| ObjectiveBased on evaluating the clinical efficacy and the quality of life of acupuncture treatment compared to waiting-list on functional constipation(Functional Constipation,FC)patients,this study aims to investigate the differences in functional connectivity of Default Model Networks(DMN)elicited by the two interventions,and the differences in functional connectivity of DMN between two acupuncture subgroups(the high responser subgroup and the responser subgroup)by Independent Component Correlation Algorithm(ICA)of resting-state functional magnetic resonance imaging(f MRI),so as to explore the partial central mechanism of the influence of needling FC patients.Methods36 FC patients were randomly divided into two groups(Group A and B).Group A is the acupuncture treatment group,and group B is the waiting treatment group.According to different treatment methods,the subjects in group A received two consecutive courses(a total of 10 sessions)of acupuncture treatment;the subjects in group B did not receive any intervention during the study period.By using the Patient Assessment of Constipation Symptom(PAC-SYM)and the Patient Assessment of Constipation Quality of Life(PAC-QOL)to assess the efficacy of acupuncture for patients with FC,this study observed changes of the severity of clinical symptoms and quality of life after intervention.Moreover,by using the resting-state Blood Oxygenation Level Dependent Functional Magnetic Resonance Imaging(BOLD-f MRI)and Independent Components Analysis(ICA)method,the Independent Components(IC)within the default mode network(DMN)were extracted.And the functional connectivity within the DMN were compared within and between the two groups before and after intervention.Then the correlation analysis between the changes of functional connectivity and clinical variables was conducted in Group A to help confirm partial central mechanism.Based on the mentioned above,FC patients in group A were divided into two subgroups: the high responser subgroup and the responser subgroup.The functional connectivity within the DMN of these FC patients were compared within and between the two subgroups,so as to testify the partial central mechanism of acupuncture effect on FC patients.Results1.Changes of clinical variables and functional connectivity within the DMN:34 patients completed the study and all data were included into statistical analysis,including 17 patients in the acupuncture group and 17 patients in the waiting-list group.(1)Baseline comparison: no statistical differences were shown in the baseline of the two groups except for age(p>0.05).(2)Evaluation of clinical efficacy:(1)Within the group: the scores of the PAC-SYM and the PAC-QOL of FC patients in group A showed significantly decrease after acupuncture treatment(p<0.01);the scores of the PAC-SYM and the PAC-QOL of FC patients in group B showed no significant difference(p>0.05).(2)Between two groups: after treatment,when the age was used as a covariate,the covariance analysis showed that the improvement of the PAC-SYM and the PAC-QOL scores in group A were significantly greater than that in group B(p<0.05).(3)The influence of different interventions on the functional connectivity within the DMN in two groups:A group-level spatial independent component analysis(Group-ICA)algorithm was used to identify a total of 29 independent components.After comparison with previous studies,5 DMN-related independent components were selected from them,namely IC2(Posterior Cingulate Cortex,PCC),IC5(precuneus),IC20(Angular Gyrus,AG),IC25(precuneus),IC26(PCC/precuneus).(1)Comparison within the group: after acupuncture,the group A showed that the functional connectivity of the left PCC(IC2),left precuneus(IC5),left AG(IC20),right superior temporal gyrus(IC25)and right cuneus(IC26)within the DMN was enhanced.The group B showed the functional connectivity of right calcarine cortex(IC20)was increased,and right supramarginal gyrus(IC5)was decreased.(2)Compared to the Group B,FC patients in group A showed increased functional connectivity in the left posterior cingulate gyrus(IC2)and right precuneus(IC25);and decrease in the left supramarginal gyrus(IC5)and left cuneus(IC26)after acupuncture treatment.(3)In the correlation analysis,the clinical improvement of PAC-SYM and PACQOL scores showed significantly positive-correlated with the decrease of functional connectivity of the left AG(IC20)in Group A(r=0.494,p=0.044),(r=0.598,p=0.011).2.Differences of the clinical efficacy and functional connectivity within the DMN between the two subgroups:According to the improvement of symptoms after treatment,FC patients in group A were divided into two subgroups,8 cases in group A1(the high responser subgroup)and 8 cases in group A2(the responser subgroup).(1)Baseline comparisons: no significant difference was shown between the baseline of the two subgroups(p>0.05)(2)Evaluation of clinical efficacy:Comparisons between groups: the improvement of PAC-SYM and PAC-QOL scores in A1 group were significantly greater than that in A2 group(p<0.01).(3)The comparison of the influence on the DMN of FC patients between the two subgroups:(1)Comparisons within the group: after acupuncture,the A1 group showed enhanced functional connectivity of the right precuneus(IC5),left AG(IC20),left precuneus(IC25)and left cuneus(IC26);the A2 group showed enhanced functional connectivity of the left precuneus(IC25).(2)Comparisons between groups: compared to FC patients in group A2,group A1 showed enhanced functional connectivity of the left precuneus(IC2),right AG(IC5)and right precuneus(IC25)within the DMN.Conclusion1.Acupuncture treatment can significantly alleviate the symptoms and improve the quality of life of patients with FC;and FC patients have no obvious self-healing tendency during the observation period;2.Acupuncture treatment can significantly affect functional connectivity within the DMN;the changes of functional connectivity within the DMN,especially of the AG and precuneus may be the partially central mechanism of acupuncture for FC treatment.3.There is a certain correlation between the brain area response range in DMN after acupuncture and the level of acupuncture efficacy. |
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