腹泻型肠易激综合征患者经匹维溴铵联合氟哌噻吨美利曲辛治疗后静息态功能磁共振分析  

A preliminary study of resting-state fMRI in patients with diarrhea-type irritable bowel syndrome after pinaverium bromide combined treatment with flupentixol-melitracen

作　　者：李洁[1] 郭赟[2] 鲁兴启 李国熊[2] 杨莹 李丽[2] 丁建平[1] Li Jie;Guo Yun;Lu Xingqi;Li Guoxiong;Yang Ying;Li Li;Ding Jianping(Department of Radiology,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Gastroenterology,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院放射科,杭州310015 [2]杭州师范大学附属医院消化内科,杭州310015

出　　处：《中华医学杂志》2019年第41期3266-3272,共7页National Medical Journal of China

基　　金：浙江省公益技术研究社会发展项目(2015C33292)。

摘　　要：目的采用静息态功能磁共振成像(rs-fMRI)观察腹泻型肠易激综合征(IBS-D)患者在胃肠解痉药(匹维溴铵,PB)和其联合抗焦虑抑郁药(氟哌噻吨美利曲辛,FM)两种治疗方法后大脑活动的区域差异,从中枢层面上探讨联合抗焦虑抑郁药治疗IBS-D患者有效性的机制。方法选取2015年10月至2018年10月杭州师范大学附属医院消化内科诊断的IBS-D患者48例(男28例/女20例),年龄22~48(33±7)岁,在接受匹维溴铵(基础治疗组,16例)、联合FM(联合治疗组,16例)和不服药(未接受治疗组,16例)后接受rs-fMRI扫描。采用单因素ANOVA分析和事后分析比较三组患者的rs-fMRI区域局部一致性(ReHo)差异,并与患者胃肠道症状评分(GSRS)和医院焦虑抑郁量表评分(HAD)治疗前后差值进行相关分析和中介效应分析。结果治疗前,三组患者未显示存在ReHo值显著差异的脑区。治疗后,两组服药患者均显示纹状体、岛叶、内侧前额叶皮质(MPFC)、胼胝体下回ReHo值减低,左侧枕中回ReHo值高于未接受治疗组。此外,联合治疗组还存在左侧丘脑、左侧颞极ReHo值减低及左侧楔前叶ReHo值增高。联合治疗组显示右侧壳核、右侧岛叶、右侧MPFC及胼胝体下回ReHo值低于基础治疗组,左侧楔前叶ReHo值高于基础治疗组。联合治疗组左侧丘脑ReHo值与HAD差值呈显著正相关(r=0.653,P=0.011),左侧楔前叶ReHo值与GSRS差值、HAD差值均呈显著负相关(r=-0.771,P=0.001;r=-0.716,P=0.004)。联合治疗组患者显示左楔前叶的ReHo值介导胃肠道症状和焦虑-抑郁症状。结论匹维溴铵联合FM治疗IBS的疗效优于单纯匹维溴铵治疗。联合抗抑郁药治疗的IBS-D患者除了表现出更广泛的疼痛相关脑区的变化外,还存在默认网络及情绪调节相关脑区的改变,并与胃肠道症状及焦虑抑郁的改善相关。Objective To observe the difference of brain activity in patients with diarrhea-type irritable bowel syndrome(IBS-D)treated with pinaverium bromide(PB)combined with flupentixol-melitracen(FM),and to explore the mechanism of efficacy of combined with anxiolytic/antidepressant drugs in IBS-D patients at the central level,using resting-state functional magnetic resonance imaging(rs-fMRI).Methods Forty-eight patients with IBS-D,including 28 males,20 females,mean age 22-48(33±7)years,were selected from the Affiliated Hospital of Hangzhou Normal University from October 2015 to October 2018.All patients with IBS-D underwent rs-fMRI scans before and after receiving either PB(basic treatment group,n=16),PB combined with FM(combination therapy group,n=16),or no medication(no treatment group,n=16).Rs-fMRI regional homogeneity(ReHo)parameter among the three groups of patients were compared using One-way ANOVA analysis and post analysis.Partial correlation and mediation analyses were performed on ReHo values and the improvement of symptoms scores(gastrointestinal symptom rating scale(GSRS)and hospital anxiety/depression scale(HAD))in the two medicated groups.Results No significant differences in ReHo values were observed among the three groups before treatment.Compared with patients on no-medication,patients receiving either PB or PB-FM showed decreased ReHo in the striatum,insular lobe,medial prefrontal cortex(MPFC)and subcallosal gyrus,and increased ReHo in the occipital cortex.In particular,the combined treatment group showed more extensive decreased ReHo in the left thalamus and left temporal pole,and increased in the left precuneus.Compared with the basic treatment group,the combined treatment group showed decreased ReHo in the right putamen,right insula,right MPFC and subcallosal gyrus,and increased ReHo in the left precuneus.In addition,the combined treatment group demonstrated a positive correlation between ReHo values in the left thalamus and the improvement of HAD score(r=0.653,P=0.011),and a negative correlation b

关 键 词：肠易激综合征 氟哌噻吨 腹泻 磁共振成像 

分 类 号：R74[医药卫生—神经病学与精神病学]