颞下颌关节滑膜炎开口痛患者功能磁共振研究
发布时间：2018-07-29 15:13
【摘要】：目的:颞下颌关节紊乱病(temporomandibular disorders,TMD)被认为是除牙痛以外口颌面部疼痛的最常见病因,发病率较高,但TMD相关疼痛的病因及病理生理机制尚缺乏相关认识。近年来,越来越多的研究提出中枢神经系统机制可能与TMD相关疼痛的发生发展有关的假设。功能性磁共振成像(functional magnetic resonance imaging,f MRI)已经广泛应用于多种疼痛性疾病的神经活动的研究中。本研究利用静息态功能磁共振技术(resting-state f MRI,rs-f MRI),来研究TMD疼痛患者的疼痛相关脑区的局部一致性(regional homogeneity,Re Ho)和静息态功能连接(functional connectivity,FC)的变化,以及相关脑区自发性神经活动与临床疼痛强度的关系,进而证实中枢神经系统机制可能与TMD相关疼痛的发生发展有关的假设。方法:选取符合纳入标准的10名颞下颌关节滑膜炎单侧开口痛女性患者与10名年龄匹配的健康对照(healthy controls,HC)参与本研究。TMD组和健康对照组均要求完成症状自评量表(Symptoms Check List-90,SCL-90)用于心理评估,并比较两组评分差异。TMD开口痛患者接受视觉模拟评分法(Visual Analogue Scale,VAS)评估疼痛强度。分别在开口状态和闭口状态采集静息态功能磁共振数据,对每个受试者进行局部一致性和静息态功能连接分析,进一步研究自发性脑活动的变化并比较两组间局部一致性与静息态功能连接差异。此外,为研究患者临床疼痛强度与自发性脑活动强度的关系,提取激活脑区局部一致性以及激活脑区与全脑其他区域功能连接的平均值,并与VAS评分作相关分析。结果:1.严格纳入及排除标准,2名TMD患者经颞下颌关节核磁共振检查及关节镜手术证实为颞下颌关节滑膜性软骨瘤病,故排除,最终纳入8名TMD患者和10名健康对照。2.心理学评估方面,与健康对照组相比,TMD组在除恐怖因子(p=0.098)以外的其他SCL-90因子分均高于对照组。多重比较校正后,TMD组在躯体症状,人际关系敏感和抑郁等SCL-90项目因子分仍显著高于健康对照组。3.静息态功能磁共振研究方面,每种条件下的单样本t检验局部一致性表现出典型的默认网络激活,而功能连接则表现为两种连接方式:与突显性网络(salience network,SN)相关脑区为正连接;与默认网络(default mode network,DMN)相关脑区表现为负连接。4.组间比较结果:与对照组相比,TMD患者组右前脑岛局部一致性减低,右前脑岛与左侧中扣带回静息态正功能连接减低,右前脑岛与右侧楔前叶/后扣带回负功能连接减低。5.临床疼痛强度与自发性脑活动强度的关系:右前脑岛与左侧中扣带回的功能连接值与疼痛强度呈负相关,即疼痛强度越强,TMD患者右前脑岛与左侧中扣带回的功能连接越弱。结论:1.本研究揭示了TMD相关疼痛不仅与突显性网络的重要脑区,右前脑岛局部神经活动一致性异常有关,而且与右前脑岛与突显性网络的其他主要脑区(中扣带回)以及与默认网络相关脑区(楔前叶)功能连接的异常相关。2.本研究结果表明,疼痛相关脑区功能性适应不良性神经可塑性改变,突显性网络内部连接以及突显性网络与默认网络的功能连接异常可能与TMD疼痛的中枢神经机制密切相关。3.TMD疼痛作为一种持续性的伤害性疼痛传入,可能会导致中枢伤害性系统兴奋性增高,疼痛调节通路异常,表现为脑区局部脑活动以及脑网络节点之间连接关系的异常,表明中枢致敏作用在TMD疼痛中的重要作用。4.心理因素,尤其是焦虑,抑郁及躯体症状也在TMD疼痛发展中起一定的作用。中枢神经系统导致慢性疼痛发展或持续途径可能与先天性格相关的心理因素有关,这些因素可能降低大脑调节伤害性疼痛传入的能力。
[Abstract]:Objective: temporomandibular disorders (TMD) is considered as the most common cause of pain in the mouth and maxillofacial regions other than toothache, but the incidence is high, but the pathogeny and pathophysiological mechanism of TMD related pain are still lack of understanding. In recent years, more and more studies have suggested that the mechanism of central nervous system may be associated with TMD pain. Functional magnetic resonance imaging (f MRI) has been widely used in the study of neural activity in a variety of painful diseases. This study uses resting state functional magnetic resonance (resting-state f MRI, rs-f MRI) to study the pain related brain regions of patients with TMD pain. The changes in the regional homogeneity (Re Ho) and the resting state function connection (functional connectivity, FC), as well as the relationship between the spontaneous neural activity and the clinical pain intensity in the related brain regions, and further confirm the hypothesis that the central nervous system mechanism may be related to the development of TMD related pain. Method: 10 in accordance with the inclusion criteria. The female patients with unilateral TMJ synovitis and 10 age matched healthy controls (healthy controls, HC) were involved in the.TMD group and the healthy control group to complete the symptom checklist (Symptoms Check List-90, SCL-90) for psychological assessment, and compared with the two groups to receive visual simulation of.TMD open pain. Visual Analogue Scale (VAS) was used to assess the intensity of pain. The resting state functional magnetic resonance (fMRI) data were collected in the open and closed state respectively. The local conformance and resting state function connection analysis for each subject were carried out to further study the changes of spontaneous brain activity and compare the local conformance and resting state function connection between the two groups. In addition, in order to study the relationship between the clinical pain intensity and the spontaneous brain activity intensity, the local consistency of the activated brain region and the activation of the functional connections between the brain region and the other regions of the whole brain were extracted, and the correlation analysis was made with the VAS score. Results: 1. strictly included and excluded the criteria, 2 TMD patients were examined by NMR examination of the temporomandibular joint. And arthroscopy was proved to be a synovial chondromatosis of the temporomandibular joint. Therefore, 8 TMD patients and 10 healthy controls were included in the psychological assessment of.2.. Compared with the healthy control group, the other SCL-90 factor scores in group TMD except the terrorist factor (p=0.098) were higher than those in the control group. After multiple comparison correction, the TMD group was in somatic symptoms, SCL-90 project factors, such as interrelationship sensitivity and depression, were still significantly higher than those of.3. resting functional MRI in the healthy control group. The local consistency of the single sample t test under each condition showed a typical default network activation, while the functional connection was two types of connection: the brain associated with the salience network (SN). The region was a positive connection; the brain region associated with the default network (default mode network, DMN) showed a negative correlation between the negative connected.4. groups. Compared with the control group, the local consistency of the right anterior insula was reduced in the TMD patients and the resting state of the right anterior insula and the left cingulate gyrus was reduced, and the right anterior insula and the right anterior cuneus / cingulate gyrus had a negative functional connection. The relationship between low.5. clinical pain intensity and spontaneous brain activity: a negative correlation between the functional connection value of the right anterior insula and the left cingulate gyrus is negatively correlated with the intensity of pain. That is, the stronger the pain intensity, the weaker the functional connection of the right anterior insula and the left cingulate gyrus in TMD patients. The 1. study revealed that the TMD related pain was not only the weight of the prominence network. In the brain area, the abnormality of local neuroactivity in the right anterior insula is associated with abnormal correlation with the right anterior insula and other major brain regions (cingulate gyrus) and the functional connection with the default network associated brain region (anterior lobe) in the right anterior insula (.2.). The internal connection of the explicit network and the abnormal functional connection between the explicit network and the default network may be closely related to the central nervous mechanism of TMD pain..3.TMD pain is a persistent nociceptive pain, which may lead to higher central nociceptive system excitability, abnormal pain modulation pathway, and local brain activity in the brain region. And the abnormality of the connection between brain network nodes indicates that the important role of central sensitization in TMD pain is.4. psychological factors, especially anxiety, depression and somatic symptoms also play a role in the development of TMD pain. The central nervous system causes chronic pain development or its continuing pathway may be related to the psychological factors associated with congenital character. These factors may reduce the ability of the brain to modulate nociceptive pain afferent.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.6
本文编号：2153085
[Abstract]:Objective: temporomandibular disorders (TMD) is considered as the most common cause of pain in the mouth and maxillofacial regions other than toothache, but the incidence is high, but the pathogeny and pathophysiological mechanism of TMD related pain are still lack of understanding. In recent years, more and more studies have suggested that the mechanism of central nervous system may be associated with TMD pain. Functional magnetic resonance imaging (f MRI) has been widely used in the study of neural activity in a variety of painful diseases. This study uses resting state functional magnetic resonance (resting-state f MRI, rs-f MRI) to study the pain related brain regions of patients with TMD pain. The changes in the regional homogeneity (Re Ho) and the resting state function connection (functional connectivity, FC), as well as the relationship between the spontaneous neural activity and the clinical pain intensity in the related brain regions, and further confirm the hypothesis that the central nervous system mechanism may be related to the development of TMD related pain. Method: 10 in accordance with the inclusion criteria. The female patients with unilateral TMJ synovitis and 10 age matched healthy controls (healthy controls, HC) were involved in the.TMD group and the healthy control group to complete the symptom checklist (Symptoms Check List-90, SCL-90) for psychological assessment, and compared with the two groups to receive visual simulation of.TMD open pain. Visual Analogue Scale (VAS) was used to assess the intensity of pain. The resting state functional magnetic resonance (fMRI) data were collected in the open and closed state respectively. The local conformance and resting state function connection analysis for each subject were carried out to further study the changes of spontaneous brain activity and compare the local conformance and resting state function connection between the two groups. In addition, in order to study the relationship between the clinical pain intensity and the spontaneous brain activity intensity, the local consistency of the activated brain region and the activation of the functional connections between the brain region and the other regions of the whole brain were extracted, and the correlation analysis was made with the VAS score. Results: 1. strictly included and excluded the criteria, 2 TMD patients were examined by NMR examination of the temporomandibular joint. And arthroscopy was proved to be a synovial chondromatosis of the temporomandibular joint. Therefore, 8 TMD patients and 10 healthy controls were included in the psychological assessment of.2.. Compared with the healthy control group, the other SCL-90 factor scores in group TMD except the terrorist factor (p=0.098) were higher than those in the control group. After multiple comparison correction, the TMD group was in somatic symptoms, SCL-90 project factors, such as interrelationship sensitivity and depression, were still significantly higher than those of.3. resting functional MRI in the healthy control group. The local consistency of the single sample t test under each condition showed a typical default network activation, while the functional connection was two types of connection: the brain associated with the salience network (SN). The region was a positive connection; the brain region associated with the default network (default mode network, DMN) showed a negative correlation between the negative connected.4. groups. Compared with the control group, the local consistency of the right anterior insula was reduced in the TMD patients and the resting state of the right anterior insula and the left cingulate gyrus was reduced, and the right anterior insula and the right anterior cuneus / cingulate gyrus had a negative functional connection. The relationship between low.5. clinical pain intensity and spontaneous brain activity: a negative correlation between the functional connection value of the right anterior insula and the left cingulate gyrus is negatively correlated with the intensity of pain. That is, the stronger the pain intensity, the weaker the functional connection of the right anterior insula and the left cingulate gyrus in TMD patients. The 1. study revealed that the TMD related pain was not only the weight of the prominence network. In the brain area, the abnormality of local neuroactivity in the right anterior insula is associated with abnormal correlation with the right anterior insula and other major brain regions (cingulate gyrus) and the functional connection with the default network associated brain region (anterior lobe) in the right anterior insula (.2.). The internal connection of the explicit network and the abnormal functional connection between the explicit network and the default network may be closely related to the central nervous mechanism of TMD pain..3.TMD pain is a persistent nociceptive pain, which may lead to higher central nociceptive system excitability, abnormal pain modulation pathway, and local brain activity in the brain region. And the abnormality of the connection between brain network nodes indicates that the important role of central sensitization in TMD pain is.4. psychological factors, especially anxiety, depression and somatic symptoms also play a role in the development of TMD pain. The central nervous system causes chronic pain development or its continuing pathway may be related to the psychological factors associated with congenital character. These factors may reduce the ability of the brain to modulate nociceptive pain afferent.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.6
【参考文献】
相关期刊论文 前1条
1 Shanshan Zhang;Wen Wu;Guozhi Huang;Ziping Liu;Shigui Guo;Jianming Yang;Kangling Wang;;Resting-state connectivity in the default mode network and insula during experimental low back pain[J];Neural Regeneration Research;2014年02期
，本文编号：2153085
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