Resting State Functional Magnetic Resonance Imaging Study On Post-stroke Insomnia Patients With Yin-deficiency And Fire-hyperactivity

ObjectiveStroke is the first cause of death in our country,and it has always been one of the main causes of long-term disability.Post-stroke insomnia(PSI)is one of the most common sequelae of post-stroke patients,and up to 70% of acute stroke patients often have sleep disorders.The impairment of cognitive function and memory function of PSI patients are often more serious than those of patients without insomnia after stroke,which not only affects the recovery of nervous system function,but also aggravates existing diseases such as hypertension and diabetes,leading to cardiovascular and cerebrovascular diseases The increase in mortality affects the patient’s recovery process and reduces the patient’s quality of life.Therefore,it is necessary to study the neuropathological mechanism of PSI.Traditional Chinese medicine believes that the main pathogenesis of stroke is liver and kidney yin deficiency and yang hyperactivity.Only when yang qi is contained in yin can a person fall asleep,while yin deficiency and fire hyperactivity can cause yang cannot be stored in yin,it also lead to insomnia,yin deficiency and fire hyperactivity are also an important pathogenesis of insomnia.A large number of studies have used Resting-state Functional Magnetic Resonance Imaging(rs-fMRI)to reveal the internal functional organization of the brains of healthy subjects and identify changes in internal functional connections under disease.Regional homogeneity(ReHo)and amplitude of low frequency fluctuations(ALFF)are the main measurement indicators of functional activity in the resting state,which have high reliability.Existing literature studies have shown that there are abnormal changes in the activities of multiple brain areas in patients with insomnia,mainly including emotion-related brain areas,cerebellum,and some brain areas related to default-mode network(DMN).In recent years,studies on resting brain function networks of primary insomnia have shown that the main neural networks involved in patients with primary insomnia include the DMN,the cerebellar network and the salient network.The severity of insomnia is closely related to changes in DMN activities and the degree of network abnormalities.This study intends to perform rs-fMRI study on PSI patients with Yin-deficiency and fire-hyperactivity.Use ReHo,ALFF and fractional amplitude of low frequency fluctuation(fALFF)analysis methods to observe the abnormal function of the local brain area of PSI patients with Yin-deficiency and fire-hyperactivity;use degree centrality(DC)and seed-based functional connection to analyze abnormal changes in the brain network of PSI patients with Yin-deficiency and fire-hyperactivity.And combined with Pittsburgh sleep quality index(PSQI)scores to analyze the possible mechanism of PSI,it also provides an objective evaluation index for the follow-up study of acupuncture treatment of PSI patients with Yin-deficiency and fire-hyperactivity.MethodsA total of 27 patients with post-stroke insomnia were collected from May2019 to August 2021,and 27 healthy people during the same period were enrolled for the control group.Select appropriate inclusion and exclusion criteria to screen patients and control group people.All enrollees were informed in detail of the purpose,methods and precautions of the experiment before the experiment,and signed an informed consent form to agree to participate in the experiment.PSQI was used to evaluate the sleep quality of all PSI patients with Yin-deficiency and fire-hyperactivity.All subjects used German Siemens Magnetom Prisma 3.0T magnetic resonance imaging scanner to collect brain functional and structural images at resting-state,and 64-channel cranial coils were used to receive nuclear magnetic resonance signals.Before data collection,routine whole-brain axial T1 WI,T2WI and FLAIR sequence scans were performed,and then 3D-T1 W structure images and resting state BOLD-fMRI data were collected.The collected fMRI resting state data preprocessing is based on the Matlab R2016 b platform,using Data Processing & Analysis for(Resting-State)Brain Imaging(DPABI)V 5.0 software package(DPABI,http://rfmri.org/DPABI).The preprocessing process includes data format conversion,removing the images at the first 10 time points,eliminating the steps of time correction,head movement correction,spatial standardization,Gaussian smoothing,three-dimensional translation and rotation head movement data obtained by head movement correction,and taking this as a covariate to reduce the impact of head movement,white matter and cerebrospinal fluid signals on the results,Finally,linear drift and low-frequency filtering are removed.Remove the respondent who does not meet the data standard in the head movement correction.The analysis of ReHo,ALFF and fALFF all used DPARSF(V5.2)in DPABI software for data processing.The analysis step for ReHo is to calculate the Kendall’s coefficient concordance(KCC)of a given voxel time series and the KCC between its nearest 26 adjacent voxels,and divide the KCC between each voxel by the entire brain The average KCC to get the normalization of the ReHo graph.ALFF is to calculate the square root of the power spectrum between 0.01 and 0.08 Hz and use it as ALFF.The ALFF of each voxel is divided by the global average ALFF value to obtain the standardized ALFF for subsequent statistical analysis.fALFF is the ratio of the power obtained by dividing our low frequency band by the power of the full frequency band.DC and the whole brain network connection based on the DC result as the area of interest are also completed on the DPABI software.Select the statistical analysis software on DPABI,use the t-test of two samples for the statistical analysis.Respectively select the analysis result files of the two groups obtained by the above method,and select the corresponding two groups of gender,age and head movement parameters as statistical covariates.Statistical analysis the differences in functional brain areas and functional connections between the two groups,and the results are obtained.During the Statistical analysis process,GRF multiple comparison correction was used.The voxel level P value was 0.001 and the cluster level P value was 0.05.A two-tailed test was used to obtain statistically significant brain regions between the two groups.SPSS25.0 statistical analysis software was used to analyze whether there were statistical differences between the Yin-deficiency and fire-hyperactivity PSI patients group and the normal control group in terms of gender,age,and education level.Results1.Comparing Yin-deficiency and fire-hyperactivity PSI patients and normal control group,there is no significant difference in age,gender,and years of education.2.ReHo analysis results: Comparing the ReHo of Yin-deficiency and fire-hyperactivity PSI patients and the normal control group,we found that ReHo of Yin-deficiency and fire-hyperactivity PSI patients was significantly reduced in multiple brain regions,including bilateral lingual gyrus,right cuneate lobe,right precentral gyrus and postcentral gyrus;Comparing with the control group,the ReHo of the Yin-deficiency and fire-hyperactivity PSI group increased significantly in the left supramarginal gyrus.3.ALFF and fALFF analysis results: Compared with the normal control group,the ALFF value of the bilateral lingual gyrus in the Yin-deficiency and fire-hyperactivity PSI group decreased;while the ALFF value of multiple brain regions increased,mainly including bilateral middle temporal gyrus,right inferior temporal gyrus,right inferior frontal gyrus(orbital and triangular),right marginal lobe,right precuneus lobe,left posterior cingulate gyrus,left middle occipital gyrus.Compared with the control group,the fALFF value of Yin-deficiency and fire-hyperactivity PSI patients decreased in multiple brain regions,including the left and right lingual gyrus,the left and right inferior occipital gyrus,and the left and right cuneiform lobes.No brain areas with elevated fALFF valueswere found.4.Through DC analysis,we found that compared with the normal control group,the Yin-deficiency and fire-hyperactivity PSI patient group had significantly lower DC valuesin the right insula,left medial cingulate gyrus,right precentral gyrus,and right postcentral gyrus;while in the bilateral angular gyrus the DC value is significantly increased.5.ROI-based FC analysis results: We used the DC results as the ROI,and analyzed the differences in the FC connections between these ROI brain regions and the whole brain between the Yin deficiency and fire-hyperactivity PSI group and the normal control group.Compared with the control group,the FC between the right insula,the left medial cingulate gyrus,the right precentral gyrus and multiple brain regions in the Yin-deficiency and fire-hyperactivity PSI patient group showed a significant decrease,there is no significant increase FC was found.Respectively,the brain areas with reduced FC from the right insula include the right superior temporal gyrus,the left anterior cingulate gyrus,the right angular gyrus,the right parahippocampal gyrus,the left angular gyrus,the left parahippocampal gyrus,the bilateral medial cingulate gyrus,and the right precentral gyrus.The brain areas with decreased FC from the left medial cingulate gyrus include the right superior temporal gyrus,right insula,right central anterior gyrus,and supplementary motor cortex area.And the brain areas with decreased FC from the right precentral gyrus include the right insula,the bilateral medial cingulate gyrus.The analysis ROI-based on the left and right angular gyrus found that there were no significant different FC brain regions between the two groups.Conclusion1.Yin-deficiency and fire-hyperactivity PSI patients have abnormal local functional activities in multiple brain regions,mainly including visual processing-related cortex,sensorimotor cortex and some DMN brain regions.2.Yin-deficiency and fire-hyperactivity PSI patients are similar to patients with primary insomnia,both manifested as excessive awakening of the DMN network,which may be one of the mechanisms of Yin-deficiency and fire-hyperactivity PSI,and it can also lead to the decline of cognitive function and abnormal emotion regulation.3.The right insula is an important node of changes in the brain function of Yin-deficiency and fire-hyperactivity PSI patients.There are obvious abnormalities in the FC between the right insula and multiple brain areas,which further confirms the impairment of emotion regulation and cognitive function in Yin-deficiency and fire-hyperactivity PSI patients.4.The FC abnormal brain areas with right insula in Yin-deficiency and fire-hyperactivity PSI patients are relatively concentrated in the limbic system,which may indicate that their cognitive impairment and abnormal mood regulation are more serious than those of primary insomnia.5.The regional brain function and FC of the sensorimotor function area of the patients with Yin-deficiency and fire-hyperactivity PSI are abnormal.Whether it is related to the brain tissue damage of stroke needs further research to confirm.