The ACC-DMN Regulating Mechanism Of Deqi Influencing On The Therapeutic Effect Of Acupuncture Treating For Funtional Dyspepsia

Objects:By clarifying the abnormal function of anterior cingulate cortex(ACC)and its correlation with clinical symptoms in functional dyspepsia(FD),this study tried to explore partial central mechanism of the influence of acupuncture with deqi treating for functional dyspepsia.Methods:1.32 FD patients and 35 health subjects(HS)were scanned by the blood oxygenation level-dependent functional magnetic resonance imaging(BOLD-fMRI)technique and analyzed with seed-based functional connectivity(seed-based FC).Eight seeds with bilateral of each were selected as regions of interest(ROIs),with four from the dorsal ACC: S2(BA24)(x=±5,y=2,z=46,r=3.5mm),I3(BA24)(x=±5,y=10,z=33,r=3.5mm),and four from the pregenual ACC: I7(BA24)(x=±5,y=38,z=6,r=3.5mm)、S6(BA9)(x=±5,y=41,z=21,r=3.5mm).The ACC functional connectivity under resting state were compared between FD patients and HC,as well as the association with FD symptoms,so as to certify the significance of ACC in the central pathological changes of FD.2.The randomized contral clinical trial was taken and FD patients were included and computered-randomized into two groups: the acupuncture with deqi group and acupuncutre without deqi group.Each group have received 20 acupuncture treatments with once every day and 5 times a week,with two days interval.The Nepean Dyspepsia Symptom Index(NDSI)and Nepean Dyspepsia Life Quality Index(NDLQI)were used as clinical measurements.The Visual Analogue Scale(VAS)was selected to estimate the real needle sensation of subjects after each acupuncture treatment.After 20 acupuncture treatments,FD patients were re-divided into two groups: the real deqi group and the real without deqi group.The two groups were compared both within group and between groups at two timespoints(before the treatment and after the treatment),so as to observe the influence of deqi on the acupuncture therapeutic effect.3.The imaging data of two groups: the real deqi group(n=16)and the real without deqi group(n=16)were collected,and same ROIs-based FC were analyzed the same as the first part.The ACC rsFC of the two groups before and after acupuncture treatment will be compared,and be overlapped with the abnormality of ACC rsFC of FD patients in the first part,as well as the association with clinical data,so as to explore the influence of acupuncture with deqi on the changes of the clinical symptoms related ACC rsFC in FD patients.Results:1.The abnormal ACC rsFC changes and their association with clinical data in FD patients(1)The abnormal ACC rsFC changes in FDCompared with HS,the increased ACC rsFC regions of FD patients were: bilateral posterior cingulate cortex(PCC),precuneus,superior parietal lobe(SPL),insular cortex(INS),superior occipital gyrus;left amygdala/hippocampus,temporal pole BA38(TP),middle occipital gyrusBA37,occipital lobeBA19;right medial prefrontal cortex(mPFC),putamen and supramarginal gyrus(SMG).Compared with HS,the decreased ACC rsFC regions of FD patients were: bilateral postcentral gyrus(PoG),precentral gyrus(PrG),supplementary motor cortex(SMC),entorhinal cortex,cerebellum;left occipital lobe and middle frontal cortex.(2)The correlation of NDSI and NDLQI with the ACC rsFC in FD patientsIn the ACC ROI of S2,there was positive correlation between ACC rsFC regions and NDSI,and these regions included: right temporalparietal junction(TPJ),superior temporal gyrus(STG),PrG and PoG;there was negative correlation between ACC rsFC regions and NDSI,and these regions included: right INS and pallidum.In the ACC ROI of I7,there was negative correlation between ACC rsFC regions and NDSI,and these regions were: bilateral precuneus,SPL,PrG and PoG;there was negative correlation between ACC rsFC regions and NDLQI,and these regions included: right middle temporal gyrus(MTG),inferior temporal gyrus,SMG,STG,angular gyrus;left dorsal lateral prefrontal cortex(dlPFC),amygdala,posterior INS and hippocampus.2.The influence of deqi on the therapeutic effect of acupuncture treating for FD(1)After the acupuncture treatment,the baseline between acupuncture with deqi group and acupuncture withoutdeqi group is comparative.(2)The NDI assessment showed that: the NDSI of the both two groups decreased significantly compared with pretreatment(p<0.05),while the NDIOL both increased(p<0.05).However,in the acupuncture with deqi group,the improvement of NDSI and NDIOL after treatment had clinical significance than before acupuncture,with MCID≧10;and the improvement of NDSI is significant different from that in the acupuncture without deqi group(p<0.05).3.The influence of acupuncture with deqi on the ACC rsFC of FD patients(1)The influence of acupuncture with deqi vs.without deqi on the ACC rsFC of FD patientsAfter acupuncture with deqi,the increased ACC rsFC brain regions included: bilateral PrG,SMC;left PoG and SMG.And the decreased ACC rsFC brain regions included: bilateral hippocampus/parahippocampus,PCC,SPL,angular gyrus;right precuneus,putamen/INS and middle occipital gyrus.After acupuncture without deqi,the increased ACC rsFC brain regions included: bilateral inferior occipital gyrus and right cerebellum.Compared with the group of acupuncture without deqi,the acupuncture with deqi group had increased ACC rsFC with bilateral SMC,which had significant differences with that in the acupuncture without deqi group.(2)The influence of acupuncture with deqi on the abnormality of the ACC rsFC of FD patientsAcupuncture with deqi can decrease the acitivity of abnormal-increasing regions including: left hippocampus,parahippocampus,temporal lobe;right posterior INS,putamen and middle occipital gyrus of FD patients;and increase the abnormal-decreasing regions including: left SMC,PoG,SMG and PrG of the FD patients.(3)Correlation between the ACC rsFC changes influenced by acupuncture with deqi and clinical data in FD patientsCompared with HS,FD patients had abnormalities of ACC rsFC with left SMC,right SPL and INS/putamen.After acupuncture with deqi treatment,the ACC rsFC with these three regions in FD patients changed,and the change had positive correlation with clinical data.Conclusion:1.Compared with HC,there exist significant abnormality of ACC rsFC with DMN regions in FD patients;2.Compared with acupuncture without deqi,acupuncture with deqi can have central influence on ACC rsFC with DMN regions,and the mediation of ACC-DMN may be the underlying partial mechanism of the influence of deqi on acupuncture treating for FD.