带状疱疹后遗神经痛患者脑基础活动改变的功能核磁共振研究

Dynamic Observation of Baseline Brain Activities in Patients With Postherpetic Neuralgia Revealed by Resting-state Functional MRI

带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是临床上一种慢性顽固性神经病理性疼痛,然而,对于其潜在的中枢机制还知之甚少.为了进一步探讨带状疱疹后遗神经痛患者的相关脑区活动,利用功能核磁共振成像低频振幅振荡(ALFF)技术观察带状疱疹后遗神经痛患者的基础脑区活动.8名带状疱疹后遗神经痛患者与8名性别、年龄相匹配的健康者行静息态功能磁共振(f MRI)成像扫描,用SPM8中的多重回归分析,在控制被试年龄、性别、教育年限的影响下,将每个体素的ALFF值同每个被试的病程、视觉模拟评分(visual analog scale,VAS)进行相关分析.与健康志愿者相比,PHN组与VAS评分相关的ALFF值增高的脑区有:右侧小脑后叶、前额叶背外侧区域(BA11/46/47)、右侧顶叶(BA40)、右侧舌回(BA17/18/19);与VAS评分相关的ALFF值降低的脑区有:右侧颞中回(BA21)、左侧舌回(BA17/18)、右侧小脑前叶、左侧后扣带回(BA30/19)和右侧中央前回(BA3/4/6);PHN组与病程相关的ALFF值增高的脑区有:右侧小脑后叶、前额叶背外侧区域(BA9/10/11/47)、左侧颞上回(BA38)、右侧顶叶和右侧舌回(BA17/18/19);与病程相关ALFF值降低的脑区有:左侧海马旁回(BA28)、右侧小脑前叶、左侧扣带回(BA24)、右侧颞上回(BA13)、左侧中央前回和右侧顶下小叶(BA39/40).研究结果提示,涉及疼痛的情绪、警觉行为、注意的脑区在带状疱疹后遗痛慢性疼痛的产生和维持中发挥重要作用.

Postherpetic Neuralgia（PHN） is a kind of chronic refractory neuropathic pain, yet there is a lack of knowledge regarding underlying brain activity. To further investigate brain activity changes in patients with PHN,we used amplitude of low frequency fluctuation（ALFF） analysis of resting-state f MRI to observe basal brain activity in those patients. Resting-state f MRI acquired in 8 PHN patients as well as in 8 age- and sex-matched normal controls was compared. Voxel-based multiple regression analysis was performed by SPM8 with voxel-wised ALFF as dependent variable, VAS score and pain duration as a covariate of interest. Comparing with healthy controls, PHN showed significant ALFF increases associated with VAS score in right cerebellum posterior lobe, dorsolateral prefrontal cortex（BA11/46/47）, right parietal lobe（BA40） and right lingual gyrus（BA17/18/19）;significant ALFF decreases associated with VAS score in right middle temporal gyrus（BA21）, left lingual gyrus（BA17/18）, right cerebellum anterior lobe, left posterior cingulate（BA30/19） and right precentral gyrus（BA3/4/6）;significant ALFF increases associated with pain duration in right cerebellum posterior lobe, right middle frontal gyrus, dorsolateral prefrontal cortex（BA9/10/11/47）, left superior temporal gyrus（BA38）, right parietal lobe and right lingual gyrus（BA17/18/19）; significant ALFF decreases associated with pain duration in left parahippocampa Gyrus（BA28）, right cerebellum anterior lobe, left cingulate gyrus（BA24）, right superior temporal gyrus（BA13）,left precentral gyrus and right inferior parietal lobule（BA39/40）. The results suggested that the brain areas involved in emotion, attention of pain played an important role in the modulation of PHN.