| ObjectiveOn the basis of comparing the difference in clinical efficacy of acupuncture at acupoints on the lung meridian and acupoints on the heart meridian in patients with chronic persistent asthma,functional Magnetic Resonance Imaging(f MRI)was used to partially explore the central mechanism of acupuncture efficacy,so as to verify the relative specificity of lung-lung meridian and provide scientific evidence for the "meridian-viscera" connection theory.Methods1.This is a randomized and controlled trial.90 patients with chronic persistent asthma who matched the inclusion criteria were randomly divided into lung meridian acupoints selection group and heart meridian acupoints selection group,with 45 patients in each group.Acupuncture was performed three times per week,three times was a course of treatment with two days of rest between treatment course.The treatment consisted of four continuous courses,a total of 12 times.Asthma Control Test(ACT)and Asthma Quality of Life Questionnaire(AQLQ)were used to evaluate the clinical symptom control and patients’ quality of life before and after treatment.The Zung Self-rating Anxiety Scale(SAS)and The Zung self-rating Depression Scale(SDS)were used to evaluate the patients’ emotion state.2.45 patients were randomly enrolled from 90 patients with chronic persistent asthma.Regional Homogeneity(Re Ho)analysis was used to compare the cerebral activity change of the patients with chronic persistent asthma before and after acupuncture,so as to identify the key brain area associated with asthma.Functional Connectivity(FC)analysis was used to compare the cerebral activity of patients with chronic persistent asthma elicited by acupuncturing at acupoints on different meridian,and partially explore the central mechanism of acupuncturing at acupoints on the involved meridian in the treatment of patients with chronic persistent asthma based on the "meridian-viscera" connection theory.Results1.90 patients with chronic persistent asthma were included in this study,and 86 patients completed the trial,with 43 patients in the lung meridian acupoints selection group and 43 patients in the heart-meridian acupoints selection group.2.Evaluation of clinical efficacy of puncturing at the acupoints on the involved meridian in the treatment of chronic persistent asthma(1)The baseline analysis showed that there was no statistical differences in the demographic characteristics and disease-related data of chronic persistent asthma between the two groups(p >0.05),and the groups were balanced and comparable.(2)Within-group comparison showed that ACT scores and AQLQ scores were significantly increased after treatment compared with before treatment,SAS scores and SDS scores were significantly decreased after treatment,and there were a statistically difference between before and after treatment(p < 0.05).(3)Between-group comparison showed that there was statistically difference in the improvement value of ACT scores between the two groups before and after treatment(p <0.05).There were no significant difference in AQLQ scores,SAS scores and SDS scores between two groups before and after treatment(p > 0.05).3.The influence of different acupuncture methods on the cerebral functional activities in patients with chronic persistent asthma(1)The influence of meridian acupoint selection acupuncture on brain functional activities in patients with chronic persistent asthma.Re Ho analysis was used to observe the changes of brain functional activities in 42 patients with chronic persistent asthma before and after acupuncture treatment,and to potentially explore the changes of brain regions in chronic persistent asthma before and after acupuncture treatment.The results showed that Re Ho of left insula,left anterior cingulate gyrus,right cerebellum,left putamen and left middle temporal gyrus were significantly increased and Re Ho of right superior frontal gyrus was significantly decreased in the two groups of chronic persistent asthma patients after acupuncture.The time series values of the above brain regions were extracted,and the correlation analysis was conducted with the improvement values of ACT score and AQLQ score of asthma patients before and after treatment with age,gender,BMI and course of disease as covariables.The results showed that the changes of Re Ho in the left insula were positively correlated with the improvement of ACT scores(r =0.353,p =0.030).(2)The influence of acupuncture on key brain regions related to chronic persistent asthma.The left insula,which is closely related to chronic persistent asthma,was used as the seeds for FC analysis.The results showed that after acupuncture in the lung meridian acupoint selection group,the FC changes in left insula and left anterior cingulate gyrus and right angular gyrus increased,while the FC changes in left insula and right superior marginal gyrus,left superior frontal gyrus,left precuneus and right inferior occipital gyrus decreased.After acupuncture treatment,FC changes in left insula,left anterior central gyrus,right superior frontal gyrus and left middle cingulate gyrus increased in patients with asthma.(3)Correlation analysis of FC of key brain regions related to disease and disease in patients with chronic persistent asthma by acupuncture with different cycle points.The time series values of functional connectivity of key brain areas related to disease were extracted from lung meridian acupoint selection group and heart meridian acupoint selection group respectively after acupuncture treatment,and the correlation analysis was conducted with age,gender,BMI and course of disease as covariables,and the improvement values of ACT scores and AQLQ scores before and after treatment in the two groups of asthma patients.The results showed that FC change value of left anterior cingulate gyrus was negatively correlated with AQLQ scores improvement after treatment in patients with chronic persistent asthma(r =-0.521,p=0.032).The left middle cingulate gyrus was negatively correlated with AQLQ score improvement(r =-0.500,p=0.041).Conclusion1.Both lung meridian acupoint selection acupuncture and heart meridian acupoint selection acupuncture can improve the quality of life and relieve clinical symptoms of chronic persistent asthma patients;Compared with acupoint selection by heart meridian acupuncture,acupoint selection by lung meridian acupuncture has more advantages in improving clinical symptoms of patients.2.Insula is an important brain region related to chronic persistent asthma.Both lung meridian acupoint selection and heart meridian acupoint selection can regulate the functional connection of insula,but their regulation modes are relatively different. |
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