应用功能性磁共振成像技术研究非糜烂性反流病患者食管酸灌注时大脑功能活动模式的变化  

Study on Human Brain Responses to Acid Exposure of Esophageal Mucosa by Functional Magnetic Resonance Imaging Technique

作　　者：李兆申[1] 杨敏[1] 徐晓蓉[1] 邹多武[1] 王莉[2] 孙振兴[1] 

机构地区：[1]第二军医大学长海医院消化内科,200433 [2]第二军医大学长海医院影像科,200433

出　　处：《胃肠病学》2006年第8期454-457,共4页Chinese Journal of Gastroenterology

摘　　要：背景:血氧水平依赖性功能性磁共振成像(BOLD-fMRI)技术近来被广泛应用于人体内脏感觉的研究,而非糜烂性反流病(NERD)的发生与内脏感觉高敏有密切关系。目的:应用BOLD-fMRI技术,通过研究食管酸灌注时NERD患者大脑功能活动模式的改变,探讨NERD患者食管内脏高敏感的中枢机制。方法:对31例NERD、13例反流性食管炎(RE)和12名健康志愿者在食管酸灌注时行fMRI;根据食管内球囊扩张和酸灌注试验结果将NERD患者分为两组:感觉高敏(NERD-H)组和感觉正常(NERD-N)组;对三组受试者大脑的兴奋情况进行统计学分析。结果:食管酸灌注刺激在NERD内脏高敏的患者中激活范围较广泛,包括单侧或双侧第Ⅱ躯体感觉皮质(SⅡ)、第Ⅰ躯体感觉皮质(SⅠ)、前额叶皮质(右侧为主)、眶额回皮质、岛叶皮质、运动区、辅助运动区、前扣带回、后扣带回、楔前叶、杏仁体、腹侧纹状体、丘脑、小脑等,其中双侧SⅡ、右前额叶皮质、运动区、辅助运动区、岛叶皮质、杏仁体、腹侧纹状体和小脑的最大信号增加幅度显著高于NERD-N组和对照组(P<0.01)。内脏高敏的NERD患者fMRI功能初始信号呈现时间、达峰值时间较NERD-N组和对照组显著缩短(P<0.01)。结论:食管酸灌注时产生的fMRI参数改变为揭示NERD患者中枢神经系统整合、处理食管感觉传入信息功能异常提供了依据。Background： Recently blood oxygen level dependent （BOLD）-functional magnetic resonance imaging （fMRI） technique was extensively used in human visceral perception research study. It has been accepted that visceral hypersensitivity is closely related with the pathogenesis of non-erosive reflux disease （NERD）. Aims： To investigate the human brain responses to esophageal acid perfusion using BOLD-fMRI technique and to explore the central mechanism of visceral hypersensitivity in NERD. Methods： Thirty-one NERD patients, 13 with reflux esophagitis （RE） and 12 volunteers were enrolled in this study. The NERD patients were divided into two groups： the sensation normal （NERD-N） group and visceral hypersensitivity （NERD-H） group, according to the results of esophageal balloon dilatation and Bernstein test. MRI scanning was performed in each subject. Cortical response to acid perfusion was determined and compared between these groups. Results： The main centers affected in NERD-H patients were secondary somatoscnsory cortex, primary somatosensory cortex, fight orbitofrontal cortex, insular cortex, amygdala, striatum, motor cortex and supplementary and cerebellum cortices. The areas were wider than those in the other groups. The average percent of signal intensity increased in the region of secondary somatoscnsory cortex, right prefrontal cortex, motor cortex and supplementary, insular cortex, amygdala, striatum and cerebellum cortices were significantly higher than those in the NERD-N group and the control group （P〈0.01）. The initial and peak fMRI signal occurred earlier in the NERD-H group compared with the NERD-N and the control groups （P〈0.01）. Conclusions： The pattern of fMRI activated by esophageal acid perfusion in NERD-H patients provides the evidence for revealing the functional abnormalities of integration of central nerves system and process of esophageal perception of afferent signals in these patients.

关 键 词：胃食管反流 非糜烂性反流病 磁共振成像 食管酸灌注 内脏高敏感 大脑皮质 

分 类 号：R571[医药卫生—消化系统] R445.2[医药卫生—内科学]