFC-DMN may be one of the brain functional network characteristics of responsive patients with KOA chronic knee pain treated by acupuncture. |
