基于静息态功能MRI的舌咽神经痛中枢发病机制研究  

Study of central mechanisms of glossopharyngeal neuralgia based on resting-state functional MRI

作　　者：郑文韬 郝庆沛 吕高泉 刘业祖 武广永 张子豪 刘如恩[1] Zheng Wentao;Hao Qingpei;Lyu Gaoquan;Liu Yezu;Wu Guangyong;Zhang Zihao;Liu Ruen(Department of Neurosurgery,Peking University People′s Hospital,Beijing 100044,China;the Department of Neurosurgery,The First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen 361003,China)

机构地区：[1]北京大学人民医院神经外科,北京100044 [2]厦门大学附属第一医院神经外科,厦门361003

出　　处：《中华神经外科杂志》2024年第7期694-701,共8页Chinese Journal of Neurosurgery

摘　　要：目的通过应用静息态功能MRI(rs-fMRI)技术分析原发性舌咽神经痛(GPN)患者和健康对照组受试者在静息状态下脑自发性功能活动局部一致性(ReHo)的差异,从脑功能学的角度探究GPN的中枢发病机制。方法前瞻性收集2020年1月至2023年6月就诊于北京大学人民医院神经外科的23例右侧原发性GPN患者的临床资料和rs-fMRI图像,与23例年龄、性别和受教育程度相匹配的健康对照组受试者进行比较。采用基于Matlab R2022a编程平台的统计参数图SPM12和RESTplus软件处理rs-fMRI图像,并计算脑功能活动ReHo值,采用双样本t检验对两组受试者进行比较,找寻差异具有统计学意义的脑区;根据是否存在神经血管压迫对GPN患者进行分层和亚组分析,采用AlphaSim方法对P值进行多重比较校正。应用Pearson相关性分析进一步评估差异脑区的ReHo值与患者的年龄、病程、疼痛视觉模拟量表评分的相关性。结果(1)与健康对照组患者相比,GPN患者的左侧丘脑、中央前回、中央后回,右侧岛叶、颞上回、颞中回、中央前回、中央后回的ReHo值显著升高(均P<0.05):而双侧前扣带回的ReHo值显著降低(均P<0.05)。(2)与伴有神经血管压迫的GPN患者相比,不伴有神经血管压迫的GPN患者双侧中央前回和中央后回的ReHo值均显著升高(均P<0.05),而双侧前扣带回的ReHo值显著降低(均P<0.05)。(3)GPN患者双侧前扣带回的ReHo值与疼痛视觉模拟量表评分呈负相关(r=-0.47,P=0.024),其余差异脑区的ReHo值与患者的年龄、病程、疼痛程度均无显著相关性(均P>0.05)。结论GPN患者多个参与疼痛处理的脑区存在显著的协调性异常,疼痛上行传导通路和下行抑制通路两者兴奋性和抑制性的失衡共同引起GPN患者疼痛调节功能的异常,GPN的发病可能是外周刺激和中枢兴奋共同导致的结果。Objective We used resting-state functional MRI(rs-fMRI)to explore the difference in regional homogeneity(ReHo)of spontaneous brain functional activity in patients with primary glossopharyngeal neuralgia(GPN)and healthy control subjects in the resting state and thus to explore the central pathogenesis of GPN from the perspective of brain function.Methods Clinical data and rs-fMRI images of 23 patients with right-sided primary GPN who were admitted to Department of Neurosurgery,Peking University People′s Hospital from January 2020 to June 2023 were prospectively collected and compared with 23 healthy control subjects matched for age,sex,and education.We used SPM12 and RESTplus softwares to process the rs-fMRI images and calculate ReHo values for functional brain activity.A two-sample independent t-test was performed on the data to compare brain areas that were significantly different between the two groups of subjects.GPN patients were stratified and subgrouped according to the presence or absence of neurovascular compression.P values were corrected for multiple comparisons using the AlphaSim method.Pearson correlation analysis was used to further assess the correlation between ReHo values and clinical indicators including age,duration of disease,extent of pain(based on visual analogue scale,VAS)in the differential brain regions.Results Compared with healthy controls,GPN patients had significantly higher ReHo values(all P<0.05)in the following brain regions:left thalamus,precentral gyrus,postcentral gyrus;right insula,superior temporal gyrus,middle temporal gyrus,precentral gyrus,postcentral gyrus.GPN patients had significantly lower ReHo values(both P<0.05)in the bilateral anterior cingulate gyrus.Compared with GPN patients with neurovascular compression,GPN patients without neurovascular compression had significantly higher ReHo values in the bilateral precentral and postcentral gyrus(all P<0.05)and lower ReHo values in the bilateral anterior cingulate gyrus(both P<0.05).The change in ReHo values in the bilater

关 键 词：舌咽神经疾病 静息态功能磁共振成像 局部一致性 中枢机制 

分 类 号：R445.2[医药卫生—影像医学与核医学] R745.13[医药卫生—诊断学]