Resting-state brain function connectivity in patients with knee osteoarthritis treated with acupuncture based on continuous edge analysis
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摘要:
目的 探讨针刺治疗膝骨性关节炎（KOA）患者静息态脑功能连接的变化，为临床针刺治疗KOA提供神经影像依据。 方法 纳入25例KOA患者进行为期3周的针刺治疗，取犊鼻穴、血海、阳陵泉、足三里、三阴交、内膝眼、梁丘组穴配伍，5次/周，30 min/次。采集KOA患者针刺前后的视觉模拟量表（VAS）、膝关节功能评分表（KSS）和头颅静息态功能MRI数据，应用连边分析方法描述KOA患者针刺后各脑区间功能连接的改变，并与临床评分作相关性分析。 结果 针刺治疗后，KOA患者VAS评分降低，KSS评分升高（P < 0.001）。连边分析显示KOA患者针刺后右侧眶部额下回与左侧梭状回，右侧角回与左侧楔前叶、右侧中央前回，左侧岛盖部额下回与左侧丘脑，左侧中央后回与右侧角回、右侧颞上回的功能连接增强（P < 0.001）；相关性分析发现，右侧角回与右侧中央前回（r=0.540，P=0.008）、左侧中央后回与右侧颞上回（r=0.654，P=0.001）的功能连接变化与VAS变化呈正相关关系。 结论 针刺可能通过正激活部分脑区间的功能连接，加强中枢镇痛区域间的联系来缓解KOA患者疼痛、改善膝关节运动障碍，这些脑区主要分布于默认模式网络、感觉运动网络、扣带岛盖网络。 -
关键词:
- 膝骨性关节炎 /
- 针刺 /
- 静息态功能磁共振成像 /
- 连边分析 /
- 脑功能连接
Abstract:Objective To explore the changes of the rest brain at rest functional connectivity in patients with knee osteoarthritis (KOA) after acupuncture treatment, so as to provide neuroimaging basis for clinical acupuncture treatment of KOA. Methods Twenty-five patients with KOA were enrolled in the study and treated with acupuncture for 3 weeks. The points of Dubi, Xuehai, Yanglingquan, Zusanli, Sanyinjiao, Neixiyan and Liangqiu group were selected for compatibility, 5 times a week, 30 minutes each time. The data of visual analogue scale (VAS), knee joint function scale (KSS) and resting state functional MRI of KOA patients before and after acupuncture were collected, and the changes of functional connectivity of various brain regions in KOA patients after acupuncture were described with the method of edge linking analysis, and the correlation analysis was made with the clinical scores. Results After acupuncture treatment, VAS score of KOA patients decreased significantly and KSS score increased significantly (P < 0.001). Edge linking analysis showed that after acupuncture, functional connectivity of the right orbital inferior frontal gyrus and the left fusiform gyrus, the right angular gyrus and the left anterior cuneiform lobe, the right anterior central gyrus, the left insular inferior frontal gyrus and the left thalamus, the left posterior central gyrus and the right angular gyrus, and the right superior temporal gyrus were enhanced in KOA patients (P < 0.001). Correlation analysis showed that the changes of functional connectivity in right angular gyrus and right anterior central gyrus (r=0.540, P=0.008), left posterior central gyrus and right superior temporal gyrus (r=0.654, P=0.001) were positively correlated with the changes of VAS. Conclusion Acupuncture may relieve pain and improve knee joint movement disorder in KOA patients by positively activating functional connections in some brain regions and strengthening connections between central analgesia regions.These brain regions are mainly distributed in the default mode network, sensorimotor network and cingulate island network. -
图 1 KOA患者针刺前后全脑静息态功能网络矩阵图
Figure 1. Matrix of whole- brain resting- state functional network before and after acupuncture in patients with KOA. Color scale represented functional connectivity strength, both horizontal and vertical coordinates represented 90 brain regions of the anatomical automatic labeling atlas.
图 2 针刺前后6对脑区FC值比较
Figure 2. Comparison of FC values of 6 pairs of brain regions before and after acupuncture. IFGoperc.L: Left subinsular frontal gyrus; ORBinf. R: Right infraorbital frontal gyrus; THA.L: Left thalamus; PoCG.L: Left postcentral gyrus; PreCG.R: Right precentral gyrus; STG.R: Right superior temporal gyrus; FFG.L: Left syrinx; PCUN.L: Left precuneus; ANG.R: Right angular gyrus.
图 3 KOA患者针刺前后全脑FC差异图
Figure 3. Difference maps of whole brain FC in KOA patients before and after acupuncture. A- C: Distribution of brain functional connectivity with differences before and after acupuncture from axial, coronal, and sagittal brain positions; D: In the right circle map, the surrounding colored squares represent different brain regions, and the middle red strip represents the connected edges with significantly enhanced FC after acupuncture.
图 4 连边FC变化与VAS变化相关性分析结果
Figure 4. Results of correlation analysis between the change of continuous edge FC and the change of VAS.
表 1 MRI扫描基本参数
Table 1. Basic parameters of MRI scanning
Parameter 3D_T1_MPRAGE BOLD_EPI TR（ms） 2530 2000 TE（ms） 3.37 26 FA（°） 7 90 Slice thickness（mm） 1.0 4.0 Voxel size（mm3） 1.0×1.0×1.0 3.5×3.5×4.0 FOV（mm2） 256×256 224×224 Slice 192 35 Time（min） 6 8 
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表 2 KOA患者针刺前后VAS、KSS评分比较
Table 2. Comparison of VAS and KSS scores before and after acupuncture in patients with KOA (score, Mean±SD)
Scale Before acupuncture After acupuncture t P VAS 7.65±2.21 7.65±2.21 14.007 ＜0.05 KSS 39.78±19.80 72.61±18.46 -12.587 ＜0.05 VAS: Visual analogue scale; KSS: Knee society score
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表 3 KOA患者针刺前后全脑FC差异脑区信息
Table 3. Information on brain regions with whole brain FC differences before and after acupuncture in KOA patients
Brain regions Z1 Z2 t P ORBinf.R-FFG.L 0.031 0.215 -4.180 ＜0.001 PoCG.L-STG.R 0.150 0.306 -3.916 ＜0.001 PoCG.L-ANG.R 0.023 0.214 -4.252 ＜0.001 ANG.R-PCUN.L 0.395 0.591 -4.058 ＜0.001 ANG.R-PreCG.R 0.057 0.227 -3.901 ＜0.001 IFGoperc.L-THA.L 0.160 0.309 -3.867 ＜0.001 Z1 and Z2 indicated the mean values of FC between pairwise brain regions before and after acupuncture, respectively. FC: Functional connection.
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