视神经脊髓炎谱系疾病患者与多发性硬化患者接触性热痛刺激诱发的脑功能磁共振成像对比研究  

Comparative study of brain functional magnetic resonance imaging of contact heat stimulation in neuromyelitis optica spectrum disorders and multiple sclerosis

作　　者：谭裕玲 涂敏 杨双凤 彭婷婷 苟晨 邓靓雅 范爔月 王晓明[1] Tan Yuling;Tu Min;Yang Shuangfeng;Peng Tingting;Gou Chen;Deng Jingya;Fan Xiyue;Wang Xiaoming(Department of Neurology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Neurology,People′s Hospital of Deyang,Deyang 618000,China;Department of Neurology,People′s Hospital of Yuechi County,Guang′an 638300,China;Department of Neurology,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]川北医学院附属医院神经内科,南充637000 [2]德阳市人民医院神经内科,德阳618000 [3]岳池县人民医院神经内科,广安638300 [4]成都医学院第一附属医院神经内科,成都610500

出　　处：《中华神经科杂志》2023年第10期1128-1135,共8页Chinese Journal of Neurology

基　　金：疑难病症诊治能力提升工程项目(2018-510000-83-01-313060);四川省自然科学基金(面上项目)(2023NSFSC0622)。

摘　　要：目的比较视神经脊髓炎谱系疾病(NMOSD)患者与多发性硬化(MS)患者在接触性热痛刺激(CHS)下的脑区激活差异,探讨NMOSD与MS疼痛相关脑网络特征。方法收集2022年9—12月在川北医学院附属医院神经内科就诊且符合诊断标准的NMOSD患者14例(NMOSD组)、MS患者12例(MS组),同期招募性别、年龄等相匹配的健康对照12名(健康对照组)。对受试者行视觉模拟量表(VAS)评分评估疼痛;采用CHS给予疼痛刺激,同时行任务态功能磁共振成像(fMRI)扫描以评估其脑区激活差异。结果(1)NMOSD组激活程度强于健康对照组的脑区包括:左距状裂周围皮质、双侧内侧额上回;NMOSD组激活程度弱于健康对照组的脑区包括:左内侧和旁扣带脑回、右顶上回、左中央后回、右补充运动区(均P<0.05)。(2)MS组激活程度弱于健康对照组的脑区包括:左尾状核、左内侧和旁扣带脑回、左中央旁小叶、右顶上回、左中央后回、左楔前叶、右补充运动区、右颞上回、右丘脑,未见激活程度强于健康对照组的脑区(均P<0.05)。(3)NMOSD组激活程度强于MS组的脑区包括:左距状裂周围皮质、右丘脑,未见激活程度弱于MS组的脑区(均P<0.05)。(4)NMOSD组躯体疼痛VAS评分与内侧额上回的激活存在相关性(r=0.66,P<0.05)。结论NMOSD组、MS组与健康对照组CHS-fMRI结果显示有多个脑区激活,表明疼痛的产生及处理由多个脑区共同参与,存在痛觉相关脑网络。NMOSD患者与MS患者痛觉相关脑网络均发生了改变,且两种疾病之间的痛觉相关脑网络存在差异。Objective To compare the differences of brain activation in patients with neuromyelitis optica spectrum disorders(NMOSD)and multiple sclerosis(MS)under contact heat stimulation(CHS),and to explore the characteristics of pain-related brain networks in NMOSD and MS patients.Methods Fourteen NMOSD patients(NMOSD group)and 12 MS patients(MS group)admitted to Affiliated Hospital of North Sichuan Medical College from September 2022 to December 2022 who met the diagnostic criteria were collected.Twelve healthy individuals(HC group)matched with gender and age were recruited during the same period.Visual Analogue Scale(VAS)score was used to evaluate the pain of the subjects,CHS painful stimuli were given,and task-state functional magnetic resonance imaging(fMRI)scans were performed at the same time,and the differences in brain activation among the 3 groups were analyzed and compared.Results(1)Compared with the HC group,the NMOSD group had a stronger activation degree than the HC group in the brain regions including the cortex around the left distance fissure,bilateral medial superior frontal gyrus;the activation degree of the NMOSD group was weaker than that of the HC group in the brain areas including the left medial and paracingulate gyrus,right superior parietal gyrus,left postcentral gyrus,and right supplementary motor area(all P<0.05).(2)Compared with the HC group,the brain regions whose activation degree was weaker in the MS group included the left caudate nucleus,left medial and paracingulate gyrus,left paracentral lobule,right superior parietal gyrus,left postcentral gyrus,left precuneus,right supplementary motor area,right superior temporal gyrus and right thalamus,and there was no brain area in the MS group whose activation degree was stronger than that of the HC group(all P<0.05).(3)Compared with the MS group,the brain regions with stronger activation degree in the NMOSD group included the left perifissure cortex and right thalamus,but no brain regions with weaker activation degree were found in the NMOSD group

关 键 词：视神经脊髓炎谱系疾病 中央后回 激活程度 脑功能磁共振成像 距状裂 多发性硬化 神经内科 尾状核 

分 类 号：R744.52[医药卫生—神经病学与精神病学] R744.51[医药卫生—临床医学]