神经源性膀胱过度活动症患者膀胱储尿期大脑功能连接的研究  

A resting-state fMRI comparative study on bladder storage function between normal volunteers and neurogenic overactive bladder

作　　者：高轶[1] 廖利民[1] 英小倩 Gao Yi;Liao Limin;Ying Xiaoqian(Department of Urology,China Rehabilitation Research Centre,School of Rehabilitation,Capital Medical University,Beijing 100068,China)

机构地区：[1]中国康复研究中心北京博爱医院泌尿外科,首都医科大学康复医学院,北京100068

出　　处：《中华泌尿外科杂志》2021年第6期430-435,共6页Chinese Journal of Urology

基　　金：国家自然科学基金(81570688)。

摘　　要：目的观察神经源性膀胱过度活动症(NOAB)患者膀胱储尿期大脑中枢控尿区域及其相关的功能连接。方法2019年9月至2021年1月选取北京博爱医院就诊的NOAB患者。纳入标准:①存在明确的神经系统原发病(除外脑部疾病和脊髓发育异常),选择脊髓损伤(Asia评级C级)、能够随意排尿的患者,主诉为尿急、尿频、急迫性尿失禁等OAB症状;②记录3 d排尿日记,24 h排尿次数≥8次,残余尿量≤100 ml;③尿动力学检查提示逼尿肌过度活动。排除标准:①有泌尿系肿瘤、结石、感染等疾病者;②不能进行MRI检查者;③存在认知障碍不能配合者;④留置导尿、膀胱造瘘者;⑤静息态功能磁共振(rs-fMRI)扫描时,头部活动超过1.5 mm和1.5°。在受试者膀胱空虚时和强烈尿意时分别进行脑部rs-fMRI扫描,第1次扫描后饮水500~1000 ml,两次扫描间隔时间为20~40 min。采用MATLAB、SPM8、DPABI等数据处理、图像分析软件,分析两种状态下患者大脑血液灌注差异。rs-fMRI扫描的主要观察数据包括:①大脑兴奋区域和抑制区域;②激活区域峰值点坐标X、Y、Z值;③激活区域体积;④区域的关系连接情况。采用局部一致性(REHO)方法分析rs-fMRI扫描中有明显激活的功能区域,做为感兴趣区域(ROI)种子点进行功能连接(FC)分析。结果本研究共纳入NOAB患者20例,年龄(30.2±4.3)岁,均为右利手。第1次扫描前检查所有受试者的残余尿量均<10 ml,排尿感评分为0分。第2次扫描前测量膀胱容量为(203.7±41.8)m1,排尿感评分为(7.1±0.5)分。NOAB患者储尿期,大脑兴奋性激活区域为左侧眶部额上回、右侧额中回、右侧背外侧额上回,抑制性激活区域为右侧中央前回。将此4个激活区域的峰值点做为ROI种子点进行全脑FC分析,发现控尿区域与额叶、顶叶、扣带回、颞叶、豆状核、岛叶、角回、海马旁回、中央前后回均存在相关性。结论NOAB患者的脑激活区域�Objective To observe central responses and functional connectivity(FC)during urinary bladder storage in neurogenic overactive bladder(NOAB).Methods Twenty patients with NOAB were recruited.Resting state functional magnetic resonance imaging(rs-fMRI)were performed in all subjects under the following two conditions:empty bladder state and full bladder(strong desire to void)state.Software MATLAB,SPM8 and DPABI were adopted to analyze the difference of brain imaging between the two conditions.Voxel-based analysis of the REHO was performed to analyze rs-fMRI data including the main excitatory regions and inhibitory areas,peak value(X-axis,Y-axis,Z-axis),clusters size(active volume unit:number of voxel),T value(the excitatory and inhibitory extent of brain active regions).Voxel-based analysis of the REHO maps and FC between empty and full bladder were performed.Results Increased activity during strong desire to void with NOAB patients was observed in the left orbital part of superior frontal,right middle frontal gyrus,and right superior frontal.Decreased activity was observed in right precentral.FC analysis found that these activated or deactivated brain regions were widely connected with other brain areas,include:frontal lobe,parietal lobe,temporal lobe,cingulate gyrus,lenticular nucleus,insular lobe,angular gyrus,parahippocampal gyrus and anterior and posterior central gyrus.Conclusions Our results suggested that the right frontal robe may play a role in the control of bladder with NOAB during strong desire to void,and inhibitory areas located in right precentral.In NOAB patients,excitatory and inhibitory connections were increased in frontal lobe and central gyrus,decreased in insular lobe and parhippocampal gyrus.

关 键 词：磁共振成像 大脑控制 膀胱过度活动症 神经源性膀胱 膀胱储尿期 静息态功能磁共振 

分 类 号：R694.5[医药卫生—泌尿科学]