颈椎间盘源性疼痛患者低频振幅改变的研究

Study on the changes of amplitude of low frequency fluctuation in patients with cervical discogenic pain

目的采用静息态功能磁共振成像(fMRI)技术和低频振幅(ALFF)探讨颈椎间盘源性疼痛(CDP)患者脑功能变化特点。方法选取2018年11月至2019年12月收治的40例CDP患者作为CDP组,另选取同期40名健康志愿者作为对照组。两组均进行静息态颅脑fMRI扫描。比较两组研究对象的MoCA、HAMD、HAMA评分;分析两组研究对象的ALFF,并探讨ALFF与VAS、MoCA、HAMD、HAMA评分的相关性。结果CDP组的MoCA评分明显低于对照组,差异具有统计学意义(P<0.05)。与对照组相比,CDP组左侧脑岛(INS)和左侧楔前叶(PCu)的ALFF升高,而左侧中央前/中央后回(PreCG/PoCG)、膝下前扣带回皮质(sgACC)和丘脑(THA)的ALFF降低。CDP患者左侧PreCG/PoCG的ALFF与VAS评分之间存在负相关性(r=-0.417,P=0.0074)。结论CDP可以引起广泛的脑功能区ALFF异常,涉及疼痛感觉运动、社会认知和情绪多个维度,静息态fMRI可为了解CDP的神经病理学提供影像学证据。左侧PreCG/PoCG的ALFF与疼痛程度存在负相关性,提示可能通过上述脑区自发神经活动的强度客观反映患者的疼痛程度。

Objective To explore the characteristics of brain function changes in patients with cervical discogenic pain(CDP)by using the resting-state functional magnetic resonance imaging(fMRI)technology and amplitude of low frequency fluctuation(ALFF).Methods Forty patients with CDP admitted from November 2018 to December 2019 were selected as CDP group,and 40 healthy volunteers at the same period were selected as control group.Both groups underwent resting-state brain fMRI scans.The MoCA,HAMD and HAMA scores of the two groups were compared;the ALFF of the two groups were analyzed,and the correlation between ALFF and VAS,MoCA,HAMD and HAMA scores were explored.Results The MoCA score of the CDP group was significantly lower than that of the control group,and the difference was statisticlly significant(P<0.05).Compared with the control group,the ALFF of left insula(INS)and the left precuneus(PCu)in the CDP group increased,while the left central anterior/posterior central gyrus(PreCG/PoCG),anterior cingulate cortex(sgACC)and thalamus(THA)decreased.There was a negative correlation between the ALFF of PreCG/PoCG on the left side of CDP patients and VAS score(r=-0.417,P=0.0074).Conclusion CDP can cause a wide range of ALFF abnormalities in brain functional areas,involving multiple dimensions of pain,sensorimotor,social cognition,and emotion.Resting-state fMRI can provide imaging evidence for understanding the neuropathology of CDP.The ALFF of PreCG/PoCG on the left side is negatively correlated with the degree of pain,suggesting that the intensity of the spontaneous nerve activity in the above-mentioned brain area may objectively reflect the degree of pain of patients.