椎间盘突出所致下腰腿痛患者后扣带回功能连接的静息态功能磁共振成像研究

Posterior Cingulate Cortex Functional Connectivity in Patients with Low Back-Related Leg Pain Due to Herniated Disk:a Resting State Magnetic Resonance Imaging Analysis

目的采用基于种子点相关性的方法研究下腰腿痛(LBLP)患者后扣带回(PCC)的静息态功能连接。方法搜集椎间盘突出所致LBLP患者(n=30)和性别、年龄相匹配的健康对照组(HCs组)(n=30)静息态功能磁共振成像(rs-fMRI)数据。数据经预处理后,采用基于种子点(PCC:-5,-49,40,半径6 mm)相关性的方法进行功能连接分析,并在显著相关脑区内进行组间比较。提取患者组的差异脑区功能连接系数与临床评估(日本骨科协会评分、视觉模拟量表评分和感觉评估等)参数进行相关性分析。结果 LBLP组(25例)与HCs组(25例)数据显示PCC功能连接显著正相关脑区[近似默认网络(DMN)]的空间分布模式类似,LBLP组PCC和双侧额内侧回、双侧楔前叶/后扣带回功能连接较HCs组显著减低(体素水平P<0.01,簇水平P<0.05,高斯随机域理论校正)。而在PCC显著负相关脑区(DMN外),LBLP组PCC和左侧额中回、右侧缘上回/中央后回功能连接增强,和左侧枕中回、右侧岛叶功能连接减弱(P<0.01,未校正)。在LBLP组功能连接改变的脑区中,PCC-右侧岛叶连接系数与日本骨科协会评分亚指标'体征'呈正相关(r=0.525,P=0.007)、与简化Fugl-Meyer感觉评分呈正相关(r=0.424,P=0.035);PCC-右侧缘上回/中央后回连接系数与日本骨科协会评分亚指标'体征'呈正相关(r=0.418,P=0.037);PCC-左侧枕中回连接系数与视觉模拟量表评分呈负相关(r=-0.569,P=0.003)。结论 LBLP患者存在DMN内的功能失连接改变,以及与临床参数相关的DMN外功能重塑现象。

Objective To study the resting-state functional connection of posterior cingulate gyrus(PCC)in patients with lower back and leg pain based on seed point correlation.Methods 3.0 T MRI was used to collect the resting-function MRI data of patients with lower lumbar leg pain(LBLP)caused by intervertebral disc herniation(n=30)and gendermatched age-matched healthy controls(n=30).After the data was pretreated,functional linkage analysis was performed based on the correlation of seed points(PCC:-5,-49,40,radius 6 mm),and comparison between groups was performed in the significantly relevant brain regions.Correlation analysis was performed on the parameters of the differential brain function connectivity of the patient group and the clinical evaluation(Japan Orthopaedic Association score,visual analog scale score,and sensory evaluation)parameters.Results The LBLP patient group(25 patients)and the healthy control group(25 patients)showed similar spatial distribution patterns of PCC functional connections with significantly positively correlated brain regions(approx.default network).In LBLP group PCC and bilateral frontal medial and bilateral wedges,the functional connection of the anterior/posterior cingulate gyrus was significantly lower than that of the HCs group(poxel level P<0.01,cluster level P<0.05,Gaussian random domain theory correction).In the PCC significantly negatively correlation brain area(outside the default network),the LBLP patient group PCC and the left frontal gyrus,right marginal gyrus/central posterior gyrus function connection,and left occipital mid-back,right insular function,the connection was weakened(P<0.01,uncorrected).In the brain region where the functional connection of the LBLP patient group was changed,the PCC-right islet leaf connection coefficient was positively correlated with the Japanese Orthopaedic Association’s sub-index'signs'(r=0.525,P=0.007),and the simplified Fugl-Meyer sensory score was positive.Correlation(r=0.424,P=0.035);PCC-right margin upper/central posterior gyrus connection coefficient was positively correlated with Japanese Orthopaedic Association sub-index'signs'(r=0.418,P=0.037);PCC-left The mid-pilus connection coefficient was negatively correlated with the visual analog scale score(r=-0.569,P=0.003).Conclusion LBLP patients have functional disconnection changes in the default network and the default extranet function remodeling associated with clinical parameters.