有先兆与无先兆偏头痛患者静息态功能磁共振局部一致性观察

Altered cortical and subcortical local coherence in migraine with and without aura： evidence from resting-state fMRI

目的 采用静息态功能磁共振（rfMRI）方法通过对比无先兆偏头痛（MwoA）患者、有先兆偏头痛（MA）患者及健康人的大脑自发脑活动的局部一致性（ReHo）差异从而进一步阐明偏头痛的脑功能机制.方法 收集2014年3至10月就诊于河北医科大学第二医院神经内科门诊的发作间期的23例MwoA（MwoA组）和12例MA患者（MA组）以及25名性别、年龄、受教育程度相匹配的健康被试对照组,对其进行临床资料的采集及rfMRI检查.应用ReHo方法分析每个被试大脑的相邻体素的血氧水平依赖（BOLD）信号在同一时间序列中波动的一致性,比较三组受试者大脑ReHo值的差异.结果 MwoA组右侧丘脑、右侧壳核、右侧前额叶皮质、右侧海马的ReHo值显著高于健康对照组（P＜0.05）.MA组右侧丘脑、右侧壳核、右侧小脑、脑干的ReHo值显著低于健康对照组,而右侧枕叶的ReHo值显著高于健康对照组（P＜0.05）.与MA组相比,MwoA组右侧小脑、脑干的ReHo值显著增高（P＜0.05）.结论 静息态下这些功能异常的脑区可能与MA及MwoA患者的疼痛调节功能受损相关.MA与MwoA脑区结果的异同可能反映出两者病理机制的异同.

Objective To compare the interictal spontaneous brain activity between migraine without aura（MwoA） patients, Migraine with visual aura（MA） patients and healthy control subjects in order to provide further insights into the complex migraine pathophysiology.Methods Twenty-three eligible MwoA patients, twelve MA patients who were treated in the neurology clinics in the Second Hospital of Hebei Medical University from March to October 2014 and twenty-five gender-, age-and education-matched healthy volunteers participated in this study.After demographic and clinical characteristics were acquired, a 3.0-T MRI system was used to obtain rfMRI.ReHo method was applied to analyze the synchronization of the BOLD signal in the same time series among neighboring voxels of the brain.Results Compared with healthy controls, MwoA patients showed significant decreases in ReHo values in the right thalamus, right putamen, right prefrontal lobe and right hippocampus （P 〈 0.05）;while MA patients showed significant decreases in ReHo values in the right thalamus, right putamen, right cerebellum and brainstem, whereas a significant increase in ReHo values in the right occipital lobe （P〈0.05）.Furthermore, compared with MA patients, increased ReHo values in the right cerebellum and brainstem were shown in the MwoA group （P 〈 0.05）.Conclusions The results suggest that the resting-state abnormalities of these regions may be associated with functional impairments in pain processing in migraine.Specifically, the results of brain regions may reflect both the similarities and differences of pathophysiological mechanisms relative to the major subtypes of migraine.