Changed ACC-DMN functional connectivity after acupuncture with deqi for functional dyspepsia treatment☆

针刺得气对功能性消化不良患者前扣带回-默认网络功能连接度的影响

Rui-rui SUN (孙睿睿)a,b, Pei-hong MA (马培宏)a,b , Zhao-xuan HE (何昭璇)a,b , Tao YIN (尹涛)a,b, Yu-zhu QU (瞿玉竹)a,b, Shuai YIN (印帅)c, Xiao-yan LIU (刘小艳)a,b, Jin LU (卢晋)a,b, Ting-ting ZHANG (张婷婷) a,b, Liu-yang HUANG (黄柳杨)a,b, Xue-ling SUO (索学玲)d, Du LEI (雷都)d, Qi-yong GONG (龚启勇)d, Fan-rong LIANG (梁繁荣)a,b,*, Fang ZENG (曾芳)a,b,*

a Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan Province, China （成都中医药大学针灸推拿学院/第三附属医院，四川 成都 611137，中国）

b Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan Province, China（成都中医药大学针刺脑科学研究中心，四川 成都 611137，中国）

c First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450000, Henan Province, China（河南中医药大学第一附属医院，河南 郑州450000，中国）

d Huaxi MR Research Center (HMRRC), Departments of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China; （四川大学华西医院放射科/华西磁共振研究中心，四川 成都 610041，中国）

*Corresponding authors.

E-mail address: 

zengfang@cdutcm.edu.cn (F.ZENG)

lfr@cdutcm.edu.cn (F.-r.LIANG)

☆Supported by grants from the National Natural Science Foundation of Outstanding Youth Fund in China:81622052, National Natural Science Foundation of China:81473602, the major program of the National Natural Science Foundation of China:81590950, the Ten Thousand Talent Program:W02020595 and Youth Science and Technology Innovative Team of Sichuan Province:2019JDTD0011.

ABSTRACT 

Objective: To clarify altered whole brain functional connectivity of the anterior cingulate cortex (ACC) in functional dyspepsia (FD) patients, and then to explore cerebral influence of acupuncture with deqi treating for FD.

Methods: Thirty-two FD patients and 35 healthy subjects (HS) were firstly scanned by the resting-state blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) to compare differences of ACC-based functional connectivity (FC). Then 32 FD patients were randomized to receive 20 sessions' acupuncture treatment with (n=16) and without deqi (n=16), as well as underwent functional magnetic resonance imaging (fMRI) scans after treatment. After group re-division according to deqi response, changes of ACC subregions-based resting-state FC (rsFC) were compared between the actual with and without deqi group. Two seeds with bilateral of each were selected as regions of interest (ROIs) of the ACC, including two from the dorsal ACC: S2 (BA24) (x=±5,y=2, z=46, r=3.5mm) and two from the pregenual ACC: I7 (BA24) (x=±5,y=38, z=6, r=3.5mm). The clinical changes of the Nepean Dyspepsia Index (NDI) that measuring symptoms and quality of life (QOL) were also used to further assess the correlation with ACC subregions rsFC in FD patients.

Results: Compared to HS, FD patients showed significantly increased ACC subregions rsFC with left fusiform gyrus, temporal cortex, hippocampus(HIPP)/amygdala, temporal pole, and right INS, superior occipital gyrus, and bilateral precuneus, superior parietal lobule (SPL), and decreased rsFC with left postcentral/precentral gyrus (PoG/PrG), supplementary motor area (SMA) and right cerebellum. 32 FD patients which were then re-divided into the actual deqi group (n=16) and actual without deqi group (n=16). The decrease of the NDI symptom score(pre-pos) in the actual deqi group was significantly greater than that in the actual without deqi group (P<0.05).  Among the two groups, the actual deqi group showed increased ACC subregions rsFC with right SMA and bilateral PrG/PoG, and decreased rsFC with right precuneus, middle occipital gyrus, bilateral posterior cingulate cortex (PCC), HIPP/paraHIPP, angular gyrus and SPL after treatment. In addition, the changed NDI QOL scores(pre-post) of the actual deqi group was significantly positively correlated with their Fisher’s transformed Z value of the altered ACC subregion (left I7) rsFC with right SPL(r=-0.597, P=0.04<0.05, FDR corrected P>0.05). 

Conclusion: The results tested the hypothesis that the advantage of deqi on efficacy is related to affecting the ACC subregions rsFC. It suggested that deqi might participate in the adaptive modulation of disrupted relationship between the ACC subregions and the default mode network (DMN).

Keywords: 

Deqi  

Functional dyspepsia

ACC subregions

Resting-state

Functional connectivity

[摘 要]

目的：探讨功能性消化不良（FD）患者前扣带回皮质（ACC）全脑功能连通性的改变，探讨针刺配合得气治疗FD对脑功能的影响。

方法：对32例FD患者和35例健康人（HS）进行静息状态血氧水平依赖性功能磁共振成像（BOLD-fMRI）扫描，比较基于ACC的功能连接（FC）的差异。32例FD患者随机分为针刺治疗组（n=16）和非针刺治疗组（n=16），治疗后进行功能磁共振成像（fMRI）检查。根据得气反应重新分组后，比较得气组与未得气组ACC亚区基于静息状态FC（rsFC）的变化。选择两个双侧种子作为ACC的感兴趣区，其中两个来自背侧ACC：S2（BA24）（x）=±5，y=2，z=46，r=3.5mm）和两个来自于前胚胎附件：I7（BA24）（x=±5，y=38，z=6，r=3.5mm）。用Nepean消化不良指数（NDI）测量FD患者症状和生活质量（QOL）的临床变化，进一步评价FD患者ACC亚区rsFC的相关性。

结果：FD组与HS组相比，左梭状回、颞叶皮质、海马（HIPP）/杏仁核、颞极、右INS、枕上回、双侧楔前叶、顶叶（SPL）ACC亚区rsFC明显增高，左中央后/中央前回（PoG/PrG）rsFC明显降低，辅助运动区（SMA）和右侧小脑。将32例FD患者分为实际得气组（n=16）和实际未得气组（n=16）。实际得气组NDI症状积分（pre-pos）下降幅度明显大于未得气组（P<0.05）。两组治疗后，实际得气组右侧SMA和双侧PrG/PoG的ACC亚区rsFC升高，右侧楔前叶、枕中回、双侧后扣带回（PCC）、HIPP/PARAHIP、角回和SPL的rsFC降低。此外，实际得气组NDI QOL评分（前后）的变化与其ACC分区（左17）rsFC和右SPL的Fisher变换Z值显著正相关（r=-0.597，P=0.04<0.05，FDR校正P>0.05）。

结论：实验结果验证了得气的疗效优势与影响ACC亚区rsFC有关的假说。这表明，得气可能参与了对ACC亚区与默认模式网络（DMN）之间关系的自适应调节。

[关键词]得气、功能性消化不良、ACC亚区、静息状态、功能连接