口下颌肌张力障碍全脑灰质形态学研究、危险因素及生命质量调查
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摘要
目的
比较口下颌肌张力障碍患者与正常对照的全脑灰质差异,以探讨其发病机制。探讨口下颌肌张力障碍发病危险因素并评价其健康相关生命质量。
方法
对19例口下领肌张力障碍患者及性别年龄匹配正常对照进行全脑轴位T1加权三维结构像采集。利用SPM8对扫描图像进行预处理,并进行基于体素的统计学分析比较。
对80例口下颌肌张力障碍患者及100例性别年龄比例匹配正常对照进行问卷调查,问卷内容包括一般情况、社会行为因素、环境因素、遗传因素、既往病史、SF-36健康调查量表、汉密尔顿焦虑及抑郁量表等,数据录入IBM SPSS20.0软件进行统计分析。
结果
口下领肌张力障碍在右侧小脑半球、右侧中央后回及双侧楔前叶呈灰质显著增加(P<0.0l,非校正),而在双侧中央前回、右侧壳核、左侧额中回、右侧颢中回则呈灰质显著减少(P 多因素回归分析显示,焦虑、抑郁程度与口下颌肌张力障碍发病呈显著正相关(P<0.05)。口下颌肌张力障碍患者SF-36各维度评分显著低于正常对照(P<0.001)。伴有颈部肌张力障碍患者SF-36躯体疼痛维度评分显著下降(P<0.05),伴有焦虑、抑郁患者SF-36各维度评分显著低于无焦虑抑郁患者(P<0.05)。
结论
口下颌肌张力障碍存在壳核、小脑、感觉运动皮层等区域灰质改变,其病理生理机制可能与皮层-基底节-丘脑-皮层回路及皮层-小脑-丘脑-皮层回路受累的感觉运动整合功能异常有关。
焦虑、抑郁是口下颌肌张力障碍重要的非运动症状,与发病呈正相关,可能为其独立危险因素。口下颌肌张力障碍患者健康相关生命质量普遍降低,伴有颈部受累患者疼痛症状更显著。焦虑、抑郁等情感障碍与健康相关生命质量密切相关,可能为其降低的重要预测因子。
Objective
Compare the difference of gray matter of the whole brain between patients with oromandibular dystonia (OMD) and healthy controls to investigate the pathophysiological mechanism of OMD. Explore the risk factors and assess health related quality of life in patients with OMD.
Method
19patients with OMD were compared with19healthy volunteers matched for sex and age. High-resolution T1-weighted magnetic resonance imaging of each participant was obtained and analyzed by voxel-based morphometry (VBM).80patients with OMD and100age and gender proportion matched healthy controls were recruited. All the patients and controls were investigated by questionnaires about general conditions, social behavioral factors, environment factors, genetic factors, previous diseases,36-item short form health survey (SF-36), Hamilton anxiety and Hamilton depression scale. All of the parameters were input into a database and analyzed using statistical software IBM SPSS20.0.
Result
In patients with OMD, VBM analysis disclosed significantly larger gray matter volume (GMV) in the right cerebellar hemisphere and right postcentral gyrus and in the precuneus bilaterally in patients than in control, while gray matter volume was decreased in the right putamen, right middle temporal gyrus and left middle frontal gyrus and in the precentral gyrus bilaterally (P<0.05, unc).
Multivariate analysis indicated that anxiety and depression were positively related with OMD (P<0.05). OMD demonstrated lower scores on all subscales of the SF-36compared to controls (P<0.001). OMD with cervical dystonia scored significantly lower for body pain (P<0.05). OMD with anxiety and depression had lower SF-36scores on all subscales (P<0.05).
Conclusion
There are gray matter volume changes in putamen, cerebellum and sensorimotor cortex between patients with OMD and healthy controls. The pathophysiological mechanism may associate with dysfunction of sensorimotor integration, involving not only cortico-basal ganglia-thalamo-cortical loop, but the cortico-cerebello-thalamo-cortical loop as well.
The risk factors of OMD are anxiety and depression. The patients with OMD have lower health related quality of life (HRQOL), and pain is more prevalent in patients with cervical dystonia. Anxiety and depression are the most important predictors of poorer HRQOL.
比较口下颌肌张力障碍患者与正常对照的全脑灰质差异,以探讨其发病机制。探讨口下颌肌张力障碍发病危险因素并评价其健康相关生命质量。
方法
对19例口下领肌张力障碍患者及性别年龄匹配正常对照进行全脑轴位T1加权三维结构像采集。利用SPM8对扫描图像进行预处理,并进行基于体素的统计学分析比较。
对80例口下颌肌张力障碍患者及100例性别年龄比例匹配正常对照进行问卷调查,问卷内容包括一般情况、社会行为因素、环境因素、遗传因素、既往病史、SF-36健康调查量表、汉密尔顿焦虑及抑郁量表等,数据录入IBM SPSS20.0软件进行统计分析。
结果
口下领肌张力障碍在右侧小脑半球、右侧中央后回及双侧楔前叶呈灰质显著增加(P<0.0l,非校正),而在双侧中央前回、右侧壳核、左侧额中回、右侧颢中回则呈灰质显著减少(P
结论
口下颌肌张力障碍存在壳核、小脑、感觉运动皮层等区域灰质改变,其病理生理机制可能与皮层-基底节-丘脑-皮层回路及皮层-小脑-丘脑-皮层回路受累的感觉运动整合功能异常有关。
焦虑、抑郁是口下颌肌张力障碍重要的非运动症状,与发病呈正相关,可能为其独立危险因素。口下颌肌张力障碍患者健康相关生命质量普遍降低,伴有颈部受累患者疼痛症状更显著。焦虑、抑郁等情感障碍与健康相关生命质量密切相关,可能为其降低的重要预测因子。
Objective
Compare the difference of gray matter of the whole brain between patients with oromandibular dystonia (OMD) and healthy controls to investigate the pathophysiological mechanism of OMD. Explore the risk factors and assess health related quality of life in patients with OMD.
Method
19patients with OMD were compared with19healthy volunteers matched for sex and age. High-resolution T1-weighted magnetic resonance imaging of each participant was obtained and analyzed by voxel-based morphometry (VBM).80patients with OMD and100age and gender proportion matched healthy controls were recruited. All the patients and controls were investigated by questionnaires about general conditions, social behavioral factors, environment factors, genetic factors, previous diseases,36-item short form health survey (SF-36), Hamilton anxiety and Hamilton depression scale. All of the parameters were input into a database and analyzed using statistical software IBM SPSS20.0.
Result
In patients with OMD, VBM analysis disclosed significantly larger gray matter volume (GMV) in the right cerebellar hemisphere and right postcentral gyrus and in the precuneus bilaterally in patients than in control, while gray matter volume was decreased in the right putamen, right middle temporal gyrus and left middle frontal gyrus and in the precentral gyrus bilaterally (P<0.05, unc).
Multivariate analysis indicated that anxiety and depression were positively related with OMD (P<0.05). OMD demonstrated lower scores on all subscales of the SF-36compared to controls (P<0.001). OMD with cervical dystonia scored significantly lower for body pain (P<0.05). OMD with anxiety and depression had lower SF-36scores on all subscales (P<0.05).
Conclusion
There are gray matter volume changes in putamen, cerebellum and sensorimotor cortex between patients with OMD and healthy controls. The pathophysiological mechanism may associate with dysfunction of sensorimotor integration, involving not only cortico-basal ganglia-thalamo-cortical loop, but the cortico-cerebello-thalamo-cortical loop as well.
The risk factors of OMD are anxiety and depression. The patients with OMD have lower health related quality of life (HRQOL), and pain is more prevalent in patients with cervical dystonia. Anxiety and depression are the most important predictors of poorer HRQOL.
引文
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