基于rs-fMRI技术探讨臭氧水对膝骨性关节炎疼痛患者镇痛作用的中枢机制

Probe of the central mechanism of analgesic effect of ozone water on patients with knee osteoarthritis pain based on rs-fMRI technique

目的利用静息态功能磁共振成像(resting state functional magnetic resonance imaging,rs-fMRI)技术探讨臭氧水对慢性疼痛的膝骨性关节炎(knee osteoarthritis,KOA)患者镇痛作用的中枢效应机制,为临床臭氧水治疗KOA提供理论依据。材料与方法将符合纳入标准的18名KOA患者进行臭氧水关节腔冲洗治疗,每周1次,共治疗3次。分别在治疗前、治疗后行疼痛视觉评分(visual analog scale,VAS)和rs-fMRI扫描;采用局部一致性(regional homogeneity,ReHo)的数据分析方法,分析臭氧水治疗后ReHo显著变化的脑区;并将ReHo与VAS评分变化进行Pearson相关性分析。结果臭氧水治疗后,KOA患者的VAS评分显著降低(P=0.000),枕上回(t=3.69)、枕中回、楔叶、角回等脑区不同区域ReHo值增高(t=4.89),中央沟盖(t=-4.19)、颞上回、中央前回等脑区不同区域ReHo值降低(t=-5.45)。相关性分析结果显示臭氧水治疗后,右岛叶(r=-0.657)ReHo变化与VAS变化呈负相关。结论臭氧水可能是通过调节颞叶、顶叶、额叶、枕叶等脑区的功能达到治疗KOA患者疼痛的作用;而岛叶可能是臭氧水镇痛作用的关键脑区。

Objective:To explore the central mechanism of analgesic effect of ozone water on knee osteoarthritis(KOA)patients with chronic pain by resting state functional magnetic resonance imaging(rs-fMRI),so as to provide theoretical basis for ozone water treatment of KOA.Materials and Methods:Eighteen patients with KOA who met the inclusion criteria were treated with joint cavity irrigation with ozone water.Visual analogue score(VAS)and rs-fMRI scan were performed before and after ozone water treatment.Regional homogeneity(ReHo)t data analysis method was used to analyze the brain areas with significant changes in ReHo after ozone water treatment.Pearson correlation analysis was performed between the changed ReHo and the changed VAS score.Results:After treatment with ozone water,ReHo values in different brain regions such as middle occipital gyrus,superior occipital gyrus,cuneiform lobe and angular gyrus in KOA patients increased,while ReHo values in superior temporal gyrus,central sulcus cover and precentral gyrus decreased.The results of correlation analysis showed that there was a negative correlation between the changes of ReHo and VAS in the right insular after ozone water treatment.Conclusions:Ozone water therapy may treat pain in patients with KOA by regulating the function of temporal lobe,parietal lobe,frontal lobe and occipital lobe,while insular may be the critical brain area of ozone water analgesia.