| Background:Hemiplegia is the most common symptom caused by stroke disease.Acupuncture therapy has unique advantages in the rehabilitation of hemiplegia.Shou Zu Shi Er Zhen,created by the famous acupuncturist Leting Wang,is the representative needling prescription in China for the treatment of post-stroke patients with motor dysfunction.Neuroimaging evidence have demonstrated the facilitating effect of this acupuncture prescription in the regulation of brain functional reorganization and structural remodeling.However,previous studies only focused on static analysis in resting state networks and average changes in white matter,while the effects on dynamic brain function and white matter microstructure have rarely been mentioned,and the potential mechanisms of Shou Zu Shi Er Zhen still need to be further explored.Objective:1 Explore the dynamic functional network connectivity and white matter microstructure changes in the brain of patients with hemiplegia after stroke.2 Explore the mechanism of the Shou Zu Shi Er Zhen acupuncture on the changes of brain dynamic functional network connectivity and white matter fiber,and made a preliminary study on the specificity of meridian acupoint effect.Methods:1 We enrolled 53 stroke patients whose course of disease was less than 1.5 months and the infarction was located in the unilateral motor pathway.And we matched 35 healthy subjects with the same sex and age as the stroke patients.The functional and structural magnetic resonance imaging were performed for all subjects.The neuroimaging data were analyzed by dynamic functional network connectivity(dFNC)and automated fiber quantification(AFQ)methods to explore the dynamic functional network connectivity and white matter microstructure changes in the brain of patients with hemiplegia after stroke.2 According to the order of admission,the stroke patients were randomly divided into Shou Zu Shi Er Zhen acupuncture group(n=36)and non-meridian and non-acupoint group(n=17)at a ratio of 2:1.In the Shou Zu Shi Er Zhen group,the patients received routine medical treatment combined with Shou Zu Shi Er Zhen acupuncture,and in the non-meridian and non-acupoint group,the patients received routine medical treatment plus non-meridian and non-acupoint acupuncture.The course of treatment was 2 weeks for all patients.The clinical neurological levels of patients were evaluated by The National Institute of Health Stroke Scale(NIHSS),the Fugl-Meyer Assessment(FMA),the Mini-Mental State Examination and the Hamilton Depression Rating Scale.All patients need to be assessed by the above scales and complete functional and structural magnetic resonance scanning on the day of admission and after acupuncture treatment.The image data were processed by dFNC and AFQ analysis methods and correlation relationship between clinical scale and imaging indicators was analyzed.The purpose of this part is to explore the brain mechanism of Shou Zu Shi Er Zhen acupuncture in the treatment of stroke and the specific central response characteristics of meridian acupoints.Results:1 The characteristics of brain dynamic functional connectivity and white matter microstructure damage in stroke patients with hemiplegia1.1 Dynamic functional connectivity analysisCompared with healthy subj ects,temporal characteristics results showed that the fraction time and mean dwelling time decreased in statel while increased in state3(P<0.05).In the results of functional connectivity in state,compared with healthy subjects,the functional connectivity between left frontoparietal network,left frontoparietal network and right frontoparietal network,right frontoparietal network and dorsal attention network decreased while the functional connectivity between left frontoparietal network and dorsal attention network increased in state1.And in state3,the functional connectivity increased between the sensorimotor network and the left frontoparietal network,the sensorimotor network and the right frontoparietal network,and between the left frontoparietal network and the dorsal attention network.Besides,the functional connectivity decreased between the right frontoparietal network and the dorsal attention network in state3.The results of the above functional connectivity were statistically different between the two groups(P<0.05).1.2 Automated fiber quantificationanal analysisThe fractional anisotropy(FA)values of tract nodes showed that FA values decreased in almost all segments of corticospinal tract and thalamic radiation in stroke patients.The FA values decreased in partial nodes of some tracts,consisting of the contralateral thalamic radiation,cingulate cingulate,arcuate tract,callosum forceps major,callosum forceps minor,the bilateral superior longitudinal fasciculus(P<0.05).The mean FA values of tracts in stroke patients was significantly lower than that in healthy subjects.The tracts concludes bilateral thalamic radiation,ipsilateral corticospinal tract,contralateral cingulate cingulate,callosum forceps major,etc(P<0.05).2 The changes of brain dynamic functional connectivity and white matter microstructure in stroke patients with hemiplegia after Shou Zu Shi Er Zhen acupuncture treatment2.1 Analysis of clinical effect of Shou Zu Shi Er Zhen acupunctureThe scores of FMA,NIHSS,and HAMD in the Shou Zu Shi Er Zhen group were improved after treatment compared with those before treatment(P<0.05).The FMA and NIHSS score in non-meridian and non-acupoint group were improved after treatment compared with those before treatment(P<0.05).The improvement degree of FMA score in the Shou Zu Shi Er Zhen group is better than that of non-meridian and non-acupoint group.But there was no significant difference between the two groups(P>0.05).2.2 Dynamic functional connectivity analysisThe mean dwelling time of state3 in the Shou Zu Shi Er Zhen group after treatment was shorter than that before treatment(P<0.05).The mean dwelling time of state2 in non-acupoint group after treatment was higher than that before treatment(P<0.05).There was no statistical difference in the difference of dynamic indicators between the two groups before and after treatment(P>0.05).In the Shou Zu Shi Er Zhen group,the functional connectivity between the dorsal attention network and the default mode network increased after treatment than that before treatment in state1.The functional connectivity between the right frontoparietal network and the sensorimotor network decreased after treatment in state2.The functional connectivity decreased between the sensorimotor network and the left frontoparietal network and the right frontoparietal network in state3.In the non-meridian and non-acupoint group,the functional connectivity in the frontoparietal network in state2 were higher after treatment than those before treatment.There were statistical differences in the results of comparison in the two groups(P<0.05).The analysis of the difference of functional connectivity between the two groups before and after treatment showed that there was a significant difference between the right frontoparietal network and the dorsal attention network in state 1(P<0.05).Correlation analysis showed that the mean dwelling time was negatively correlated with FMA lower limb score in state 1.The difference of mean dwelling time between state1 and state3 was positively correlated with FMA lower limb score.The functional connectivity between the right frontoparietal network and sensorimotor network was positively correlated with the FMA total score in state3.In state1,the functional connectivity in the left frontoparietal network,between the dorsal attention network and the default mode network,between the dorsal attention network and the right frontoparietal network were positively correlated with the FMA lower limb score.The functional connectivity between the dorsal attention network and the right frontal parietal network was positively correlated with MMSE score.2.3 Automated fiber quantification analysisIn the Shou Zu Shi Er Zhen group,the FA values of partial nodes of the contralateral thalamic radiation,corticospinal tract,callosum forceps minor,callosum forceps major,etc were significantly higher after treatment than those before treatment.The FA values of partial nodes in the ipsilateral corticospinal tract and cingulum cingulate showed an decreasing trend after treatment than those before treatment.In the non-meridian and non-acupoint group,the FA values of partial nodes in callosum forceps major was higher than that before treatment.The FA values of partial nodes in most tracts showed an decreasing trend after treatment,including contralateral thalamus radiation,ipsilateral corticospinal tract,callosum forceps major,etc.There were significant differences in FA values of the above-mentioned fiber nodes in the two groups(P<0.05).The analysis of differences of FA values in partial nodes of ipsilateral corticospinal tract and callosum forceps minor showed significant differences between the two groups(P<0.05).There was no significant difference in the mean FA value of each tract in the Shou Zu Shi Er Zhen group before and after treatment(P>0.05).The mean FA value of the ipsilateral corticospinal tract in the non-meridian and non-acupoint group was lower after treatment than that before treatment(P<0.05).There was no significant difference in the average FA value in other fibers before and after treatment(P>0.05).The analysis of differences of mean FA values of callosum forceps minor and bilateral inferior longitudinal fasciculus showed significant differences between the two groups(P<0.05).Correlation analysis showed that the FA values of most nodes in the ipsilateral corticospinal tract were positively correlated with FMA score,a few nodes were negatively correlated with NIHSS score,a few nodes were positively correlated with MMSE score,and a small range of nodes were negatively correlated with HAMD score.The FA values of partial nodes of the ipsilateral thalamic radiation,the callosum forceps major and the ipsilateral superior longitudinal fasciculus were positively correlated with the MMSE score.Conclusions:1 The brain dynamic functional connectivity and white matter microstructure are damaged after stroke,which is characterized by changes in temporal features and network connectivity mode,as well as extensive damage of white matter fibers in the whole brain.2 Shou Zu Shi Er Zhen can improve the brain’s abnormal temporal characteristics after stroke,promote the balance of brain function separation and integration,and facilitate the segmental repair of some white matter fibers.3 Compared with non-meridian and non-acupoint stimulation,meridian acupoint stimulation may have more advantages in adjusting brain temporal characteristics and delaying some white matter fibers degeneration. |
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