| Objective:Stroke is a common disease that seriously affects the health of human.Shou Zu Shi Er acupuncture has a good clinical effect on stroke,but its curative mechanism is not clear.This study was based on resting state functional magnetic resonance(fMRI)technology,voxel-based degree centrality analysis and graph theory analysis were used to compare the topological parameters of brain functional network between stroke hemiplegia patients and healthy subjects.A course of Shou Zu Shi Er acupuncture was used as intervention in the experimental group,at the same time,non-meridian and non-acupoint acupuncture was used in control group.Combined with clinical scale evaluation of neurology and neuroimaging analysis,the regulation effect of Shou Zu Shi Er acupuncture on the brain functional network of stroke patients was explained from a macro perspective,and the specificity of acupuncture points was initially explored from the perspective of brain effects.Methods:Study 1:Forty-five stroke patients with hemiplegia were finally included,,whose infarction course was less than 1.5 months and the focus was mainly located in the unilateral motor pathway.At the same time,30 healthy subjects were enrolled,matching the gender and age of the patients.All subjects underwent fMRI scanning.The fMRI data were analyzed and compared by voxel-based degree centrality analysis method and graph theory analysis of complex network.Study 2:As a randomized controlled trial,45 stroke patients with hemiplegia were finally included,,whose infarction course was less than 1.5 months and the focus was mainly located in the unilateral motor pathway.The patients were randomly divided into 30 cases in the Shou Zu Shi Er acupuncture group and 15 cases in the non-meridian and non-acupoint group according to the admission order by envelope method.The Shou Zu Shi Er acupuncture group received conventional medical treatment and a course of Shou Zu Shi Er acupuncture;the nonmeridian and non-acupoint group received conventional medical treatment and sham acupuncture.Patients of both groups totally received 10 times acupuncture in 2 weeks.The clinical scale of neurology was evaluated for patients,including:The National Institutes of Health Stroke Scale(NIHSS)and Fugl-Meyer assessment scale(FMA)were used to assess overall neurological deficits and the motor function in stroke patients.The Hamilton Depression Scale(HAMD)was used to assess emotional state,and the Brief Mental State Scale(MMSE)was used to assess cognitive status.All stroke patients were assessed on the above clinical scales on the day of enrollment and after the acupuncture intervention,and fMRI scan was completed at the corresponding time points before and after the acupuncture course.The functional magnetic resonance data before and after acupuncture were analyzed and compared by degree centrality analysis method and graph theory analysis,so as to explore the central mechanism of action of Shou Zu Shi Er acupuncture in regulating hemiplegia after stroke and the characteristics of brain effects specific to acupuncture points.Results:Study 11.Voxel-based degree centrality analysisVoxel-based degree centrality analysis found that,compared with healthy subjects,the brain areas with increased degree centrality(DC)in stroke hemiplegia patients were mainly the right postcentral gyrus,right precentral gyrus,right superior parietal lobule,left lingual gyrus,left hippocampus and parahippocampal gyrus,and the brain areas with decreased DC was the left posterior cingulate gyrus.2.Small-world global index and node index of brain functional network based on graph theory analysisThe graph theory analysis showed that the brain functional network of stroke patients belonged to small-world network,and there were significant changes in small-world index,which were shown as clustering coefficient,characteristic path length and standardized feature path length decreased significantly,small-worldness and standardized clustering coefficient increased significantly,local network efficiency decreased,and global network efficiency increased.In terms of nodal index of the network,compared with healthy subjects,nodal degree values of sixteen brain regions in stroke patients with hemiplegia increased significantly,including bilateral ventromedial prefrontal lobe,right dorsal frontal lobe,right superior temporal gyrus,bilateral insula,et al.The nodal degree of ten brain regions decreased significantly,including right occipital lobe,bilateral temporal lobe,bilateral anterior central gyrus,left precuneus,left temporo-parietal junction,et al.In stroke patients with hemiplegia,nodal betweenness centrality of twelve brain regions increased significantly,including right ventrolateral prefrontal cortex,bilateral ventromedial prefrontal cortex,bilateral occipital lobe,right superior temporal gyrus,bilateral middle insula,right ventromedial prefrontal lobe,while five brain regions’ nodal betweenness centrality decreased significantly,which were right parietal lobe,left occipital lobe,left angular gyrus,left precuneus,and left temporo-parietal junction.In patients,nodal efficiency of fourty one brain regions decreased significantly,including right middle insula,left ventromedial prefrontal cortex,bilateral temporal lobe,left basal ganglia,bilateral anterior central gyrus,et al.The nodal efficiency of four brain regions,including right dorsal frontal cortex,right ventral frontal cortex,left posterior cingulate gyrus and left occipital lobe,increased significantly.Study 2Clinical effect of Shou Zu Shi Er acupuncture group and non-meridian and non-acupoint groupNIHSS score,FMA score and HAMD score were significantly improved after treatment in the Shou Zu Shi Er acupuncture group.FMA score was significantly improved in the nonmeridian and non-acupoint group,while NIHSS score and HAMD score were not significantly improved.After treatment,the improvement of NIHSS score,FMA score and HAMD score in the Shou Zu Shi Er acupuncture group was better than that in the non-meridian and nonacupoint group,but the differences between groups were not significant.2.Degree centrality analysis based on voxelIn the Shou Zu Shi Er acupuncture group,some brain regions’ DC decreased after acupuncture compared with that before acupuncture,including right rolandic operculum,right precentral gyrus,right superior temporal gyrus and right postcentral gyrus.In the non-meridian and non-acupoint group,the DC decreased after acupuncture compared with that before acupuncture,including bilateral supplemental motor area,left paracentral lobule,right middle cingulate gyrus and paracingulate gyrus.3.Small-world global index and nodal index of brain functional network based on graph theory analysisIn terms of global index of brain functional network,the area under the curve of them such as clustering coefficient,characteristic path length,small-worldness,standardized clustering coefficient,standardized characteristic path length,global network efficiency and local network efficiency did not change significantly after treatment in the Shou Zu Shi Er acupuncture group.After treatment,the area under the curve of the above global indicators did not change significantly in the non-meridian and non-acupoint group.In terms of nodal index analyzed by graph theory,in the Shou Zu Shi Er acupuncture group,four brain regions showed significant decrease in nodal degree after treatment(right ventromedial prefrontal cortex,right dorsalfrontal cortex,left interparietal sulci,right posterior occipital lobe),and nodal degree increased in six brain regions(left temporal lobe,right occipital lobe,right precuneus lobe,left inferior temporal gyrus,right apex lobule,left posterior parietal lobe),The betweenness centrality increased significantly in left posterior occipital lobe,and decreased in five brain regions(medial prefrontal cortex,right ventrolateral prefrontal lobe,right occipital lobe,left ventromedial prefrontal lobe,left temporal lobe).There were four brain regions with significantly enhanced nodal efficiency(right parietal lobule,left ventromedial prefrontal cortex,left temporal lobe,right middle insula).In the non-acupoint group,the nodal degree of three brain regions(left occipital lobe,medial prefrontal cortex and medial frontal cortex)decreased,and only degree of right dorsal anterior cingulate cortex increased.The betweenness centrality increased in two brain regions(left dorsal frontal cortex and left occipital lobe)and decreased in right dorsal anterior cingulate cortex.Node efficiency increased in two brain regions(left angular gyrus and right ventromedial prefrontal cortex)and decreased in three brain regions(right frontal lobe,right fusiform gyrus,right dorsal anterior cingulate cortex).Conclusion:1.In stroke patients with hemiplegic,the topological structure of brain functional network is disordered and tends to shift to random network.Extensive node characteristics of the whole brain are changed,mainly for the changes of node degree and betweenness centrality in sensorimotor network,executive control network,default network,etc.,and the nodal efficiency of the whole brain functional network is mainly decreased.2.Shou Zu Shi Er acupuncture can effectively improve the motor function and nerve defects of the stroke patients with hemiplegia,promote the DC value of the patients to return to a relatively normal state,and help to adjust the topological index of brain nodes in the sensorimotor network,executive control network,default network,etc.,and improve the node efficiency.3.Compared with the non-meridian and non-acupoint group,the Shou Zu Shi Er acupuncture can specifically adjust the abnormal brain region of DC in stroke patients and hemiplegia,adjust the topological index of more brain region,and improve the nodal efficiency. |
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