慢性腰腿痛患者左侧眶额皮层的静息态脑活动及功能连接异常

Abnormal Resting-State Brain Activity and Functional Connectivity in the Left Orbitofrontal Cortex in Patients with Chronic Low Back-Related Leg Pain

目的探讨腰椎间盘突出(LDH)所致的慢性腰腿痛患者在静息态下的自发性脑神经活动和功能连接(FC)改变模式及其与疼痛的关系。方法对55例LDH所致的慢性腰腿痛患者(慢性腰腿痛组)及年龄、性别、受教育程度相匹配的60名健康志愿者(对照组)行静息态功能磁共振成像(rs-fMRI)。比较组间比率低频振幅(fALFF)值的差异。以差异脑区为种子点行体素水平全脑FC分析,并分析显著差异脑区的fALFF值及FC值与慢性腰腿痛患者视觉模拟量表(VAS)评分之间的相关性。结果与对照组相比,慢性腰腿痛组左侧眶额皮层(OFC)的fALFF值升高(P<0.05)。以左侧OFC为种子点的FC分析提示,慢性腰腿痛组与对照组比较,左侧OFC与双侧楔前叶的FC增强,与左侧岛叶、右侧额中回和右侧缘上回的FC减弱(P均<0.05);此外,慢性腰腿痛组左侧OFC与右侧额中回的FC值与VAS评分之间呈负相关(r=-0.273,P=0.044)。结论左侧OFC神经活动的升高及其与楔前叶、岛叶、额中回和缘上回的FC改变可能在慢性腰腿痛患者疼痛调节障碍中扮演着重要角色,并且OFC-背外侧前额叶(DLPFC)环路异常可能与疼痛程度有关。

Objective To investigate the patterns of change in spontaneous brain activity and functional connectivity(FC)at resting-state in patients with chronic low back-related leg pain(LBLP)caused by lumbar disc herniation and its relation to pain.Methods Fifty-five patients with LBLP(LBLP group)and 60 age-,sex-and education levelmatched healthy volunteers(control group)underwent a resting-state functional magnetic resonance imaging.First,fractional amplitude of low frequency fluctuation values were compared between the two groups.Then,voxel-wise whole-brain FC analysis was performed with the brain regions showing significant inter-group differences as seed points,and the correlation between the f ALFF and FC values of regions with significant inter-group differences and the visual analogue scale(VAS)scores was analyzed in patients with LBLP.Results Compared with the control group,the LBLP group showed higher f ALFF values in the left orbitofrontal cortex(left OFC)(P<0.05).FC analysis with the left OFC as seed point indicated that the LBLP group,relative to the control group,exhibited decreased FC between the left OFC and the bilateral precuneus,and increased FC between the left OFC and the left insula,right middle frontal gyrus,and right superior margin gyrus(all P<0.05).Furthermore,the FC value between the left OFC and the right middle frontal gyrus was negatively correlated with the VAS score(r=-0.273,P=0.044).Conclusion Increased neural activity of the left OFC and its altered FC with the precuneus,insula,middle frontal gyrus,and superior margin gyrus might play an important role in the dysregulation of pain in patients with LBLP,and the OFC-dorsolateral prefrontal cortex circuit might be associated with the severity of pain.