慢性下腰痛患者静息态功能磁共振成像脑活动差异研究
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摘要
目的探究慢性下腰痛(CLBP)患者的脑静息态功能磁共振成像(rs-fMRI)改变。方法对23例CLBP患者(CLBP组)及20名正常受试者(HC组)进行血氧水平依赖(BOLD)rs-fMRI扫描。采用中文版简版McGill疼痛评分问卷-2(SF-MPQ-2)、Oswestry腰背、下肢功能障碍评分问答调查表(ODI)、PHQ-9抑郁症筛查量表及医院焦虑抑郁情绪测量表(HAD-A量表)评判受试者临床状态,比较两组之间局部一致性(ReHo)、低频振幅(ALFF)、默认网络(DMN)的功能连接差异,并比较DMN差异脑区的Z值与疼痛种类、疼痛程度的相关性。结果与HC组相比,CLBP组的右侧额中回ALFF增高,右侧额上回、右侧楔前叶及楔叶的ALFF减低。左侧前额叶、双侧中后扣带回的DMN功能连接减低。两组之间的ReHo没有显著差异。DMN差异脑区的活动与疼痛种类、疼痛程度没有直接的联系。结论静息态下,CLBP组存在局部脑区的ALFF、DMN功能连接存在异常,这些异常可能与下腰痛的疼痛发生或疼痛抑制相关。
Objective To investigate the changes of resting function magnetic resonance imaging in patients with chronic low back pain. Methods 23 patients with chronic low back pain and 20 normal controls underwent with resting Bold-fMRI,to compare the difference in ReHo,ALFF and DMN functional connection between the two groups. The clinical status of the subjects was evaluated by Short-form McGill Pain Questionnaire-2,Oswestry disability index,PHQ-9 depression screening scale and HAD-A scale. The Z value of the brain region in the default network differences and its relationship with the type and the degree of pain was explored. Results Compared with the normal control group,the ALFF increased in the right frontal gyrus,and the ALFF of the right superior frontal gyrus,precuneus and cuneus decreased in the patients with chronic low back pain. The functional connection of DMN in the left prefrontal cortex and bilateral cingulate cortex decreased. There was no significant difference in ReHo between the two groups and there was no difference in DMN between the activities of the brain region and the type/degree of low back pain. Conclusion In the resting state,there were changes of ALFF and DMN functional connections in some local brain region: of the patients with chronic low back pain. These changes may be related to the pain or pain suppression of the low back pain.
Objective To investigate the changes of resting function magnetic resonance imaging in patients with chronic low back pain. Methods 23 patients with chronic low back pain and 20 normal controls underwent with resting Bold-fMRI,to compare the difference in ReHo,ALFF and DMN functional connection between the two groups. The clinical status of the subjects was evaluated by Short-form McGill Pain Questionnaire-2,Oswestry disability index,PHQ-9 depression screening scale and HAD-A scale. The Z value of the brain region in the default network differences and its relationship with the type and the degree of pain was explored. Results Compared with the normal control group,the ALFF increased in the right frontal gyrus,and the ALFF of the right superior frontal gyrus,precuneus and cuneus decreased in the patients with chronic low back pain. The functional connection of DMN in the left prefrontal cortex and bilateral cingulate cortex decreased. There was no significant difference in ReHo between the two groups and there was no difference in DMN between the activities of the brain region and the type/degree of low back pain. Conclusion In the resting state,there were changes of ALFF and DMN functional connections in some local brain region: of the patients with chronic low back pain. These changes may be related to the pain or pain suppression of the low back pain.
引文
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11 刘颖,安孝梅.慢性疼痛的功能MRI研究进展[J].磁共振成像,2016,7:876-880.
12 Baliki MN,Chialvo DR,Geha PY,et al.Chronic pain and the emotional brain:specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain[J].J Neurosci,2006,26:12165-12173.
13 Giesecke T,Gracely RH,Clauw DJ,et al.Central pain processing in chronic low back pain.Evidence for reduced pain inhibition[J].Schmerz,2006,20:411-417.
14 Song XW,Dong ZY,Long XY,et al.REST:a toolkit for resting-state functional magnetic resonance imaging data processing[J].PLoS One,2011,6:e25031.
15 李雨,舒华.默认网络的神经机制、功能假设及临床应用[J].心理科学进展,2014,22:234-249.
16 Wasan AD,Loggia ML,Chen LQ,et al.Neural correlates of chronic low back pain measured by arterial spin labeling[J].Anesthesiology,2011,115:364-374.
17 Matsuo Y,Kurata J,Sekiguchi M,et al.Attenuation of cortical activity triggering descending pain inhibition in chronic low back pain patients:a functional magnetic resonance imaging study[J].J Anesth,2017,31:523-530.
18 Kobayashi Y,Kurata J,Sekiguchi M,et al.Augmented cerebral activation by lumbar mechanical stimulus in chronic low back pain patients:an FMRI study[J].Spine (Phila Pa 1976),2009,34:2431-2436.
2 Baliki MN,Petre B,Torbey S,et al.Corticostriatal functional connectivity predicts transition to chronic back pain[J].Nat Neurosci,2012,15:1117-1119.
3 Hashmi JA,Baliki MN,Huang L,et al.Shape shifting pain:chronification of back pain shifts brain representation from nociceptive to emotional circuits[J].Brain,2013,136:2751-2768.
4 Baliki MN,Geha PY,Apkarian AV,et al.Beyond feeling:chronic pain hurts the brain,disrupting the default-mode network dynamics[J].J Neurosci,2008,28:1398-1403.
5 Baliki MN,Geha PY,Fields HL,et al.Predicting value of pain and analgesia:nucleus accumbens response to noxious stimuli changes in the presence of chronic pain[J].Neuron,2010,66:149-160.
6 Kong J,Spaeth RB,Wey HY,et al.S1 is associated with chronic low back pain:a functional and structural MRI study[J].Mol Pain,2013,9:43.
7 Kregel J,Meeus M,Malfliet A,et al.Structural and functional brain abnormalities in chronic low back pain:A systematic review[J].Semin Arthritis Rheum,2015,45:229-237.
8 Giesecke T,Gracely RH,Grant MA,et al.Evidence of augmented central pain processing in idiopathic chronic low back pain[J].Arthritis Rheum,2004,50:613-623.
9 Letzen JE,Robinson ME.Negative mood influences default mode network functional connectivity in patients with chronic low back pain:implications for functional neuroimaging biomarkers[J].Pain,2017,158:48-57.
10 Ng SK,Urquhart DM,Fitzgerald PB,et al.The Relationship between Structural and Functional Brain Changes and Altered Emotion and Cognition in Chronic Low Back Pain:A Systematic Review of MRI and fMRI Studies[J].Clin J Pain.2018,34:237-261.
11 刘颖,安孝梅.慢性疼痛的功能MRI研究进展[J].磁共振成像,2016,7:876-880.
12 Baliki MN,Chialvo DR,Geha PY,et al.Chronic pain and the emotional brain:specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain[J].J Neurosci,2006,26:12165-12173.
13 Giesecke T,Gracely RH,Clauw DJ,et al.Central pain processing in chronic low back pain.Evidence for reduced pain inhibition[J].Schmerz,2006,20:411-417.
14 Song XW,Dong ZY,Long XY,et al.REST:a toolkit for resting-state functional magnetic resonance imaging data processing[J].PLoS One,2011,6:e25031.
15 李雨,舒华.默认网络的神经机制、功能假设及临床应用[J].心理科学进展,2014,22:234-249.
16 Wasan AD,Loggia ML,Chen LQ,et al.Neural correlates of chronic low back pain measured by arterial spin labeling[J].Anesthesiology,2011,115:364-374.
17 Matsuo Y,Kurata J,Sekiguchi M,et al.Attenuation of cortical activity triggering descending pain inhibition in chronic low back pain patients:a functional magnetic resonance imaging study[J].J Anesth,2017,31:523-530.
18 Kobayashi Y,Kurata J,Sekiguchi M,et al.Augmented cerebral activation by lumbar mechanical stimulus in chronic low back pain patients:an FMRI study[J].Spine (Phila Pa 1976),2009,34:2431-2436.
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