应用fMRI研究非糜烂性反流病和糜烂性食管炎患者酸灌注时脑激活模式的差异  

Characteristics of cortical mapping in response to acid exposure in non-erosive reflux disease and erosive esophagitis using functional magnetic resonance imaging

作　　者：杨敏[1] 李兆申[1] 陈东风[2] 徐晓蓉[1] 许国铭[1] 邹多武[1] 房殿春[3] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433 [2]第三军医大学大坪医院消化内科 [3]第三军医大学西南医院消化内科

出　　处：《中华医学杂志》2008年第14期952-956,共5页National Medical Journal of China

摘　　要：目的探索食管内脏高敏感性形成的脑机制。方法2005年9月至2007年6月随机选择31例非糜烂性反流病（NERD）患者、13例糜烂性食管炎（EE）患者和12名正常对照者参与实验，并将NERD患者分为感知过敏组（NERD—H）21例和感知正常组（NERD-N）10例。利用血氧水平依赖脑功能磁共振成像（BOLD—fMRI）技术对比研究食管酸灌注时NERD-H组、NERD-N组、EE患者及正常对照者大脑功能活动区域定位、MR．BOLD信号激活及消退模式的差异。结果NERD—H组酸灌注时激活的脑区包括单侧或双侧第二躯体感觉皮质（SII）、初级躯体感觉皮质（SI）、前额叶皮质（右侧为主）、框额皮质、岛叶皮质、楔前叶、杏仁体、腹侧纹状体、运动区／辅助运动区及小脑半球，且以双侧大脑激活为主。NERD—H组上述感兴趣区（ROI）区的fMRI峰值影像强度和最大磁共振（MR）信号增加幅度明显高于NERD-N组和正常对照组（均P〈0．01），前扣带回激活信号值（562±104）明显低于正常组（587±126，P〈0．05），但显著高于EE组（535±91，P〈0．05）。酸灌注刺激后，NERD—H组初始影像潜伏期、峰值影像潜伏期（1．7min±0．9min、4．5min±1．3min）均明显短于NERD—N组（4．0min±1．1min、6．8min±1．6min，均P〈0．01）和正常对照组（5．4min±1．7min、7．2min±1．5min，均P〈0．01）。NERD．H组双侧SII、右前额皮质信号消退失活幅度（26．5％±5．4％、20．3％±3．0％）均明显高于NERD—N组（8．2％±2．2％、16．4％4-3．6％，均P〈0．05）和EE组（11．9％±4．8％、11．7％±3．1％，均P〈0．01），而正常对照组前扣带回的MR信号消退失活幅度（16．9％±2．5％）明显高于NERD．H组、EE组（11．8％±2．8％、6．4％±1．0％，均P〈0．05）。结论在食管内脏高敏感状态下，中枢神经系统处理整合、处理食管痛敏传入信息功能异常。Objective To investigate the brain mechanisms for esophageal visceral hypersensitivity. Methods Thirty-one non-erosive reflux disease （NERD） patients, 21 in the group of NERD with esophageal hypersensitivity （NERD-H） and 10 in the group of NERD with normal esophageal sensation （NERD-N）, 13 patients with erosive esophagitis （EE）, and 12 healthy volunteers, all sex- and age- matched, underwent whole brain blood oxygenation level dependent （ BOLD ） fictional magnetic resonance imaging （fMRI） to record the cortical fMRI response to intraesophageal perfusion of normal saline or dilute hydrochloric acid. Results The main centers affected in the NERD-H patients included the secondary somatosensory cortex （SⅡ）, primary somatosensory cortex （SⅠ）, right prefrontal cortex （PFC）, right orbitofrontal cortex （ OFC ）, insular cortex, amygdala, striatum , motor cortex and its supplementary area, and cerebellum cortices, which form part of the matrix controlling emotional, autonomic modulatory responses to pain. The peak fMRI signal intensity and average maximum percent signal increase in the regions of interest （ ROI ） at above-mentioned brain areas of the NERD-H group were significantly stronger than those of the NERD-N and control groups （all P 〈 0.01 ）. The peak image intensity of the anterior cingulate gyms （ACC） of NERD-H group was 562 ± 104, significantly lower than that of the control group （587 ± 126, P 〈 0.05 ） , but significantly higher than that of the EE group （535 ± 91, P 〈 0.05 ）. The timeline of activation and deactivation events of particular ROI differentiate the four groups. The initial image latency and peak fMRI latency after hydrochloric acid perfusion of the NERD-H patients were 1. 7 min ±0.9 min and peak 4.5 min ± 1.3 min respectively, both significantly shorter than those of the NERD-N group （4.0 min ± 1.1 min and 6.8 min ± 1.6 min respectively, both P 〈0.01 ） and those of the control group （5. 4 min ± 1.7 min and 7.2 mi

关 键 词：磁共振成像 胃食管反流 食管内脏高敏感性 

分 类 号：R686[医药卫生—骨科学]