腹泻型肠易激综合征患者直肠气囊扩张刺激的脑功能研究  

Brain function in patients with diarrhea type irritable bowel syndrome after rectal balloon distention

作　　者：李田[1] 季公俊[3] 辛海威[1] 臧玉峰[3] 侯波[2] 朱丽明[1] 方秀才[1] 柯美云[1] Li Tian Ji Gongjun Xin Haiwei Zang Yufeng Hou Bo Zhu Liming Ke Meiyun Fang Xiucai(Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,100730 [2]中国医学科学院北京协和医学院北京协和医院放射科,100730 [3]杭州师范大学认知与脑疾病研究中心

出　　处：《中华消化杂志》2017年第1期24-29,共6页Chinese Journal of Digestion

基　　金：“十一五”国家科技支撑计划（2007BAI04B01）;国家国际科技合作专项（2014DFA31850）;国家自然科学基金（81370488）

摘　　要：目的 通过功能磁共振成像（fMRI）探讨腹泻型肠易激综合征（IBS-D）患者在不同症状发作状态时直肠气囊扩张刺激的脑区激活，以及其与肠道症状、精神心理状态、生命质量的相关性。方法 根据症状发作情况将IBS-D患者分为发作组（7例）、缓解组（5例）和持续组（6例），同时纳入健康对照者6名。以初始感觉阈值、持续便意感阈值和80%最大耐受量作为直肠气囊扩张刺激容量进行fMRI检查，采用单因素方差分析、两组独立样本t检验对差异脑区进行两两比较，Pearson相关分析差异脑区和IBS-D患者肠道症状评分、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）、肠易激综合征专用生命质量量表（IBS-QOL）评分的相关性。结果 各组受试者初始感觉阈值、持续便意感阈值和80%最大耐受量等直肠感觉阈值差异均无统计学意义（P均〉0.05），各组受试者直肠容量刺激状态下差异脑区为前扣带回皮质、顶下小叶和额中回。与健康对照组相比，发作组患者前扣带回皮质、顶下小叶和额中回激活减低（P均〈0.05）。持续组患者额中回的活动性和肠道症状计分呈正相关（r＝0.823，P＝0.048）；持续组患者额中回（r＝－0.816，P＝0.048）和顶下小叶（r＝－0.860，P＝0.028），缓解组患者额中回（r＝－0.892，P＝0.042）的活动性与HAMD评分呈负相关；持续组患者额中回（r＝0.818，P＝0.047）和顶下小叶（r＝0.907，P＝0.013）的活动性，缓解组患者额中回（r＝0.914，P＝0.030）的活动性与IBS-QOL得分呈正相关。结论 IBS-D患者和健康对照者在直肠气囊扩张时均存在脑区激活，患者不同症状发作状态时发生改变的脑区有差异。Objective To investigate the correlation between activated brain regions examined by functional magnetic resonance imaging （fMRI） after rectal balloon distention and intestinal symptoms, psychological status, and quality of life in patients with diarrhea type irritable bowel syndrome （IBS-D） at different stages of disease.Methods According to the symptoms status, patients with IBS-D were divided into onset group （seven patients）, remission group （five patients） and persistence group （six patients）, and six healthy individuals were selected as healthy controls at the same time. After stimulated with rectal balloon distention at first sensation thresholds, continual defecation thresholds or 80% of maximum tolerable thresholds, patients received fMRI examination. Analysis of variance and two-sample t test were used to compare the difference in activated brain areas between two groups. Pearson analysis was performed to analyze the correlations between activated brain areas and scores of irritable bowel syndrome （IBS） intestinal symptom, Hamilton depression scale （HAMD）, Hamilton anxiety scale （HAMA） and irritable bowel syndrome special quality of life scale （IBS-QOL）.Results There was no significant difference in first sensation thresholds, continual defecation thresholds or 80% of maximum tolerable thresholds between patients of different groups. After rectal balloon distention, there were differences in such brain areas： bilateral anterior cingulate cortex （ACC）, left inferior parietal lobe, and left middle frontal gyrus. Compared with those of control group, the activation of ACC, inferior parietal lobe and middle frontal gyrus lowered in patients of onset group （both P〈0.05）. There was positive correlation between the activation of middle frontal gyrus and intestinal symptom scores in persistence group（r=0.823, P=0.048）. There were negative correlations between the activation of inferior parietal lobe （r =-0.816, P=0.048）, middle frontal gyrus（r=-0.860, P=

关 键 词：肠易激综合征 腹泻型 磁共振成像 脑区活动性 直肠气囊扩张 

分 类 号：R445.2[医药卫生—影像医学与核医学] R574[医药卫生—诊断学]