基于动态低频振幅观察不同性别无先兆偏头痛患者脑功能活动差异

Observation on gender differences of brain functional activity in migraine patients without aura using dynamic low-frequency amplitude

目的 采用动态低频振幅(dALFF)技术分析不同性别无先兆偏头痛(MwoA)患者脑功能活动的差异。方法 前瞻性纳入50例MwoA患者(男23例、女27例)及46名健康受试者(男19名、女27名)采集脑功能MRI,以析因设计方差分析观察不同性别MwoA患者与健康受试者各脑区dALFF值的差异,以及其与临床量表评分的相关性。结果 相比健康受试者,MwoA患者右侧舌回及右侧丘脑dALFF值明显降低、左侧颞下回dALFF值明显升高(体素水平P<0.005,簇水平P<0.05);男性MwoA患者右侧岛叶、右内侧和旁侧扣带回dALFF值低于女性(体素水平P<0.005,簇水平P<0.05)。女性健康受试者右侧岛叶、右内侧和旁侧扣带回dALFF值低于男性(体素水平P<0.005,簇水平P<0.05)。交互效应结果显示,女性MwoA患者左侧眶额中回、左内侧额上回脑区活动强于男性、左侧丘脑活动弱于男性;男性健康受试者左侧额中回脑区活动强于女性,左侧额上回、左侧颞下回、右侧丘脑弱于女性(体素水平P<0.005,簇水平P<0.05)。女性MwoA患者左侧丘脑dALFF值与抑郁自评量表评分呈正相关(r=0.39,P=0.043)。结论 MwoA主要表现为皮层活动异常;相比男性,女性MwoA患者脑活动异常主要见于疼痛感知及情绪调节脑区,丘脑可能为其调节疼痛情绪的关键脑区。

Objective To observe the gender differences of brain functional activity between male and female patients with migraine without aura(MwoA)using dynamic amplitude of low-frequency fluctuations(dALFF)technique.Methods Totally 50 MwoA patients(23 males and 27 females)and 46 healthy subjects(19 males and 27 females)were prospectively enrolled,and brain functional MRI were acquired.The differences of dALFF values in different brain regions between MwoA patients and healthy subjects were explored using factorial design analysis of variance,and correlations of dALFF values with clinical scale scores were analyzed.Results dALFF values in right lingual gyrus and right thalamus of MwoA patients were significantly lower,while in left inferior temporal gyrus were significantly higher than those of healthy subjects(voxel level P<0.005,cluster level P<0.05).dALFF values in the right insula,right medial and lateral cingulate gyrus in male MwoA patients were significantly lower than those in female patients(voxel level P<0.005,cluster level P<0.05).dALFF values in the right insula,right medial and lateral cingulate gyrus in female helthy subjects were significantly lower than those in males(voxel level P<0.005,cluster level P<0.05).Female MwoA patients had stronger activity in left middle orbital frontal gyrus and left medial superior frontal gyrus than those in male patients but weaker activity in left thalamus than that in male patients.The brain activity in the left middle frontal gyrus in healthy males was stronger than that in healthy females,while in the left superior frontal gyrus,left inferior temporal gyrus and right thalamus were weaker than that in healthy females(voxel level P<0.005,cluster level P<0.05).dALFF values of the left thalamus in female patients was positively correlated with the depression self-rating scale scores(r=0.39,P=0.043).Conclusion MwoA mainly present as abnormalities in the visual cortex.Compared with male MwoA patients,abnormal brain activity in female MwoA patients mainly located in areas for pain perception and emotion regulation.Thalamus might be the key brain area of female MwoA patients for regulating pain emotion.