基于静息态功能磁共振探讨脑安滴丸治疗偏头痛的中枢机制

Central Mechanism of Naoan Dropping Pill in Treatment of Migraine:A Study Based on Resting-state Functional Magnetic Resonance Imaging

目的基于静息态功能磁共振技术探究脑安滴丸治疗偏头痛的中枢机制。方法纳入19例偏头痛患者作为观察组,16例健康受试者作为对照组。观察组给予12周的脑安滴丸治疗,对照组不予任何干预。观察组在治疗前后进行静息态功能磁共振(resting state function magnetic resonance imaging,rs-fMRI)扫描,对照组仅在入组当天进行1次扫描。记录观察组治疗前后、随访4周头痛发作天数、头痛发作次数、头痛持续时间、视觉模拟评分(visual analogue scale,VAS)及患者报告的结局(patients-reported outcomes,PRO)量表评分。分析治疗前两组间的低频振幅(amplitude of low frequency fluctuation,ALFF)、局部一致性(regional homogeneity,ReHo)差异脑区,以ALFF、ReHo的共同差异脑区为感兴趣脑区(region of interest,ROI),分析计算观察组治疗前后ROI与全脑体素的功能连接(functional connectivity,FC)变化,并将FC的变化值与临床数据的改善值进行Pearson相关分析。结果观察组治疗后、随访4周的头痛发作天数、头痛发作次数、头痛持续时间及PRO量表评分均显著低于治疗前(P<0.05),且观察组随访4周的VAS评分亦显著降低(P<0.05);与对照组比较,治疗前观察组左侧背外侧额上回、右侧前扣带和旁扣带脑回、右侧岛叶、双侧内侧额上回、双侧额中回和左侧楔前叶的ALFF值显著降低(P<0.05),右侧中央前回的ReHo值显著升高(P<0.05),左侧楔前叶的ReHo值显著降低(P<0.05)。以左侧楔前叶为ROI,治疗后左侧楔前叶与左侧壳核的FC值较治疗前降低(P<0.05),未发现治疗前后FC的变化值与临床数据的相关性(P>0.05)。结论偏头痛患者存在认知、情感、感觉等多个脑区的功能活动异常,而脑安滴丸可能是通过调控楔前叶—壳核的FC达到治疗偏头痛的作用。

Objective To investigate the central mechanism of Naoan Dropping Pill in the treatment of migraine based on resting-state functional magnetic resonance imaging(rs-fMRI).Methods A total of 19 patients with migraine were enrolled as observation group,and 16 healthy subjects were enrolled as control group.The patients in the observation group received Naoan Dropping Pill for 12 weeks and underwent rs-fMRI before and after treatment,while those in the control group received no intervention and only underwent one rs-fMRI scan on the day of enrollment.Related data were recorded for the patients in the observation group,including the number of days of headache attack,the frequency/duration/intensity of headache attack,and patient-reported outcomes(PRO)score before and after treatment and at week 4 of follow-up.The two groups were compared in terms of the brain regions with differences in amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(ReHo)before treatment.With the common brain regions with differences in ALFF and ReHo as the region of interest(ROI),the observation group was analyzed in terms of the change in functional connectivity(FC)between the ROI and the whole-brain voxels after treatment,and a Pearson correlation analysis was performed between the change in FC value and the improvements in clinical data.Results[WT5"BZ]The observation group showed significant reductions in the number of days of headache attacks,the number of headache attacks,the total duration of headache attack,and PRO score after treatment and at week 4 of follow-up(P<0.05),as well as a significant reduction in VAS score at week 4 of follow-up(P<0.05).Compared with the control group,the observation group had significant reductions in ALFF values of the left dorsolateral superior frontal gyrus,the right anterior cingulate and paracingulate gyri,the right insular lobe,the bilateral medial superior frontal gyrus,the bilateral middle frontal gyrus,and left precuneus before treatment(P<0.05),as well as a significant increase in the ReHo value of the right precentral gyrus(P<0.05)and a significant reduction in the ReHo value of the left precuneus(P<0.05).With the left precuneus as the ROI,there was a significant reduction in the FC value between the left precuneus and the left putamen after treatment(P<0.05),while no correlation was found between the change in FC and clinical data(P>0.05).Conclusion Patients with migraine exhibit abnormal functional activity in multiple brain regions involved in cognition,emotion,and sensation.Naoan Dropping Pill may exert a therapeutic effect on migraine by regulating the functional connectivity between the precuneus and the putamen.