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

Abstract

ObjectiveTo 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. MethodsThirty-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=3.5 mm) and two from the pregenual ACC: I7 (BA24) (x=±5,y=38, z=6, r=3.5 mm). 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. ResultsCompared 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). ConclusionThe 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).