帕金森病伴疼痛患者大脑皮层厚度改变的结构MRI研究

Changes of cortical thickness in Parkinson's disease patients with pain:A structural MRI study

目的基于高分辨率结构MRI技术探讨帕金森病(Parkinson’s disease,PD)伴疼痛患者大脑皮层厚度(cortical thickness,CT)的异常改变及其与疼痛评分的相关性,揭示PD疼痛的神经解剖基础。材料与方法本研究于2020年9月至2022年3月招募了经苏州大学附属第二医院神经内科确诊的82例PD患者及附近社区的29例无痛正常对照(normal control,NC)志愿者。采集所有受试者的人口学、临床资料以及结构MRI图像。采用非运动症状问卷和视觉模拟评分法(Visual Analog Scale,VAS)对PD患者分别进行疼痛筛查和疼痛程度评估。依据VAS评分将PD患者分为PD伴疼痛(PD patients with pain,PDP)组41例和PD不伴疼痛(PD patients without pain,nPDP)组41例。CT分析步骤如下:采用计算解剖学工具箱12(Computational Anatomy Toolbox 12,CAT12)软件包对结构像进行预处理获得全部被试者的全脑CT图;统计分析采用one-way ANOVA及post-hoc事后检验。统计结果采用无阈值聚类增强(threshold-free cluster enhancement,TFCE)及错误发现率(false discovery rate,FDR)进行多重比较校正,阈值设为P<0.05。最后,提取PDP组差异脑区的CT值与VAS评分进行偏相关性分析。结果One-way ANOVA分析发现PDP组、nPDP组及NC组间CT值存在差异的脑区包括右侧额上回、右侧额中回下部及右侧额下回三角部。Post-hoc事后分析显示,与nPDP组相比,PDP组的右侧额中回下部及右侧额下回三角部CT值减低(P=0.033、0.007)。与NC组相比,PDP组的右侧额上回、右侧额中回下部及右侧额下回三角部CT值均减低(P<0.001)。偏相关分析未发现PDP组的右侧额中回下部及右侧额下回三角部CT值与VAS评分存在显著相关(P=0.088)。结论右侧前额叶区域(额中回及额下回)的CT减低可能是PD伴疼痛患者的神经解剖基础,该区域可能通过调节疼痛感知以及与疼痛相关的情绪/情感、认知加工等方面参与了PD疼痛的发生。

Objective:To explore the alterations of cortical thickness(CT)in Parkinson's disease(PD)patients with pain using high-resolution structural MRI and their correlations with pain scores,revealing the neuroanatomical basis of pain in PD patients.Materials and Methods:From September 2020 to March 2022,82 PD patients diagnosed by the Neurology Department of the Second Affiliated Hospital of Soochow University and 29 pain-free normal controls(NC)from local communities were recruited.Demographic and clinical data as well as structural and MRI images of all subjects were collected.The non-motor symptoms questionnaire and the visual analog scale(VAS)were applied to pain screening and pain severity assessment.The PD patients were divided into 41 PD patients with pain(PDP)and 41 PD patients without pain(nPDP)according to the VAS scores.CT analysis steps are as follows:Frist,the structural MRI data were pre-processed by the computational anatomy toolbox 12(CAT12)software package to get the CT maps of all subjects.Then,one-way ANOVA and post hoc analysis were used to compare the three groups.The statistical results were corrected for multiple comparisons using the threshold-free cluster enhancement(TFCE)and false discovery rate(FDR),and the threshold was set at P<0.05.Finally,the CT values of significant regions in PDP groups were extracted and partial correlated with VAS scores.Results:The CT values of the right superior frontal gyrus,right middle frontal gyrus,and right pars triangularis showed significant differences among the three groups.Post hoc analysis showed that the CT values of the right middle frontal gyrus and right pars triangularis were significantly reduced in the PDP group relative to the nPDP group(P=0.033,0.007).Compared with the NC group,the PDP group showed decreased CT in the right superior frontal gyrus,right middle frontal gyrus,and pars triangularis.There was no significant correlation between CT values of significant regions and VAS scores in PDP group(P=0.088).Conclusions:The decreased CT of the prefrontal region(middle frontal gyrus and inferior frontal gyrus)may be the underlying structural basis of pain in PD patients,which might be involved in the pain through the mechanisms of pain perception and regulation,emotional processing,and cognitive processing.