男性慢性盆腔疼痛综合征患者疼痛调节fMRI局部一致性研究

Mechanisms of pain regulation in chronic pelvic pain syndrom：a fMRI study based on regional homogeneity method

目的 采用基于局部一致性（regional homogeneity,ReHo）方法的静息态fMRI技术探讨男性慢性盆腔疼痛综合征（chronic pelvic pain syndrome,CPPS）的脑发病机制.方法 纳入19例男性CPPS患者和19例年龄匹配的男性健康对照.所有受试者在3.0 T磁共振成像仪上完成脑部静息态fMRI数据采集并在进行磁共振扫描前完成慢性前列腺炎症状评分量表（National Institutes of Health Chronic Prostatitis Symptom Index,NIH-CPSI）的总分和疼痛评分.采用SPM5和DPARSF软件对fMRI数据进行处理后得到每个受试者的标准化全脑ReHo图.对患者组和健康对照组间的差异脑区进行双样本t检验,采用基于蒙特卡罗模拟的AlphaSim方法进行多重比较校正,校正后P＜0.05为差异有统计学意义.分别提取CPPS患者组中存在统计学差异脑区的时间序列并与NIH-CPSI的疼痛评分进行相关性分析.结果 与健康对照组相比,CPPS患者组的ReHo值在左侧前扣带回区（MNI坐标：-5,31,26）和右侧前扣带回区（6,12,28）显著减低（P＜ 0.05,Alphasim校正）,而在右侧丘脑区（9,-10,7）显著增高（p＜0.05,Alphasim校正）.在CPPS患者组中,左侧前扣带回和右侧前扣带回区的激活程度均与NIH-CPSI量表疼痛评分呈显著负相关（r值分别为-0.6和-0.5,均P＜0.05）,而右侧丘脑区的激活程度与NIH-CPSI量表疼痛评分呈显著正相关（r=0.6,P＜0.05）.结论 与健康对照相比,CPPS患者存在多个异常激活的脑区.这些脑区导致了CPPS患者的痛觉调节功能异常.

Objective To explore the mechanism of chronic pelvic pain syndrome （CPPS） using fMRI based on regional homogeneity （ReHo） method.Methods 19 male patients with CPPS and 19 agematched nale healthy controls were enrolled in this study.Resting-state fMRI data were obtained from all participants using a 3.0 T magnetic resonance unit.National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI） total score and pain subscale were obtained from each participant before the magnetic resonance imaging scan.The softwares of SPM5 and DPARS were adopted to process the resting-state fMRI data and acquire individual ReHo maps for each participant.A two-sample t-test was used to detect the differences of cerebral regions in the ReHo maps between the patients with CPPS and the healthy controls.AlphaSim based on Monte Carlo simulation was applied for multiple comparison correction.After correction,P〈0.05 was considered statistically significant.The time series in the significantly alerted cerebral regions of the patients were extracted and correlated with the NIH-CPSI pain subscales.Results The patients with CPPS had significantly decreased ReHo in the left anterior cingulate cortex （MNI coordinate：-5,31,26）and the right anterior cingulate cortex （6,12,28） （P〈 0.05,Alphasim correction）,while significantly increased ReHo in the right thalamus （9,-10,7） compared with the healthy controls （P〈0.05,Alphasim correction）.In the patients with CPPS,there were significantly negative correlations between the left anterior cingulate cortex and the NIH-CPSI pain subscale （r=-0.6,P〈0.05）,and between the right anterior cingulate cortex and the NIH-CPSI pain subscale（r=-0.5,P〈0.05）,while a significantly positive correlation between the right thalamus and the NIH-CPSI pain subscale （r=0.6,P〈0.05）.Conclusions The patients with CPPS have alerted cerebral regions compared with the healthy controls.The abnormal brain regions maybe result in dysfunction pain modulation in patients with CPPS.