腰背痛对静息状态下岛叶神经功能连接的影响  

Changes in the functional activity and connectivity of the insular cortex in patients with low back pain

作　　者：张珊珊[1] 吴文[1] 刘自平[1] 郭世贵[1] 杨建明[2] 

机构地区：[1]南方医科大学珠江医院康复医学科,广州510282 [2]南方医科大学珠江医院影像诊断科,广州510282

出　　处：《中华物理医学与康复杂志》2013年第9期691-695,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：广东省科技计划项目（2007B031402007、2012B031800305）

摘　　要：目的利用功能磁共振成像（fMRI）技术探讨静息状态下腰背痛受试者岛叶功能活动及连接特点。方法采用飞利浦3．0T Achieva磁共振成像仪分别采集12例健康志愿者在正常状态及腰背部疼痛时（向腰背部肌肉注射3％高渗盐水）静息态fMRI数据。利用DPARSF软件计算受试者在不同状态下双侧前、后岛叶的功能连接情况，选用spin8软件对所得数据进行配对t检验，得到疼痛状态下静息态岛叶的功能连接数据，并比较前、后岛叶的功能连接差异。结果受试者在腰背痛状态下其疼痛视觉模拟评分（VAS）为（6．02±1．96）分。受试者在腰背痛状态下岛叶与额叶、丘脑、海马旁回的功能连接增强，与后扣带回、楔前叶、颞叶、中央旁小叶、小脑扁桃体的功能连接减低；此外顶下小叶与前岛叶功能连接增强，与后岛叶功能连接减低（P〈0．001，K≥10）。结论静息态下腰背痛受试者的岛叶功能连接存在异常，这可能与疼痛刺激引起一系列认知及情绪功能改变有关。Objective To investigate the functional activity and connectivity of the insular cortex at rest in persons with low back pain （LBP）. Methods Twelve healthy subjects （ male 6, female 6 ; age 24.8 ±3.3 years） were given fMRI 3.0T scans at rest. Back muscle pain was then induced with an intramuscular injection of 3% hypertonic saline solution and a second scan was performed. The pain-free and in-pain fMRI data were compared using paired t-tests to highlight any changes in the functional connectivity of the anterior and posterior insular cortex on both sides. Pain severity was quantified using a visual analogue scale （VAS）. Results Ratings of LBP severity peaked at 6.02±1.96 on the VAS. The functional connectivity of the inferior insular cortex with the frontal cortex, the thala- mus and the parahippoeampal gyrus was enhanced when the subjects were in pain, but connectivity with the posterior cingulate cortex, the preeuneus, the temporal cortex, the paracentral lobule and the cerebellar tonsil was reduced. The inferior parietal lobule exhibited significantly enhanced connectivity with the anterior insular cortex, but reduced connectivity with the posterior insular cortex. In addition, the medial cingulate cortex displayed decreased functional connectivity with the anterior insular cortex, but increased functional connectivity with the posterior insular cortex when the subjects were in pain. Conclusion This study has revealed impeded functional connectivity of the insular cortex when experiencing LBP at rest. This may possibly be related to pain＇s disruption of cognition and emotion.

关 键 词：腰背痛 静息态 功能磁共振成像 功能连接 岛叶 

分 类 号：R681[医药卫生—骨科学]