| Objective: Based on the hypothesis of "brain-bowel interaction",and discussed the effects on fMRI and BGP of HSDPI with abdominal massage.It was analyzed the mechanism of abdominal massage in treating insomnia.Methods:1 Observation on the effect of abdominal massage on HSDPIThis study took HSDPI as the object of study and carried out small sample size clinical observation.To observe the clinical effect of abdominal massage on HSDPI.A total of 75 patients were admitted,10 were shed,3 were removed,and 2 were terminated.Finally,60 cases were enrolled.According to the numerical random method,enter respectively massage group,drug group,massage plus drug group.Abdominal massage,drug therapy and abdominal massage plus drug therapy were respectively performed according to different groups.PSQI,AIS and TPF were used as the evaluation criteria,It statistical comparied the data that was the PI s‘ isincluded,the outgoing,the follow-up The measurement data were analyzed by one-way anova,and the counting data were tested by chi-square test.2 Effect of abdominal massage on fMRI of HSDPIIn this study,20 HSDPI subjects and 20 healthy volunteers were recruited.The trial was divided into a healthy group（volunteers）,a patient group（before treatment）,and a treatment group（after treatment）,each with 20 patients.The patient group was compared with the healthy group and the treatment group.RsfMRI was used for data collection,and Reho,ratio fAlFF and seed correlation analysis were used for analysis.On Metlab,Dpabi software was used for image preprocessing,SPM software was used for image statistics,and Xjview software was used for image analysis.3 Effect of abdominal massage on hypothalamic MRS of HSDPIThis study recruited subjects and grouped them in the same way as the RsfMRI study.After the completion of RsfMRI,the patient underwent proton wave detection directly,and the target area was the hypothalamus.The displacement values of n-acetyl aspartic acid（NAA）,creatine/additional creatine（Cr/pCr）,choline complex（Cho）,inositol（Ins1）were determined and measured.Semi-quantitative analysis method was used to compare the relative value of each substance NAA/Cr.Cho/Cr;Ins1 / Cr;PCr /Cr,one-way anova was used for measurement data,and chi-square test was used for counting data.4 Effect of abdominal massage on brain gut peptide of HSDPIThis study recruited subjects and grouped them in the same way as the RsfMRI study,and carried out a small clinical sample size BGP study.Enzyme-linked immunoassay was used to observe the changes of serum SP,ENK,Ghrelin,NPY and GFAP in the insomnia group,the healthy group and the treatment group,with the same statistical methods.5 Study on abdominal massage on 1H NMR serum metabolomics of HSDPIIn this study,subjects were recruited and grouped in the same way as the RsfMRI study to carry out a small clinical sample size study on the metabolomics of serum h NMR spectrum.Common metabolites,differential metabolites,potential metabolic biomarkers and metabolic pathways among each group were analyzed.Superconducting NMR spectrometer was used for data collection,and MestReNova 12.0.3-21384 software was used for original data processing.SIMCA-P14.0 software was used to complete principal component analysis and orthogonal partial least squares analysis in multivariate statistical analysis.Using MetabaAnlyst4.0 software with the help of online metabolism（http://www.metaboanalyst.ca）to complete the metabolic pathways and data analysis.Results:1 Observation on the effect of abdominal massage on HSDPIThere was no difference in age,gender,anxiety scale standard score,depression scale standard score,PSQI,AIS and TPF among patients in the massage group,the positive drug group and the massage plus positive drug group at baseline,which met the requirements of clinical research.After the treatment course,there was no difference in PSQI,AIS and TPF sleep parameters（total sleep time,deep sleep time,total bed-leaving time,and comprehensive sleep score）between groups（P>,0.05）.The differences between the two groups were obvious by comparison of enrollment,exit and follow-up.The results showed that abdominal massage and drug therapy had a good effect on HSDPI treatment,especially in promoting deep sleep and improving wakefulness.The curative effect of the patients was definite during the follow-up,but the medication status of the patients after leaving the group was not excluded.2 Effect of abdominal massage on fMRI of HSDPIThe fMRI study was conducted on the premise of the clinical effect of abdominal massage on HSDPI.The patient’s Reho of brain regions was more decreased than healthy group in 19 regions,including InsulaL,HeschlL,PutamenL,TemporalMidR,et al.The patient’s Reho was more elevated than healthy group in the TemporalPoleSupL,TemporalPoleMidL,FrontalInfOrbL.The amplitude of neurons decreased the oxygen consumption of neurons in InsulaR,PutamenR,CingulateMidR,ACCsupR,CaudateR,TemporalMidR,Occipit alMidR,ect.9 areas.Oxygen consumption increased in 4 brain regions: AngularR 、PrecuneusR,PostcentralR,PrecuneusL.The functional connections of the suprachiasmatic nucleus（SCN）of the hypothalamus with the Cerebelum45L,Vermis45,CingulatePostL,ParaHippocampalL,ParaHippocampalR,Cerebelum6R,TemporalInfR were weakened.After massage treatment,the neurological function of the patients was improved in 13 brain regions,including TemporalMidL,TemporalSupL,TemporalSupL,SupraMarginalL,ParacentralLobuleR,PrecuneusR,PostcentralR,PrecuneusR ect.al.There was decrease in the local consistency of RectusR,RectusL,FrontalMedOrbR,CaudateR,CingulateMidR,ACCsupR,RectusR,FrontalMedOrbR.The oxygen consumption of neurons increased in ParaHippocampalL,OlfactoryL,ParaHippocampalL,Cerebelum45L,HippocampusL,PostcentralL,SupraMarginalL,PrecentralL,CuneusL,OccipitalSupLect.Oxygen consumption decreased in 7 brain regions including ParacentralLobuleR,PrecuneusR,PostcentralR,CuneusR,OccipitalSupR,PrecuneusR,ect..In the analysis of functional connection with SCN,there was a tendency to improve the functional connection with the parhippocampus,but there was no statistical difference.3 Effect of abdominal massage on hypothalamic MRS of HSDPIThe results showed that the concentration of NAA and Cho in the hypothalamus of HSDPI was decreased compared with that in the healthy group,with statistical difference（P<0.05）,but no difference between Ins1 and pCr.After massage treatment,NAA increased between the patient group and the treatment group with statistical difference（P<0.05）,and Cho increased with no statistical difference（P> 0.05）.There were no changes in Ins1 and pCr.The results indicated that the activity of neurons in HSDPI hypothalamus decreased,and the NAA content was increased after abdominal massage treatment,which indirectly indicated that the activity of neurons in hypothalamus was increased and the function of hypothalamus was improved,which was positively correlated with the improvement of sleep status of insomnia patients.Cho showed an increasing trend after treatment,but there was no statistical difference.It may be related to the improvement of patients’ insomnia,so it can be used as a direction for future research.4 Effect of abdominal massage on brain gut peptide of HSDPIThe results showed that compared with the healthy group,the patient group and the treatment group,the peripheral blood serum levels of SP,ENK and Ghenlin increased in the patient group,but decreased after massage,and did not return to the normal state（P<0.05）.The content of NPY in the patient group was lower than that in the healthy group,and the content of peripheral blood was higher after treatment,but it did not return to normal.This is consistent with the conclusion of clinical treatment.Compared with the healthy group,the peripheral GFAP content of the patient group increased,and the GFAP decreased after massage treatment,indicating that massage inhibited the peripheral blood GFAP content and played a role in maintaining the brain homeostasis of the patients.5 Study on abdominal massage on 1H NMR serum metabolomics of HSDPIThrough metabonomics research,we discovered that the including histidine,glutamic acid,glycine,serine,asparagine 40 kinds of metabolites,such as filtering through the analysis of the differences between the histidine,glycine,serine,glutamic acid,asparagine and other 24 kinds of differences metabolites,histidine was determined by the comparison between groups finally,asparagine,creatine,glycerin,taurine,glycine,serine,is a research value difference of 10 kinds of metabolites,and completed the differences in metabolic pathway diagram,determine the glycine pathway is of great significance in promoting the metabolic pathways of sleep.It has been proved that abdominal massage can effectively regulate sleep-related metabolites and play an important role in regulating lipid metabolism.Conclusion:In this study,from the perspective of "brain-intestine interaction" and on the premise of verifying the clinical effect of abdominal massage in the treatment of primary insomnia with heart and spleen deficiency,the following conclusions were obtained from the analysis of brain functional imaging,brain proton spectrum,brain intestinal peptide,and serum metabolomics:1.Abdominal massage can improve the sleep quality of patients with primary deficiency of the heart and spleen,especially can prolong the patients’ deep sleep time and reduce the probability of awakening.2.Through fMRI detection,it was confirmed that HSDPI treated with abdominal massage increased the activity of brain areas negatively correlated with the number of awakenations,and decreased the function of brain areas positively correlated with the severity of sleep.3.Through MRS test,it was indirectly confirmed that abdominal massage could improve the activity of hypothalamic neurons and improve the insomnia state of patients with insomnia.NAA/Cr was negatively correlated with PSQI score.4.Through the detection of brain-gut peptide,it was verified that abdominal massage could improve the secretion disorder of BGP in peripheral blood serum,in which ENK,SP and PSQI had linear positive regression relationship.5.Through metabolomic analysis,this study found 40 kinds of common metabolites and 24 kinds of differential metabolites（10 with research value）in healthy,insomnia and massage patients after treatment,and identified 6 differential metabolic pathways,and screened glycine pathway to be of great significance in abdominal massage sleep-promoting metabolic pathways.6.In addition,it has been confirmed that abdominal massage can improve the function of brain areas related to learning and memory and regulate the brain intestinal peptides related to learning and memory.The regulation effect of abdominal massage on lipid metabolism pathway in HSDPI patients was verified.In a word,the mechanism of action of abdominal massage on HSDPI is mainly to improve the functional activity of sleep-related brain areas,regulate the activity of clock center,improve the disorder of serum brain-intestinal peptide,stimulate the metabolic pathway related to sleep induction,and finally play a therapeutic role.Its role in improving patients’ overarousal and promoting deep sleep is clear.It provides experimental basis for abdominal massage to improve the amnesia symptoms of patients and plays an experimental verification in regulating the disorder of lipid metabolism. |
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