顳下頜關(guān)節(jié)滑膜炎開(kāi)口痛患者功能磁共振研究
發(fā)布時(shí)間：2018-07-29 15:13
【摘要】：目的:顳下頜關(guān)節(jié)紊亂病(temporomandibular disorders,TMD)被認(rèn)為是除牙痛以外口頜面部疼痛的最常見(jiàn)病因,發(fā)病率較高,但TMD相關(guān)疼痛的病因及病理生理機(jī)制尚缺乏相關(guān)認(rèn)識(shí)。近年來(lái),越來(lái)越多的研究提出中樞神經(jīng)系統(tǒng)機(jī)制可能與TMD相關(guān)疼痛的發(fā)生發(fā)展有關(guān)的假設(shè)。功能性磁共振成像(functional magnetic resonance imaging,f MRI)已經(jīng)廣泛應(yīng)用于多種疼痛性疾病的神經(jīng)活動(dòng)的研究中。本研究利用靜息態(tài)功能磁共振技術(shù)(resting-state f MRI,rs-f MRI),來(lái)研究TMD疼痛患者的疼痛相關(guān)腦區(qū)的局部一致性(regional homogeneity,Re Ho)和靜息態(tài)功能連接(functional connectivity,FC)的變化,以及相關(guān)腦區(qū)自發(fā)性神經(jīng)活動(dòng)與臨床疼痛強(qiáng)度的關(guān)系,進(jìn)而證實(shí)中樞神經(jīng)系統(tǒng)機(jī)制可能與TMD相關(guān)疼痛的發(fā)生發(fā)展有關(guān)的假設(shè)。方法:選取符合納入標(biāo)準(zhǔn)的10名顳下頜關(guān)節(jié)滑膜炎單側(cè)開(kāi)口痛女性患者與10名年齡匹配的健康對(duì)照(healthy controls,HC)參與本研究。TMD組和健康對(duì)照組均要求完成癥狀自評(píng)量表(Symptoms Check List-90,SCL-90)用于心理評(píng)估,并比較兩組評(píng)分差異。TMD開(kāi)口痛患者接受視覺(jué)模擬評(píng)分法(Visual Analogue Scale,VAS)評(píng)估疼痛強(qiáng)度。分別在開(kāi)口狀態(tài)和閉口狀態(tài)采集靜息態(tài)功能磁共振數(shù)據(jù),對(duì)每個(gè)受試者進(jìn)行局部一致性和靜息態(tài)功能連接分析,進(jìn)一步研究自發(fā)性腦活動(dòng)的變化并比較兩組間局部一致性與靜息態(tài)功能連接差異。此外,為研究患者臨床疼痛強(qiáng)度與自發(fā)性腦活動(dòng)強(qiáng)度的關(guān)系,提取激活腦區(qū)局部一致性以及激活腦區(qū)與全腦其他區(qū)域功能連接的平均值,并與VAS評(píng)分作相關(guān)分析。結(jié)果:1.嚴(yán)格納入及排除標(biāo)準(zhǔn),2名TMD患者經(jīng)顳下頜關(guān)節(jié)核磁共振檢查及關(guān)節(jié)鏡手術(shù)證實(shí)為顳下頜關(guān)節(jié)滑膜性軟骨瘤病,故排除,最終納入8名TMD患者和10名健康對(duì)照。2.心理學(xué)評(píng)估方面,與健康對(duì)照組相比,TMD組在除恐怖因子(p=0.098)以外的其他SCL-90因子分均高于對(duì)照組。多重比較校正后,TMD組在軀體癥狀,人際關(guān)系敏感和抑郁等SCL-90項(xiàng)目因子分仍顯著高于健康對(duì)照組。3.靜息態(tài)功能磁共振研究方面,每種條件下的單樣本t檢驗(yàn)局部一致性表現(xiàn)出典型的默認(rèn)網(wǎng)絡(luò)激活,而功能連接則表現(xiàn)為兩種連接方式:與突顯性網(wǎng)絡(luò)(salience network,SN)相關(guān)腦區(qū)為正連接;與默認(rèn)網(wǎng)絡(luò)(default mode network,DMN)相關(guān)腦區(qū)表現(xiàn)為負(fù)連接。4.組間比較結(jié)果:與對(duì)照組相比,TMD患者組右前腦島局部一致性減低,右前腦島與左側(cè)中扣帶回靜息態(tài)正功能連接減低,右前腦島與右側(cè)楔前葉/后扣帶回負(fù)功能連接減低。5.臨床疼痛強(qiáng)度與自發(fā)性腦活動(dòng)強(qiáng)度的關(guān)系:右前腦島與左側(cè)中扣帶回的功能連接值與疼痛強(qiáng)度呈負(fù)相關(guān),即疼痛強(qiáng)度越強(qiáng),TMD患者右前腦島與左側(cè)中扣帶回的功能連接越弱。結(jié)論:1.本研究揭示了TMD相關(guān)疼痛不僅與突顯性網(wǎng)絡(luò)的重要腦區(qū),右前腦島局部神經(jīng)活動(dòng)一致性異常有關(guān),而且與右前腦島與突顯性網(wǎng)絡(luò)的其他主要腦區(qū)(中扣帶回)以及與默認(rèn)網(wǎng)絡(luò)相關(guān)腦區(qū)(楔前葉)功能連接的異常相關(guān)。2.本研究結(jié)果表明,疼痛相關(guān)腦區(qū)功能性適應(yīng)不良性神經(jīng)可塑性改變,突顯性網(wǎng)絡(luò)內(nèi)部連接以及突顯性網(wǎng)絡(luò)與默認(rèn)網(wǎng)絡(luò)的功能連接異�？赡芘cTMD疼痛的中樞神經(jīng)機(jī)制密切相關(guān)。3.TMD疼痛作為一種持續(xù)性的傷害性疼痛傳入,可能會(huì)導(dǎo)致中樞傷害性系統(tǒng)興奮性增高,疼痛調(diào)節(jié)通路異常,表現(xiàn)為腦區(qū)局部腦活動(dòng)以及腦網(wǎng)絡(luò)節(jié)點(diǎn)之間連接關(guān)系的異常,表明中樞致敏作用在TMD疼痛中的重要作用。4.心理因素,尤其是焦慮,抑郁及軀體癥狀也在TMD疼痛發(fā)展中起一定的作用。中樞神經(jīng)系統(tǒng)導(dǎo)致慢性疼痛發(fā)展或持續(xù)途徑可能與先天性格相關(guān)的心理因素有關(guān),這些因素可能降低大腦調(diào)節(jié)傷害性疼痛傳入的能力。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R782.6
本文編號(hào)：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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R782.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
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
，本文編號(hào)：2153085
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