Mechanism of granules for replenishing kidney and dispersing mass in the treatment of dysmenorrhoea of endometriosis with syndrome of kidney deficiency and blood stasis based on resting-state functional magnetic resonance imaging
Objective It is to investigate the central mechanism of granules for replenishing kidney and dispersing mass in the treatment of dysmenorrhoea of endometriosis(EM)with syndrome of kidney deficiency and blood stasis at the level of brain function based on resting-state functional magnetic resonance imaging(rs-fMRI).Methods Fifteen patients with dys-menorrhea of EM with syndrome of kidney deficiency and blood stasis were recruited from the department of gynecological outpatient of Dongfang Hospital of Beijing University of Chinese Medicine from September 2020 to September 2022 as the dysmenorrhea group,and 15 healthy subjects with matching age were recruited during the same period as the healthy group.The dysmenorrhea group was treated with granules for replenishing kidney and dispersing mass for 1 menstrual cycle,and the healthy group was not given any intervention.The duration of dysmenorrhea before and after treatment,NRS score at most painful period,NRS score of menstrual pain,The Cox Menstrual Symptom Scale(CMSS)score(including symptom duration score and symptom severity score)were observed in patients of the dysmenorrhea group.The rs-fMRI data of sub-jects in the healthy group and patients in the dysmenorrhea group before and after treatment were collected,and the differ-ence in brain regions between subjects of the healthy group and patients of the dysmenorrhea group before treatment,and the difference in the dysmenorrhea group before treatment and after treatment were compared with amplitude of low frequen-cy fluctuation(ALFF)and whole brain functional connectivity(FC).Meanwhile,the correlations between FC difference and NRS score difference before and after treatment in dysmenorrhea group were analyzed.Results After treatment,the du-ration of dysmenorrhea in the dysmenorrhea group was significantly shortened compared with that before treatment(P<0.05),and the NRS score at the most painful menstruation,NRS score of menstrual pain,scores of symptom duration symptom severity were significantly decreased compared with that before treatment(all P<0.05).rs-fMRI analysis showed that the ALFF values of the left fusiform gyrus,left parahippocampal gyrus,left cerebellar area 8,left middle temporal gy-rus,left inferior temporal gyrus,left central sulcus,left inferior frontal gyrus-triangular part,left inferior frontal gyrus-oper-cular part,left precentral gyrus and left middle frontal gyrus were all significantly increased in patients with dysmenorrhea before treatment(all P<0.05),the ALFF values of the right inferior temporal gyrus,right middle occipital gyrus,left ca-lar fissure and its surrounding cortex,right middle temporal gyrus,right superior occipital gyrus,right cuneus,right pre-central gyrus,right postcentral gyrus,right middle frontal gyrus,right precuneus,and left postcentral gyrus were all signifi-cantly decreased(all P<0.05),the FC values of right cerebellar area 6,right fusiform gyrus,right cerebellar peduncle area 1,right lingual gyrus,left superior occipital gyrus,left middle occipital gyrus and right superior temporal gyrus were significantly increased(all P<0.05).Compared with before treatment,the ALFF values of the left postcentral gyrus,left calar fissure and its surrounding cortex,right precuneus were significantly increased in the patients of the dysmenorrhea group after treatment(all P<0.05),while the ALFF value of the left fusiform gyrus was significantly decreased(P<0.05),and the FC values of the right supramarginal gyrus and left superior parietal gyrus were significantly increased(all P<0.05).The difference in NRS scores before and after treatment in the the dysmenorrhea group was negatively correlated with the FC difference in the right supramarginal gyrus(r=-0.104,P<0.05),and negatively correlated with the FC difference in the left superior parietal gyrus(r=-0.179,P<0.05).Conclusion EM patients with dysmenorrhea have abnormal functional activities in temporal lobe,occipital lobe,parietal lobe and cerebellar related brain regions.Granules for replenishing kidney and dispersing mass may be effective by regulating abnormal neuronal activities in pain related brain regions.
endometriosisabdominal pain during menstruationgranules for replenishing kidney and dispersing massresting-state functional magnetic resonance imaging
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