肠易激综合征重叠功能性消化不良患者脑部痛觉区域研究

Research about brain pain region of patients with irritable bowel syndrome and functional dyspepsia

目的:探讨单纯肠易激综合征与肠易激综合征重叠功能性消化不良患者在直肠容积性刺激下脑部痛觉功能区域的变化差异。方法:连续收集共纳入30例入住医院诊断为单纯肠易激综合征患者(单纯组)及30例肠易激综合征重叠功能性消化不良患者(重叠组)作为病例观察对象,同时随机选择30例健康人作为正常对照组。所有受试者均行直肠容积性刺激,通过功能性磁共振(fMRI)分析直肠扩张50、100、150 mL容积情况下感觉阈值和痛觉评分。结果:单纯组与重叠组初始感觉、排便感觉及疼痛感觉阈值均低于对照组(P均<0.05)。直肠注气100及150 mL时,单纯组与重叠组疼痛感觉明显高于对照组,差异有统计学意义(P<0.05);脑部疼痛区域主要集中于扣带回、岛叶、额前皮质及丘脑。直肠注气50、100、150 mL时,单纯组与重叠组疼痛兴奋面积及MRI信号强度均明显高于对照组,差异有统计学意义(P<0.05)。结论:在直肠容积性刺激下,肠易激综合征患者存在感觉过敏,虽然其与功能性消化不良有症状的重叠,但重叠功能性消化不良并未影响其敏感性,且脑部痛觉功能区亦无明显叠加表现。

Objective To explore the alteration of brain pain functional areas in patients with functional dyspepsia and irritable bowel syndrome when rectal balloon volume stimulation performed. Methods A total of 30 patients with irritable bowel syndrome alone, 30 patients with functional dyspepsia patients and irritable bowel syndrome and 30 healthy volunteers were recruited. Sensory thresholds and pain scores were recorded during the rectal balloon air injection process. The changes of brain activated areas were analyzed by functional MRI when the rectum was stimulated at the volume of 50,100 and 150 mL. Results The threshold of initial feeling, defecation feeling and pain feeling in pure and overlapping groups were lower than that in the control group（P〈0.05）. The differences of initial feeling, defecation feeling and pain feeling in pure and overlapping group were not significant（P〉0.05）. The pains of rectums with 50 mL volumetric gas injection in the three groups were not statistically different（P〉0.05）. The pains of rectums with 100 and 150 mL volumetric gas injection in the pure and overlapping group were significantly higher than that in the control group（P〈0.05）. The difference between pains of the pure and overlapping groups was not significant（P〉0.05）. Brain pain areas mainly concentrated in cingulate gyrus, insula, forehead cortex and thalamus. The excited area and MRI signal intensity in the pure and overlapping groups were significantly higher than that in the control group（P〈0.05）. The differences between the excited areas and MRI signal intensities in the pure and overlapping group were not significant（P〉0.05）. Conclusion There is no significant difference in activations of brain areas between functional dyspepsia alone and combined functional dyspepsia and irritable bowel syndrome under rectal volumetric stimulation. Under rectal volumetric stimulation, although symptoms overlapped, there is no evidence of the overlap of brain-gut axis and visceral hypersensitivity between functional dyspepsia alone and functional dyspepsia combined with irritable bowel syndrome.