前扣带回功能连接异常对无先兆偏头痛患者非甾体类抗炎药疗效的预测效能

The predicting effect of disrupted functional connectivity of anterior cingulate cortex on the efficacy of nonsteroidal anti-inflammatory drugs in migraineurs without aura

目的探讨前扣带回皮层(anterior cingulate cortex,ACC)功能连接变化对无先兆偏头痛(migraine without aura,MwoA)患者非甾体类抗炎药(non-steroid anti-inflammatory drugs,NSAIDs)疗效的预测效能。方法2019年1月至2021年1月选取偏头痛患者70例及同期健康体检者33例。采用基于ACC为种子点的功能连接方法,对NSAIDs有效(n=35)、NSAIDs无效(n=35)的MwoA患者和健康对照(n=33)的静息态脑功能活动进行比较,分析异常功能连接改变与偏头痛临床特征的相关性。运用受试者工作特征(ROC)曲线分析ACC异常功能连接对MwoA患者NSAIDs疗效的预测效能。结果(1)与NSAIDs无效组相比,NSAIDs有效组患者左侧ACC与左侧中央后回(posterior central gyrus,PoCG)(MNI坐标:x,y,z=-21,-45,69,团簇=12,t=3.016)、右侧ACC与左侧中扣带回(middle cingulate cortex,MCC)(MNI坐标:x,y,z=0,-24,48,团簇=14,t=3.380)功能连接均显著增强(均P<0.005,Bonferroni矫正)。与健康组相比,NSAIDs有效组和无效组患者左侧ACC与同侧顶下小叶、额中回、角回功能连接增强;右侧ACC与右侧楔前叶、两侧额中回、左侧角回功能连接增强(均P<0.005,Bonferroni矫正)。(2)NSAIDs有效组右侧ACC与同侧楔前叶功能连接强度和MIDAS评分呈正相关(r=0.375,P=0.035);NSAIDs无效组左侧ACC与同侧角回和额中回的功能连接强度分别与头痛发作持续时间(r=0.357,P=0.045)和偏头痛病程(r=-0.367,P=0.039)呈显著相关性。(3)ROC曲线分析得出右侧ACC与左侧MCC、左侧ACC与左侧PoCG功能连接预测NSAIDs疗效的曲线下面积(AUC)分别是0.728和0.736。结论静息态ACC功能连接参与NSAIDs镇痛作用,并对药物疗效具有一定预测作用,为进一步解释偏头痛神经生理机制和辅助临床个体化精确治疗提供影像学证据。

Objective To investigate the predicting effect of the disrupted functional connectivity of the anterior cingulate cortex(ACC)on the efficacy of non-steroidal anti-inflammatory drugs(NSAIDs)in patients with migraineurs without aura(MwoA).Methods From January 2019 to January 2021,seventy patients with migraine and thirty-three healthy people in the same period were selected.The functional connectivity analysis based on the ACC was used in MwoA patients with NSAIDS-effective(n=35),MwoA patients with NSAIDS-ineffective(n=35),and healthy controls(HCs)(n=33).The abnormal resting-state functional connectivity patterns among the three groups were analyzed to reveal potential correlations with clinical characteristics in migraine.Then the receiver operating characteristic(ROC)curve was used to analyze the predictive ability of the abnormal ACC functional connectivity on the efficacy of NSAIDs in patients with MwoA.Results(1)Compared with the MwoA patients with NSAIDs-ineffective,the MwoA patients with NSAIDs-effective showed higher functional connectivity between bilateral ACC and left middle cingulate cortex(MCC)(MNI:x,y,z=0,-24,48,cluster=14,t=3.380)and postcentral gyrus(PoCG)(MNI:x,y,z=-21,-45,69,cluster=12,t=3.016)(all P<0.005,Bonferroni correction).Compared with the HCs,patients with MwoA showed increased functional connectivity between left ACC and ipsilateral inferior parietal lobule,middle frontal gyrus(MFG)and angular gyrus(AG),and between right ACC and right precuneus,bilateral MFG and left AG(all P<0.005,Bonferroni correction).(2)There was a positive correlation between the functional connectivity of right ACC to right precuneus and MIDAS scores(r=0.375,P=0.035)in MwoA patients with NSAIDs-effective.In MwoA patients with NSAIDs-ineffective,there were also significant correlations between the functional connectivity of left ACC to ipsilateral AG and MFG and headache onset duration(r=0.357,P=0.045)and disease duration(r=-0.367,P=0.039).(3)ROC curve analysis showed that the area under the curve(AUC)for the functional connectivity between the right ACC and left MCC and between the left ACC and left PoCG to predict the efficacy of NSAIDs were 0.728 and 0.736,respectively.Conclusions Resting-state functional connectivity of the ACC is involved in the evaluation and prediction for analgesic efficacy of NSAIDs in migraine patients,which provides neuroimaging evidence for further investigations on the neurophysiological mechanism of migraine and assistance in clinical individualized precise treatment.