腰椎间盘突出症慢性下腰痛患者脑局部一致性改变研究

Changes of regional homogeneity in brain in patients with chronic low back pain due to lumbar disc herniation

目的探讨腰椎间盘突出症(LDH)慢性下腰痛患者脑局部一致性(ReHo)的改变。方法选择2017年1月至2018年3月新乡医学院第二附属医院收治的经保守治疗无效且疼痛持续时间大于3个月的LDH慢性下腰痛患者50例为研究对象(LDH慢性下腰痛组),同期纳入47例性别、年龄相匹配的健康志愿者作为对照组。对所有受试者行常规磁共振检查及脑功能成像,采用基于Matlab2011A下的静息态功能磁共振数据处理助手DPARSF4.3(http://www.restfmri.net)对血氧水平依赖(BOLD)序列进行数据预处理及ReHo计算,分析2组受试者ReHo指标有差异的脑区,并与病程、疼痛程度及抑郁情绪评分进行相关性分析。结果与对照组比较,LDH慢性下腰痛组患者左侧海马旁回、双侧眶部额上回、右侧眶部额下回、右侧三角部额下回、左侧楔前叶、右侧中扣带回ReHo值显著升高,右侧梭状回、左侧距状回、左侧楔叶ReHo值显著减低(P<0.05,GRF校正)。LDH慢性下腰痛组患者右侧眶部额下回ReHo值的增加与病程呈正相关(r=0.444,P=0.001),左侧眶部额上回ReHo值的增加与抑郁自评量表(SDS)评分呈负相关(r=-0.460,P=0.001)。结论LDH慢性下腰痛患者大脑多个脑区存在活动异常,这可能与疼痛引起的情绪障碍相关的身心疾病症状有一定关系。

Objective To investigate the changes of regional homogeneity in brain in patients with chronic low back pain due to lumbar disc herniation(LDH).Methods A total of 50 patients with chronic low back pain due to LDH who failed conservative treatment and had pain lasting longer than three months in the Second Affiliated Hospital of Xinxiang Medical University from January 2017 to March 2018 were selected as the LDH chronic low back pain group,and 47 healthy volunteers with gender and age matching were selected as the control group during the same period.The resting state functional magnetic resonance data processing assistant DPARSF4.3(http://www.restfmri.net)based on Matlab2011A was used for data preprocessing and regional homogeneity(ReHo)calculation of the Blood Oxygen Level Dependent(BOLD)sequence.The brain areas with differences in ReHo were analyzed,and the correlation with disease course,pain degree and depressive mood score was analyzed.Results Compared with the control group,the ReHo values of left parahippocampal gyrus,bilateral orbital frontal gyrus,right orbital inferior frontal gyrus,right triangular inferior frontal gyrus,left precuneus and right middle cingulate gyrus were higher,and the ReHo values of the right fusiform gyrus,the left talus gyrus,and the left cuneus were lower in the LDH chronic low back pain group(P<0.05,GRF corrected).In the LDH chronic low back pain group,the ReHo of the right orbital inferior frontal gyrus was positively correlated with the course of disease(r=0.444,P=0.001).While the ReHo of the left orbital superior frontal gyrus was negatively correlated with the self-rating depression scale score(r=-0.460,P=0.001).Conclusion Abnormal activity of multiple brain regions in LDH patients with chronic low back pain may be related to psychosomatic symptoms related to mood disorders caused by pain.