帶狀皰疹后遺神經(jīng)痛患者腦靜息態(tài)功能磁共振研究
發(fā)布時間：2018-09-10 21:42
【摘要】：[目的]帶狀皰疹后遺神經(jīng)痛是臨床上一種慢性頑固性神經(jīng)病理性疼痛,然而,對于其潛在的神經(jīng)病理機(jī)制還知之甚少,利用靜息態(tài)功能磁共振成像(Rs-fMRI)低頻振幅分?jǐn)?shù)(fALFF)及局部一致性(ReHo)的腦功能分析方法觀察帶狀皰疹后遺神經(jīng)痛(PHN)患者靜息狀態(tài)下相關(guān)腦區(qū)功能改變情況;并探討PHN患者fALFF及ReHo異常腦區(qū)與自發(fā)性疼痛強(qiáng)度及病程的相關(guān)性。[資料與方法]收集帶狀皰疹后遺神經(jīng)痛患者15例(PHN組)及與PHN組性別、年齡及受教育程度匹配的健康志愿者15名(HC組),所有患者由疼痛科專家嚴(yán)格按照國內(nèi)專家共識的診斷標(biāo)準(zhǔn)確診。采用荷蘭PHILIPS Achieva 3.0T TX超導(dǎo)磁共振掃描儀,8通道頭部相控陣線圈進(jìn)行常規(guī)頭顱磁共振、全腦3D結(jié)構(gòu)相及靜息態(tài)功能序列掃描,獲取被試者全腦相應(yīng)數(shù)據(jù)。采用DPARSF 4.3軟件對原始數(shù)據(jù)進(jìn)行預(yù)處理,并進(jìn)行fALFF、ReHo腦功能分析。統(tǒng)計分析采用SPSS 17.0組間一般資料進(jìn)行兩獨(dú)立樣本t檢驗(yàn),采用REST1.8軟件對兩組間Rs-fMRI(fALFF、ReHo)數(shù)據(jù)進(jìn)行雙樣本t檢驗(yàn)(年齡、性別及受教育程度作為協(xié)變量),再將PHN組Rs-fMRI結(jié)果中異常腦區(qū)分別與患者疼痛強(qiáng)度(VAS)、病程進(jìn)行相關(guān)性分析(年齡、性別及疼痛部位作為協(xié)變量)。[結(jié)果]1 fALFF分析:與正常對照組相比,fALFF升高的區(qū)域分布于左側(cè)小腦前葉/后葉、小腦蚓部、中腦、腦橋、左側(cè)腦干、左側(cè)額上回、左側(cè)額下回、左側(cè)中央前回、左側(cè)顳上回、左側(cè)顳中回、左側(cè)顳下回、左側(cè)梭狀回、左側(cè)緣上回、左側(cè)頂下小葉、左側(cè)中央后回、左側(cè)中央旁小葉、左側(cè)枕中回、左側(cè)枕下回、左側(cè)丘腦、左側(cè)邊緣葉、左側(cè)島葉、左側(cè)海馬、左側(cè)海馬旁回、左側(cè)尾狀核、左側(cè)殼核、左側(cè)蒼白球、左側(cè)杏仁核,其中島葉神經(jīng)元活動最強(qiáng);fALFF減低區(qū)域分布于左側(cè)額上回、左側(cè)額中回、左側(cè)額下回、右側(cè)額上回、右側(cè)額中回、右側(cè)額下回、右側(cè)顳上回、右側(cè)顳中回、右側(cè)中央后回,其中左側(cè)額上回的神經(jīng)元活動最弱)。(經(jīng) AlphaSim 校正,取 P0.001,激活簇(cluster size)≥54 為閾值)。2 ReHo分析:與正常對照組相比,PHN組ReHo升高的腦區(qū)位于:左側(cè)腦干、中腦、左側(cè)小腦半球、左側(cè)額上回、左側(cè)額中回、左側(cè)中央前回、左輔助運(yùn)動區(qū)、左側(cè)旁中央小葉、左側(cè)顳上回、左側(cè)顳中回、左側(cè)顳下回、左側(cè)顳橫回、左側(cè)中央后回、左側(cè)緣上回、左側(cè)枕中回、左側(cè)梭狀回、左側(cè)腦島、左側(cè)扣帶回、左側(cè)海馬旁回、左側(cè)海馬、左側(cè)丘腦、左側(cè)尾狀核、左側(cè)殼核,其中腦干ReHo升高最明顯;ReHo減低的腦區(qū)分布于左側(cè)額上回、右側(cè)額上回、左側(cè)額中回、右側(cè)額中回、左側(cè)前扣帶回、右側(cè)前扣帶回、左側(cè)直回、右側(cè)直回、右側(cè)中央前回,其中右側(cè)前扣帶回ReHo降低最明顯。(經(jīng)AlphaSim校正,取P0.001,激活簇(cluster size)≥54 為閾值)。3 PHN患者fALFF、ReHo結(jié)果中異常腦區(qū)與疼痛強(qiáng)度無相關(guān)性(P0.05)。4 PHN患者fALFF、ReHo結(jié)果中異常腦區(qū)與病程無相關(guān)性(P0.05)。[結(jié)論]PHN患者腦內(nèi)存在多個fALFF、ReHo異常改變的腦區(qū),提示相應(yīng)腦區(qū)內(nèi)神經(jīng)元活動強(qiáng)度、同步性發(fā)生了改變,說明PHN可導(dǎo)致相對應(yīng)區(qū)域腦功能的異常,并且PHN患者腦局部活動異常不局限于疼痛矩陣,除了與疼痛感知相關(guān)的區(qū)域,還涉及認(rèn)知、運(yùn)動、情緒活動區(qū)域,進(jìn)一步說明PHN患者大腦功能存在可塑性變化。聯(lián)合應(yīng)用RS-fMRI的兩種分析方法(fALFF、ReHo)能有效地評價靜息態(tài)下腦功能狀態(tài)的改變,更有利于探討PHN的神經(jīng)功能受損情況,為PHN患者神經(jīng)病理生理機(jī)制的研究提供功能神經(jīng)解剖學(xué)依據(jù)。
[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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R752.12
本文編號：2235695
[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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R752.12
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