非甾体抗炎药不同疗效无先兆偏头痛患者大脑静息态振荡振幅百分比变化

Differences of resting-state percent amplitude of fluctuations among migraineurs without aura with different efficacy of non-steroidal anti-inflammatory drugs

目的探讨非甾体抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)不同疗效的无先兆偏头痛(migraine without aura,MwoA)患者静息态脑功能自发活动的差异及其与偏头痛临床特征的相关性。方法2021年2月至2022年4月,在南京医科大学附属江宁医院收集NSAIDs有效偏头痛患者30例、NSAIDs无效偏头痛患者30例和健康志愿者30例。对所有被试进行3.0 T静息态功能磁共振扫描。采用振荡振幅百分比(percent amplitude of fluctuation,perAF)对3组受试者的静息态脑功能活动进行比较(Bonferroni多重比较校正)。使用SPSS 24.0软件和RESTplus软件进行统计分析。采用方差分析比较3组间perAF值,所得差异脑区perAF值与两组偏头痛患者临床特征进行相关性分析。结果3组被试左侧前扣带回(x,y,z=-6,9,-3)、左侧额中回(x,y,z=-39,48,9)和左侧颞中回(x,y,z=-57,-30,-15)的perAF值差异有统计学意义(均P<0.05,Bonferroni校正)。与无效组MwoA患者相比,有效组MwoA患者左侧前扣带回皮层、左侧额中回和左侧颞中回perAF值减低;与健康对照组相比,无效组MwoA患者左侧额中回perAF值升高。有效组MwoA患者左侧前扣带回皮层的perAF值与病程呈正相关(r=0.506,P=0.007);无效组MwoA患者左侧前扣带回皮层的perAF值与头痛频率呈负相关(r=-0.414,P=0.032)。结论前额叶皮层和前扣带回皮层的神经活动可能是MwoA患者对NSAIDs应答的潜在神经病理基础,其中前扣带回皮层功能活动与偏头痛特征存在一定相关性,可以作为评估NSAIDs疗效的影像学指标。

Objective To explore the differences of resting-state spontaneous neural activity between migraine without aura(MwoA)patients with response or nonresponse to non-steroidal anti-inflammatory drugs(NSAIDs),and its correlation with migraine-related features.Methods From February 2021 to April 2022,thirty MwoA patients with response to NSAIDs,30 MwoA patients with nonresponse to NSAIDs,and 30 healthy controls were recruited in the Affiliated Jiangning Hospital of Nanjing Medical University.All subjects were scanned with a 3.0 T resting-state functional magnetic resonance imaging scanner.The percent amplitude of fluctuation(perAF)approach was used to calculate the differences of the resting state brain functional activities among the three groups(Bonferroni multiple comparison correction).SPSS 24.0 software and RESTplus software were used for statistical analysis.Analysis of variance was used for the perAF values of three groups.Correlation analysis was performed between perAF values of brain regions with significant differences and migraine-related features.Results The brain areas showing significant differences of perAF among the three groups located in the left anterior cingulate cortex(ACC)(x,y,z=-6,9,-3),left middle frontal gyrus(MFG)(x,y,z=-39,48,9)and left middle temporal gyrus(MTG)(x,y,z=-57,-30,-15)(all P<0.05,Bonferroni correction).Compared with nonresponse group,the perAF in response group showed significant decreased in the left ACC,MFG and MTG.There was positive correlation between the perAF of left ACC and disease duration(r=0.506,P=0.007).Compared with healthy controls,the perAF of nonresponse group showed increased in the left ACC,which was negatively correlated with frequency(r=-0.414,P=0.032).Conclusion The neural activity of prefrontal cortex and ACC may be the neuropathological basis underlying response to NSAIDs in MwoA treatment.Moreover,the ACC has certain correlations with migraine-related characteristics,which may serve as a potential neuroimaging biomarker to evaluate the efficacy of NSAIDs.