Neuroimaging Study Of Electroacupuncture In Patients With Asthma

Objective: To observe the changes of brain spontaneous activity,functional connectivity and somatosensory abnormalities in patients with asthma,and to analyze the neuroimaging mechanism of the immediate and cumulative effects by electroacupuncture(EA).Materials and Methods: Part 1: 30 patients with asthma(PA)and 30 healthy controls(HCs)were recruited and matched each other in terms of gender,age,handedness and years of education.All subjects were scanned by fMRI and analyzed by amplitude of low-frequency fluctuations(ALFF),degree centrality(DC),functional connectivity(FC).The different spontaneous activity and functional connectivity between PA and HCs were compared.Part 2: All subjects were underwent EA stimulation at Dazhui(GV14),Fengmen(BL12)and Feishu(BL13).The visual analogue score(VAS)of EA was recorded and the second phase of fMRI scanning was performed immediately after EA.The different ALFF,DC and FC values before and after EA were compared and the correlations between VAS score and the ALFF,DC and FC values were analyzed.Part 3: 12 patients with asthma underwent EA stimulation at GV14,BL12,BL13 and 3 phases of rs-fMRI scanning.Phase 1: Preparation(before needle insertion);Phase 2: instantly after the first time of EA;Phase 3: after 6 times of EA stimulation.The rs-fMRI data were processed using DPABI and SPSS 25.Results: Part 1: 1.The two groups of subjects had no significant differences in basic data such as average age,gender,years of education,etc.(P﹥0.05);the two groups of subjects had statistically significant differences in HRSD and HRSA scores(P <0.01).2.Compared with the HCs,in PA group,the ALFF value of left superior frontal gyrus was decreased,right inferior frontal gyrus and the right precentral gyri were increased.The DC values of left middle temporal gyrus,right superior temporal gyrus,left middle frontal gyrus,left caudate were decreased.The DC values of right precentral gyri was increased.The FC values between left v AI and bilateral anterior cingulate gyrus was decreased.The FC values between left PI and right precentral gyri,right postcentral gyri were increased.The FC values between right v AI and right precentral gyri,right postcentral gyri were increased.3.In terms of correlation analysis,the patient’s duration of disease was negatively correlated with years of education(r =-0.341,P = 0.014),HRSD(r =-0.384,P = 0.005),HRSA score(r =-0.434,P = 0.001)),positively correlated with ACT score(r = 0.290,P = 0.037).Years of education were negatively correlated with ACT score(r =-0.419,P = 0.002),positively correlated with HRSD score(r = 0.486,P <0.001),HRSA score(r = 0.516,P <0.001).ACT score was negatively correlated with HRSA score(r =-0.319,P =0.021).Part 2: 1.Comparing the sensation scores after EA in two groups,there was no difference in VAS scores such as soreness,numbness,and transmission,but there was a significant difference in pain scores(P < 0.01).2.Comparing the two groups after EA,the ALFF values of bilateral superior frontal gyrus,right middle frontal gyrus,right inferior frontal gyrus were increased in PA,the ALFF values of the right middle occipital gyrus was decreased.The DC values of bilateral superior temporal gyrus,right calcarine were decreased,the DC values of left angular gyrus,left caudate were increased.The FC values of right d AI and bilateral precuneus was decreased,the FC values of right PI and left superior temporal gyrus,left middle temporal gyrus were decreased.In the HCs,compared with before EA,the ALFF values of right precentral gyri and the right postcentral gyri were increased after EA.In the HCs,The FC values between left v AI and left precuneus,bilateral posterior cingulate gyrus,left PI and bilateral superior frontal gyrus,right d AI and bilateral precuneus,bilateral posterior cingulate gyrus,right PI and increased in the right precentral gyri and right postcentral gyri were increased.After EA in PA,the ALFF values of left middle frontal gyrus,bilateral superior frontal gyrus were increased compared with those before EA.3.Correlation analysis showed that the pain score of PA was negatively correlated with the duration of the disease(r =-0.604,P = 0.002),the soreness score of HCs was positively correlated with the HRSA score(r = 0.411,P <0.001).Part 3: 1.In terms of clinical data,the scores of HRSD,HRSA,and ACT in PA before and after EA were statistically different(P < 0.01),and there was no statistical difference in the sensation scores of EA(P>0.05).2.Comparing the 3 phases fMRI results in PA,the different DC values were concentrated in the left lingual gyrus,left inferior frontal gyrus,right supramarginal gyrus,and bilateral precentral gyri.post-hoc showed that,comparing with phase 1,the DC values of left inferior frontal gyrus,right superior marginal gyrus were increased,the DC values of left lingual gyrus,bilateral precentral gyri were decreased in phase 2,the DC values of right supramarginal gyrus was increased,left inferior frontal gyrus,bilateral precentral gyri were decreased in phase 3.Comparing with phase 2,the DC value of left lingual gyrus was decreased,the left inferior frontal gyrus and the right supramarginal gyrus in phase 3 were increased.3.ROC analysis showed that the DC values of left precentral gyri can separate the phase1 and phase 2(AUC = 0.797,P <0.001),phase 1 and phase 3(AUC = 0.944,P <0.001)phase 2 and phase 3(AUC = 0.776,P <0.01).Meanwhile,the left lingual gyrus(AUC= 0.804,P <0.001)and right precentral gyri(AUC = 0.849,P <0.001)can differentiate phase 1 and phase 2,left inferior frontal gyrus(AUC = 0.774,P = 0.001)and right precentral gyri(AUC = 0.835,P <0.001)can differentiate phase 1 and phase3,left inferior frontal gyrus(AUC = 0.891,P <0.001)can differentiate phase 2 and phase 3.Correlation analysis showed that the right precentral gyri in phase 3 was positively correlated with the HRSD score(r = 0.450,P = 0.046),and positively correlated with the soreness score(r = 0.459,P = 0.042).The left precentral gyri was positively correlated with the HRSA score(r = 0.846,P <0.001),the left lingual gyrus was positively correlated with the numbness score(r = 0.502,P = 0.024).Conclusion: By using ALFF,DC and FC,our study reflected different patterns of brain functional changes at the regional and network levels in patients with asthma.Regional abnormalities reflected independent changes within the prefrontal cortex.This study explored the abnormal sensation for pain and its neuroimaging mechanism in patients with asthma for the first time.our results show that there is an increased threshold of pain in patients with asthma,which suggests that dyspnea and pain share a specific nerve loop.This study also explored the cerebral regional and network characteristics in PA and analyzed the relationship between dyspnea and the sensation of pain.To our knowledge,this is the first study to explore allodynia in patients with asthma.Our findings provide neuroimaging evidence for the treatment of asthma by EA.