慢性腰背痛患者的大脑灰质异常:基于体素的形态测量学分析

Brain gray matter abnormalities revealed by voxel-based morphometry in patients with chronic low back pain

目的探讨慢性腰背痛患者大脑灰质的形态学变化。方法选择30例慢性腰背痛患者和30例健康志愿者,行3.0T磁共振扫描,获得高分辨T1结构像数据并用FMRIB软件库中的基于体素的形态学分析方法进行数据处理和统计学分析,获得疼痛组和健康组之间大脑灰质的形态学差异信息。结果与健康志愿者相比较,慢性腰背痛患者大脑皮层多个脑区灰质体积减少,包括双侧额上回、右侧额极、左侧岛叶、左侧颞下回及左侧颞中回(P<0.05,TFCE校正后);皮层下多个灰质核团体积增加,包括左侧丘脑、双侧壳核、双侧伏隔核、右侧尾状核(P<0.05,TFCE校正后)。结论慢性腰背痛患者大脑皮层和皮层下灰质存在不同的改变模式,这种变化可能与大脑对慢性疼痛的适应不良有关。

Objective To explore the morphometric abnormalities of brain gray matter(GM) in patients with chronic low back pain(CLBP). Methods Thirty patients with CLBP and 30 healthy individuals were enrolled and examined with a 3.0 T magnetic resonance(MR) scanner. High-resolution T1 structural MR data were acquired and data analysis was performed using voxel-based morphometry(VBM) in FMRIB Software Library. The morphological differences were compared between the two groups. Results Compared with the healthy control subjects, patients with CLBP showed decreased GM volumes in several brain cortical areas including the bilateral superior frontal gyrus, right frontal pole, left insular cortex, left middle and left inferior temporal gyrus(P<0.05, after TFCE correction). Increased GM volumes were found in the patients in the subcortical structures including the left thalamus, bilateral putamen, bilateral nucleus accumben and right caudate nucleus(P<0.05, after TFCE correction). Conclusion Patients with CLBP have different patterns of GM abnormalities in different brain regions, characterized by reduced GM volume in cerebral cortical regions and increased GM volume in the subcortical nuclei.Such changes might be associated with the maladaptation of the brain in chronic pain state.