带状疱疹后遗神经痛患者脑静息态功能磁共振研究

发布时间：2018-09-10 21:42

【摘要】：[目的]带状疱疹后遗神经痛是临床上一种慢性顽固性神经病理性疼痛,然而,对于其潜在的神经病理机制还知之甚少,利用静息态功能磁共振成像(Rs-fMRI)低频振幅分数(fALFF)及局部一致性(ReHo)的脑功能分析方法观察带状疱疹后遗神经痛(PHN)患者静息状态下相关脑区功能改变情况;并探讨PHN患者fALFF及ReHo异常脑区与自发性疼痛强度及病程的相关性。[资料与方法]收集带状疱疹后遗神经痛患者15例(PHN组)及与PHN组性别、年龄及受教育程度匹配的健康志愿者15名(HC组),所有患者由疼痛科专家严格按照国内专家共识的诊断标准确诊。采用荷兰PHILIPS Achieva 3.0T TX超导磁共振扫描仪,8通道头部相控阵线圈进行常规头颅磁共振、全脑3D结构相及静息态功能序列扫描,获取被试者全脑相应数据。采用DPARSF 4.3软件对原始数据进行预处理,并进行fALFF、ReHo脑功能分析。统计分析采用SPSS 17.0组间一般资料进行两独立样本t检验,采用REST1.8软件对两组间Rs-fMRI(fALFF、ReHo)数据进行双样本t检验(年龄、性别及受教育程度作为协变量),再将PHN组Rs-fMRI结果中异常脑区分别与患者疼痛强度(VAS)、病程进行相关性分析(年龄、性别及疼痛部位作为协变量)。[结果]1 fALFF分析:与正常对照组相比,fALFF升高的区域分布于左侧小脑前叶/后叶、小脑蚓部、中脑、脑桥、左侧脑干、左侧额上回、左侧额下回、左侧中央前回、左侧颞上回、左侧颞中回、左侧颞下回、左侧梭状回、左侧缘上回、左侧顶下小叶、左侧中央后回、左侧中央旁小叶、左侧枕中回、左侧枕下回、左侧丘脑、左侧边缘叶、左侧岛叶、左侧海马、左侧海马旁回、左侧尾状核、左侧壳核、左侧苍白球、左侧杏仁核,其中岛叶神经元活动最强;fALFF减低区域分布于左侧额上回、左侧额中回、左侧额下回、右侧额上回、右侧额中回、右侧额下回、右侧颞上回、右侧颞中回、右侧中央后回,其中左侧额上回的神经元活动最弱)。(经 AlphaSim 校正,取 P0.001,激活簇(cluster size)≥54 为阈值)。2 ReHo分析:与正常对照组相比,PHN组ReHo升高的脑区位于:左侧脑干、中脑、左侧小脑半球、左侧额上回、左侧额中回、左侧中央前回、左辅助运动区、左侧旁中央小叶、左侧颞上回、左侧颞中回、左侧颞下回、左侧颞横回、左侧中央后回、左侧缘上回、左侧枕中回、左侧梭状回、左侧脑岛、左侧扣带回、左侧海马旁回、左侧海马、左侧丘脑、左侧尾状核、左侧壳核,其中脑干ReHo升高最明显;ReHo减低的脑区分布于左侧额上回、右侧额上回、左侧额中回、右侧额中回、左侧前扣带回、右侧前扣带回、左侧直回、右侧直回、右侧中央前回,其中右侧前扣带回ReHo降低最明显。(经AlphaSim校正,取P0.001,激活簇(cluster size)≥54 为阈值)。3 PHN患者fALFF、ReHo结果中异常脑区与疼痛强度无相关性(P0.05)。4 PHN患者fALFF、ReHo结果中异常脑区与病程无相关性(P0.05)。[结论]PHN患者脑内存在多个fALFF、ReHo异常改变的脑区,提示相应脑区内神经元活动强度、同步性发生了改变,说明PHN可导致相对应区域脑功能的异常,并且PHN患者脑局部活动异常不局限于疼痛矩阵,除了与疼痛感知相关的区域,还涉及认知、运动、情绪活动区域,进一步说明PHN患者大脑功能存在可塑性变化。联合应用RS-fMRI的两种分析方法(fALFF、ReHo)能有效地评价静息态下脑功能状态的改变,更有利于探讨PHN的神经功能受损情况,为PHN患者神经病理生理机制的研究提供功能神经解剖学依据。
[Abstract]:[Objective] Posterior herpes zoster neuralgia is a chronic refractory neuropathic pain in clinic. However, little is known about its underlying neuropathological mechanism. Low frequency amplitude fraction (fALFF) and local consistency (ReHo) of resting state functional magnetic resonance imaging (Rs-fMRI) were used to observe the brain function of postherpetic neuralgia. [Materials and Methods] Fifteen patients with postherpetic neuralgia (PHN group) and 15 healthy volunteers (HC group) matched with sex, age and educational level of PHN group were collected. All patients were diagnosed by pain specialists strictly according to the diagnostic criteria agreed by domestic experts. The subjects were scanned with 8-channel phased-array coil and PHILIPS Achieva 3.0T TX superconducting magnetic resonance scanner. The whole brain was scanned with 3-D phase and resting functional sequence. The data were obtained by DPARSF 4.3 software. The original data were preprocessed and analyzed by fALFF and ReHo. The statistical analysis was performed with SPSS 17.0 general data for two independent sample t-test. REST 1.8 software was used for two-sample t-test of Rs-fMRI (fALFF, ReHo) data between the two groups (age, sex and education level as covariates), and then the results of Rs-fMRI in PHN group were included. [Results] 1 fALFF analysis: Compared with the normal control group, the areas of increased fALFF were distributed in the left anterior/posterior cerebellar lobe, cerebellar vermis, midbrain, pons, left brainstem, left superior frontal gyrus, left inferior frontal gyrus, left inferior frontal gyrus, and left cerebellar vermis. Anterior central gyrus, left superior temporal gyrus, left inferior temporal gyrus, left fusiform gyrus, left superior marginal gyrus, left inferior parietal lobule, left posterior central gyrus, left paracentral lobule, left middle occipital gyrus, left suboccipital gyrus, left thalamus, left marginal lobe, left insular lobe, left hippocampus, left parahippocampal gyrus, left caudate nucleus, left putamen, left pale The fALFF decreased in the left superior frontal gyrus, the left middle frontal gyrus, the left inferior frontal gyrus, the right superior frontal gyrus, the right middle frontal gyrus, the right inferior frontal gyrus, the right superior temporal gyrus, the right middle temporal gyrus, and the right posterior central gyrus. ReHo analysis: Compared with the normal control group, the elevated areas of ReHo in PHN group were located in left brain stem, middle brain, left cerebellar hemisphere, left superior frontal gyrus, left middle frontal gyrus, left anterior central gyrus, left auxiliary motor area, left lateral central lobule, left superior temporal gyrus, left middle temporal gyrus, left inferior temporal gyrus. Left transverse temporal gyrus, left posterior central gyrus, left superior marginal gyrus, left middle occipital gyrus, left fusiform gyrus, left insula, left cingulate gyrus, left parahippocampal gyrus, left hippocampus, left thalamus, left caudate nucleus, left putamen, of which the brainstem ReHo increased most significantly; the brain areas of ReHo decreased were distributed in left superior frontal gyrus, right superior frontal gyrus, left middle frontal gyrus, right putamen ReHo in the right anterior cingulate gyrus was the lowest in the lateral middle frontal gyrus, left anterior cingulate gyrus, right anterior cingulate gyrus, and right anterior central gyrus. There was no correlation between the abnormal brain areas and the course of the disease in LFF and ReHo results (P 0.05). [Conclusion] Abnormal changes of fALFF and ReHo in the brain of PHN patients suggest that the intensity and synchronization of neuronal activity in the corresponding brain areas have changed, indicating that PHN can cause abnormal brain function in the corresponding areas, and the abnormal brain activities in PHN patients are not limited to pain. Matrix, in addition to pain perception related areas, but also related to cognitive, motor, emotional activity areas, further illustrates the plasticity of brain function in patients with PHN. The combination of two methods of RS-fMRI analysis (fALFF, ReHo) can effectively evaluate the changes of brain function in resting state, more conducive to explore the neurological impairment of PHN. It provides functional neuroanatomical basis for the study of neuropathophysiological mechanism in PHN patients.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R752.12

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