大脑控制膀胱储尿功能的静息态功能核磁成像研究

A resting-state functional MRI study on brain control of bladder storage function

目的采用静息态功能核磁（rs—fMRI）技术观察健康成人膀胱储尿期的大脑功能控制区域。方法2014年10月至2016年10月选取健康受试者，分别在膀胱空虚状态（膀胱容量〈10m1）和膀胱充盈状态（强烈的排尿感，膀胱容量在200—400m1）进行rs—fMRI扫描。扫描后通过rs—fMRl分析软件SPM8、DPABI、REST等，处理分析两种状态下大脑血液灌注的差异，对健康受试者的脑激活区域进行比较。运用局部一致性（ReHo）方法分析FS—fMRI扫描的大脑功能核磁数据：①大脑的主要观察区域，包括兴奋区域和抑制区域；@peek点坐标X、Y、Z值；③激活体积（体束）；④大脑激活区域兴奋、抑制程度（T值）。结果共纳入健康受试者44名。男19名，女25名。年龄22—50岁[（32．3±2．2）岁]。44名均为右利手。其中9名受试者由于行rs-fMRI扫描时头部活动超过1．5mm或1．5。被剔除，共35名受试者纳入数据分析。rs—fMRI检查结果显示膀胱充盈状态下，大脑激活区域包括前额叶、前扣带回、下丘脑、颞叶和左侧尾状核，这些区域与膀胱充盈后的感知及控制相关。结论通过ReHo分析，发现健康受试者膀胱充盈时，前额叶、前扣带回、下丘脑、颞叶和左侧尾状核区域在控尿方面发挥重要作用。

Objective In order to observe central responses during naturally occurring urinary bladder storage in healthy subjects, we examined brain areas that control strong bladder sensation by resting- state functional magnetic resonance imaging （rs-fMRI）. Methods 44 healthy subjects （19 men and 25 women ,between 22 and 50 years of age） were screened in the study from October 2014 to October 2016. All subjects were right-handed and scanned twice under the following two conditions ： empty bladder （ bladder volume 〈 10 ml）and full bladder （＇strong desire to void＇, bladder volume between 200 and 400 ml） without the use of filling with a catheter. Brain imaging softwares （SPM8,DPABI, REST） were adopted to analyze the difference in brain-blood perfusion between these two conditions. Voxe[-based analysis of the regional homogeneity （ReHo） was performed to analyze rs-fMRI data including the main excitatory regions and inhibitory areas, peak value （ X-axis, Y-axis, Z-axis ） , clusters size （ active volume unit ： number of voxel ） , T value （ the excitatory and inhibitory extent of brain active regions）. Results The rs-fMRI scans of 44 healthy subjects were analyzed. Nine subjects were excluded because of excessive head movements of more than 1.5 mm and 1.5~ in rotation. Data sets were obtained from 35 subjects in two states of bladder, empty bladder and strong desires to void. Increased activity during strong desire to void was observed in the prefrontal cortex （PFC）, anterior cingulate cortex （ACC）, hypothalamus, temporal lobes and left caudate nucleus. Conclusions There are significant changes in the brain＇ s ReHo during the strong sensation to void. The results suggest that the PFC, the ACC ,hypothalamus, temporal lobes and left caudate nucleus play a role in the cerebral control of bladder storage without artificial bladder filling in healthy people.