| Background:Hypertension is a common cardiovascular and cerebrovascular disease, which is one of the most common diseases that seriously endanger human health, and it is a major public health problem in the world. Hypertension is divided into primary and secondary, primary hypertension in essential hypertension (EH) is a blood pressure increased as the main clinical manifestations and etiology is unknown, may is associated with various cardiovascular risk factors of syndrome, the proportion accounted for more than 95%. China is a large country with high blood pressure, the prevalence rate of hypertension increased significantly since half a century, there are currently about 200 million patients with hypertension,2 of every 10 adults have high blood pressure.Now, drug therapy is still a recognized treatments of hypertension, mainly including diuretics, CCB, β-adrenergic receptors blockers, ACEI, ARB such as five categories. But there are adverse side effects of these drugs, so patient’s compliance is not high. So it is very important for both blood pressure control and the new path of unfavorable factors brought by the reduction of drug.With the enhancement of people’s awareness of drug safety, the proportion of non drug therapy in the treatment of hypertension is gradually increased. There wea no hypertension in the traditional Chinese medicine (TCM), modern Chinese medicine experts according to the clinical symptoms of hypertension research, hypertension is associated with symptoms of dizziness, so that hypertension belongs to the category of "vertigo". "Vertigo" is named after the symptoms of the disease, the main characteristics are dizziness or sitting in a boat, standing instability, even with nausea and vomiting. These clinical symptoms are similar to the characteristics of "wind" in TCM theory. While the "Huangdi’s Canon of Internal Medicine" said, "the wind off dazzle, all belonging to the liver" records can be differentiated from the point of view on the treatment of liver. There are some patients with hypertension combined with a headache, so some experts have also classified as a "headache" category of hypertension.Acupuncture therapy in China has thousands of years of history, has been widely used in various clinical diseases, including hypertension. But these studies tend to focus on the clinical curative effect of acupuncture on hypertension, no attention to the mechanism of Acupuncture.In recent years, functional magnetic resonance imaging (fMRI) into imaging technology (functional magnetic resonance imaging, fMRI) due to its high temporal and spatial resolution, accurate location of brain function, on the human body without traumatic and other advantages and is widely used in the research of acupuncture mechanism. At the same time, foreign research shows that the brain function of patients with hypertension has changed, and some of the brain areas and blood pressure changes. For example, Gianaros found the anterior cingulate cortex two regions (the perigenual and mid-anterior) and insula, thalamus and midbrain aqueduct around gray matter and other brain display stronger blood oxygenation level dependent activation and higher mean arterial blood pressure. Jennings used PET brain imaging techniques in patients with essential hypertension in memory and cognitive task state, right frontal lobe, frontal, parietal and temporal lobes corresponding functional areas of the cerebral blood flow decreased, and left cortex with functional area compensatory activation.Using fMRI technology and resting state experimental design, the primary hypertension patients divided into acupuncture LR3 group and sham acupoint acupuncture group and every group was divided into acupuncture instant and acupuncture treatment, and in the course of test monitoring blood pressure changes and improvement of quality of life, observe and compare the acupuncture at Taichong (LR3) and non acupoint on different areas of the brain activation effect of change and its connection and to explore the mechanism of acupuncture for treatment of hypertension. Different from the previous analysis using Alff and ReHo technology, and the study by brain function connection analysis method, attempts to with a view of the functional network structure of the interpretation of acupuncture Taichong on hypertensive patients with brain regions activated effect influence.Objective:Observing the change of quality of life and compare the differences in brain functional connectivity by investigating instantaneous and short-term acupuncture treatment in essential hypertension (EH) patients.Methods:According to the complete randomized block design, the 30 subjects were distributed into the LR3 group and sham acupoint group, with each group consisting of 15 people. LR3:On the dorsum of the foot, in the depression anterior to the junction of the first and second metatarsal bones (Chinese National Standards GB/T12346) Sham point:On the midpoint of the line connecting the anterior superior iliac spine and lateral border of the patella,2 cm inside. After local skin disinfection and sterilizing with alcohol, sterile acupuncture needles (0.3mm diameter,40mm long, Huatuo acupuncture needles, Suzhou, China) were vertically punctured at 15±2 mm. After developing needle sensation, twirling at an angle of 90-180° and a frequency of 60-90 times/min and lifting and thrusting at a range of 0.3-0.5 cm and a frequency of 60-90 times/min were conducted. After manipulating the needle for 1 min, the needle was held in place for 30 min. During the 30 min, the physician repeated this manipulation for 1 min every 10 min. The BP measurements are performed with mercurial sphygmomanometer (Jiangsu Yuyue medical equipment & supply Co., Ltd.). Advised by a quiet rest for 5 min after blood pressure values measured, seat, bare arms, palms upward, abducts the elbow 45 degrees, elbow and the right atrium with a level. Open the blood pressure meter switch, the liquid level of the mercury column should be and 0 points for a flush and exhaust air in the air bag, the air sleeve even close to the skin around the upper arm, under the cuff edge 2-3 cm from the elbow stripes, proper tightness, central gas sleeve is located in surface of the brachial artery. Prior to the fossa cubitalis place palpable and brachial artery pulsatility, stethoscope diaphragm body piece is placed in the antecubital fossa brachial artery, do not plug in under the cuff, right to cuff inflation high 30mmhg slow deflated, until the arterial pulse disappeared, then decreased slowly (it is advisable to 2mm/s), hear first pulsation sound when the mercury column numerical systolic pressure. With the decline of the mercury column, when the sound disappears, the mercury column value is measured in the diastolic pressure interval of 1-2 minutes, and the average value of the data is recorded by the same physician. The subjects were treated with acupuncture for 15 minutes,30 minutes before acupuncture, and after treatment. Before and after scan, patients were under professional guidance complete quality of life scale. Experiments were performed using a GE 3.0T MRI scanner with an 8 channel head coil. The MRI data (resting-state BOLD sequence) were collected at 15 min before needling and 15 min after withdrawing the needle. The scanning methods were identical between sham and true acupuncture.1) Transverse T1-weighted image (T1WI) sequence:1 min,51 s, fast spin echo sequence; OAx T1 FLAIR, repetition time:1750 ms/echo time:24 ms, inversion time:960 ms, field of view:24 cm×24 cm/Z, matrix:320× 224/number of excitations=1, thickness:5.0 mm/interval:1.0 mm,30 slices total, echo train length:8, and bandwidth:31.25.2) Resting-state fMRI BOLD data collection:gradient echo-echo-planar imaging sequence scanning was conducted for 6 min in accordance with the following parameters:repetition time:3000 ms/minimum, echo time:minimum, flip angle:90, field of view:240 mm× 240 mm, thickness:5.0 mm/interval:1.0 mm,30 slices each time, and matrix:96× 96/number of excitations=1. Preprocessing was performed using Data Processing Assistant for Resting-State fMRI (DPARSF V2.3; Yan& Zang,2013, http://rfmri.org/DPARSF), which based on Statistical Parametric Mapping (SPM8; member& collaborators of the Welcome Trust Centre for Neuroimaging,2009, http://www.fil.ion.ucl.ac.uk/spm) and Resting-State fMRI Data Analysis Toolkit (REST 1.8, Song et al.2012. http:// www.restfMRI.net).The preprocessing procedure includes:(1) Convert DICOM to NIFTI; (2) Slice Timing after removing first 10 time points; (3) Realign and exclude subjects with ma x head motion> 1.5mm on any axis and head rotation> 1.5 degree; (4) Coregister T 1 to Fun; (5) Segment and affixer Regularization according to East Asian; (6) Normal ize by using EPI templates; (7) Smooth images with a Gaussian kernel with a isotropi c full-width at half-maximum (FWHM) of 6 mm.Functional connectivity (FC) maps were obtained using the voxel wise approach by computing FC between the region of interest (ROI) and each voxel within the brain. As SO and Pa may be the key role in the CNS in cardiovascular regulation, we selected them as the seed point regions to explore modulated brain network changes underlying acupuncture hypertension treatment. We defined two ROIs:the bilateral SO (x:±6.1; y:0.5; z:-15.0, radius lmm) and Pa (x: ±2.2; y:-1.4; z:-12.3, radius 1mm). We defined SO (right, R) as ROI1, SO (left, L) as ROI 2, Pa (R) as ROI 3, Pa (L) as ROI 4. Data were analyzed using REST1.8 software. In the statistical analysis, t-test was used to explore the differences among before, after once and after treatment acupuncture at the LR3 or between the LR3 and Sham groups. Rest1.8 software Viewer was employed to identify the precise anatomical position in the brain with statistical significance on the corresponding MNI coordinate. The results are presented as images visualized with the BrainNet Viewer.Results:There were no statistical differences observed between LR3 group and Sham group in SBP and DBP before acupuncture, after once acupuncture and after treatment. There was statistical difference between SBP in LR3 group after treatment compared to before acupuncture, P=0.006, which could demonstrate the SBP decreased in LR3 group after treatment. In the QLICD-HY, participants in the LR3 group reported increased scores of SPD. Changes in PHD, PSD, SOD, TOT did not differ among participants.We selected bilateral SO and Pa as the seed point regions to explore functional connectivity changes before and after once acupuncture in LR3 group:1) ROI 1, there were functional connectivity changes in right cerebrum superior frontal gyrus and left cerebrum sub-lobar extra-nuclear.2) ROI 2, there were functional connectivity changes in right cerebrum frontal lobe sub-gyral, left cerebrum frontal lobe sub-gyral and limbic lobe cingulate gyrus.3) ROI 3, there were functional connectivity changes in right cerebrum frontal lobe medial frontal gyrus and left cerebrum frontal lobe medial frontal gyrus.4) ROI 4, there were functional connectivity changes in right cerebrum frontal lobe middle frontal gyrus, medial frontal gyrus and left cerebrum frontal lobe middle frontal gyrus.We selected bilateral SO and Pa as the seed point regions to explore functional connectivity changes before and after once acupuncture in Sham group:1) ROI 1, there were functional connectivity changes in right cerebrum frontal lobe sub-gyral. 2) ROI 2, there were functional connectivity changes in left cerebrum limbic lobe anterior cingulated.3) ROI 3, there were functional connectivity changes in right cerebrum frontal lobe superior frontal gyrus, occipital lobe precuneus and left cerebrum frontal lobe inferior frontal gyrus.4) ROI 4, there were functional connectivity changes in left cerebrum limbic lobe anterior cingulated.We selected bilateral SO and Pa as the seed point regions to explore functional connectivity changes before and after treatment acupuncture in LR3 group:1) ROI 1, there were functional connectivity changes in right cerebrum frontal lobe sub-gyral and left cerebrum limbic lobe medial frontal gyrus.2) ROI 2, there were functional connectivity changes in right cerebrum frontal lobe superior frontal gyrus and inferior frontal gyrus.3) ROI 3, there were functional connectivity changes in right cerebellum posterior lobe declive and left cerebrum limbic lobe cingulate gyrus.4) ROI 4, there were functional connectivity changes in right cerebrum frontal lobe middle frontal gyrus, sub-lobar insula and left cerebrum frontal lobe middle frontal gyrus.Conclusion:In our study, there was only decrease in SBP after treatment compared to before acupuncture in LR3 group.There was no significant difference in QLICD-HY scores except SPD in QLICD-HY. The SPD was the specific module in QLICD-HY questionnaires, which could reflect the symptom of headache, dizziness, palpitation, shortness and anxiety of drugs. These symptoms are the most common and most directly affecting the quality of life in patients with hypertension. We could improve these problems by acupuncturing LR3.Compared with sham, acupuncture LR3 instantaneous effects in the functional connectivity with seed points were more concentrated in the frontal lobe. Compared with instantaneous effects, acupuncture LR3 short-term effects in the functional connectivity with seed points had more regions in frontal lobe and cerebellum, insula. |
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