fMRI在功能性慢性內(nèi)臟痛研究中的進(jìn)展課件

fMRI在功能性慢性內(nèi)臟痛研究中的應(yīng)用和進(jìn)展

TheapplicationandprogressoffMRIinthestudyoffunctionalchronicvisceralpain

xxx重點實驗室

JiangsuProvincekeyLabofxxx14級研究生：xxx

導(dǎo)師：xxx教授

綜述報告結(jié)語與展望fMRI在CRD實驗動物中的應(yīng)用fMRI在臨床IBS病人中的應(yīng)用及進(jìn)展目錄fMRI與功能性慢性內(nèi)臟痛背景簡介

一、二、三、四、一、fMRI與功能性慢性內(nèi)臟痛背景簡介

1.2fMRI歷史194619731992199119771990取得了臨床MRI掃描器的專利；Mansfield使用回波成像(EPI)序列更快的得到圖像FelixBloch和EdwardPurcell分別發(fā)現(xiàn)了核磁共振(NuclearMagneticResonance)現(xiàn)象Lauterbur提出NMR可以用來成像Ogawa通過T2加權(quán)像觀察到BOLD效應(yīng)

Belliveau首次通過對比機制觀察到功能圖像

Ogawa&Kwong發(fā)表了通過BOLD信號成像的結(jié)果1.3fMRI簡介

功能性磁共振成像（functionalMagneticResonanceImaging，fMRI）：是利用磁振造影來測量神經(jīng)元活動所引發(fā)之血液動力的改變。目前主要是運用在研究人及動物的腦或脊髓。capillary含氧血紅蛋白去氧血紅蛋白BloodOxygenLevelDepend1.4功能性慢性內(nèi)臟痛簡介

功能性慢性內(nèi)臟痛（Functionalchronicvisceralpain）：是一種以腹痛或腹部不適,伴或不伴排便習(xí)慣改變?yōu)樘卣鞯奈改c功能性疾病,癥狀至少持續(xù)3個月,但結(jié)腸組織未見明顯病理學(xué)變化。功能性慢性內(nèi)臟痛IBSCRD與內(nèi)臟傷害性感受處理息息相關(guān)的三個環(huán)路：

Emerana.Mayeretal.,Gastroenterology(2006)C穩(wěn)態(tài)傳入網(wǎng)絡(luò)包括：臂旁核、丘腦、島葉、dACC等。1.4.1穩(wěn)態(tài)傳入網(wǎng)絡(luò)（homeostatic-afferentnetwork）Figure1.Ascendingprojectionsofhomeostaticafferents.(B)Spino-thalamo-corticalsystem.(C)Corticalmodulationofhomeostaticafferentinputtothecentralnervoussystem.

Fig.3.Sexdifferencesinactivationofthehomeostaticafferent,emotional–arousal,andcortical–modulatorynetworksinresponsetonoxiousvisceralstimulation.

MaleFemaleZ.Wangetal.,Pain(2009)1.4.3內(nèi)臟刺激腦部環(huán)路聯(lián)系IBS患者與正常人之間腦局部一致性(ReHo)的差異Figure4.ReHodifferencesbetweenIBSpatientsandcontrols.J.KEetal.,NeurogastroenterolMotil(2015)中央后回、丘腦、小腦蚓、頂葉aMCC、pACC、sACC、vm/dl/vlPFCIBS組和對照組接受直腸刺激后的腦區(qū)激活Figure6.Majorsitesofactivationdifferencesbetweenirritablebowelsyndrome(IBS)andhealthycontrolsubjects.C.L.Kwanetal.,Neurology(2005)對照組和IBS組接受直腸刺激誘導(dǎo)的腦區(qū)激活Figure7.(A–D)BrainactivationincontrolsandIBSpatientsduringsubliminalandliminalrectaldistensions.(E)Seedregionsdefinedintheanteriorinsula(left)andaMCC(right)basedonrectaldistension-inducedactivationinthecontrolgroup.(F)Seedregionsdefinedsimilarlyinthebilateralanteriorinsula(left)andpACC(right)intheIBSpatientgroup.X.LIU，NeurogastroenterolMotil(2015)PCC、PAGaMCC、insula、dmPFC、caudate,andPAG感覺運動皮質(zhì)、vmPFC運動皮質(zhì)

SMAthalamus,SMA,下頂葉組內(nèi)、組間激活功能區(qū)的比較Figure8.(A)Comparisonofbrainactivationbetweensubliminalandliminalstimulationconditionsinthecontrolgroup.(B)ThesameintheIBSpatientgroup.(C)GroupcomparisonofbrainactivationbetweencontrolsandIBSpatientsduringsubliminalstimulation.(D)Thesameduringliminalstimulation.對照組和IBS組島葉和扣帶回種子區(qū)的功能聯(lián)系Figure9.(AandB)FunctionalconnectivityoftheinsulaseedsinthecontrolandIBSgroupsduringliminalstimulation.(CandD)ThesameintheaMCC(incontrols)andpACC(inIBSpatients)seedsduringliminalstimulation.(EandF)GroupcomparisonsofinsularandcingulatefunctionalconnectivitybetweencontrolsandIBSpatients.(IBSVS.controls:dmPFC,vmPFC,dlPFC,andPCC)dlPFCIBS組和對照組在情緒認(rèn)知過程中的性別差異Fig.10.Sexdifferences(IBS+HC)forME-MF(ME-MF=matchingemotion–matchingform).J.S.Labusetal.Pain(2013)Fig.11.DiseaseandsexdifferencesforME-MF.健康成年人接受直腸擴張刺激的纖維束聯(lián)系Fig.13.Connectionsbetweenthemainareasactivatedduringvisceralperception.X.Moissetetal.,EuropeanJournalofPain(2010)

目前關(guān)于IBS的fMRI研究主要集中在靜息態(tài)、不同條件直腸刺激下的腦區(qū)變化，便秘型和腹瀉型差異、性別差異，安慰劑效應(yīng)、痛覺期待因素、注意力因素、不同的干預(yù)治療措施對IBS腦區(qū)變化的影響。近年來，關(guān)于IBS在情緒、認(rèn)知、情感處理中的進(jìn)展得到了關(guān)注，為探討情感體驗成分在疼痛的作用中提供了更多的依據(jù)和思考。雄性S-D大鼠在接受不同壓力下CRD刺激后的腦區(qū)激活J.Lazovicetal.,NeurogastroenterolMotil(2005)Figure14.AxialfMRIimagesoftheratbrainatthepressuresof40mmHg(A)60mmHg(B)and80mmHg(C),ofthesameanimal.amygdalaHypothalamus（PVN）NTStrigeminalnucleusFigure15.AxialfMRIimagesoftheratbrainduringtherectalballoonstimulationatthepressureof60mmHg(A)and80mmHg(B),ofthesameanimal.SCPAGthalamusCblHiIL、PLWistar大鼠接受CRD的SPECT局部腦血流（regionalcerebralbloodflow，rCBF）顯像Fig.18.Comparisonofchangesinregionalcerebralbloodflow-relatedtissueradioactivityinresponseto60-mmHgcolorectaldistensioninfemaleandmalerats.Z.Wangetal.,Pain(2009)

目前關(guān)于fMRI在CRD模型所致慢性內(nèi)臟痛的實驗尚未開展。接受急性結(jié)直腸內(nèi)臟刺激的動物在fMRI中的研究也較少，重復(fù)刺激和單次刺激的差異與否，不同的給藥途徑，不同藥物的干預(yù)等都存在較大的科研價值。當(dāng)然fMRI活體動物成像麻醉對實驗存在一定的影響，但活體成像后動物可以繼續(xù)進(jìn)行分子生物學(xué)等實驗，在一定程度上降低了實驗相關(guān)性數(shù)據(jù)的個體差異和組間、組內(nèi)差異，由此關(guān)于CRD模型在fMRI中的基礎(chǔ)研究亟待開展。四、結(jié)語與展望參考文獻(xiàn)1.Lazovic,J,Wrzos,H.F,Yang,Q.X,etal.Regionalactivationintheratbrainduringvisceralstimulationdetectedbyc-fosexpressionandfMRI[J].Neurogastroenterology&Motility,2005,17(4):548–556.2.Annalisa,DalLago,AlbertoE,Minetti,Pietro,Biondetti,etal.Magneticresonanceimagingoftherectumduringdistension.[J].DiseasesoftheColon&Rectum,2005,48(6):1220-1227.3.KwanCL,DiamantNE,PopeG,,etal.Abnormalforebrainactivityinfunctionalboweldisorderpatientswithchronicpain.[J].Neurology,2005,65(8):1268-1277.4.LawalA,KernM,SidhuH,etal.Novelevidenceforhypersensitivityofvisceralsensoryneuralcircuitryinirritablebowelsyndromepatients.[J].Gastroenterology,2006,130(1):26–33.5.JohnsonAC,BrentM,JelenaL,etal.BrainActivationinResponsetoVisceralStimulationinRatswithAmygdalaImplantsofCorticosterone:AnfMRIStudy[J].PlosOne,2010,5(1)::e8573.6.LarssonMBO,KirstenT,CraigAD,etal.BrainResponsestoVisceralStimuliReflectVisceralSensitivityThresholdsinPatientsWithIrritableBowelSyndrome[J].Gastroenterology,2012,142(3):463-472.7.KeszthelyiD,TroostFJ,MascleeAA.Irritablebowelsyndrome:methods,mechanisms,andpathophysiology.Methodstoassessvisceralhypersensitivityinirritablebowelsyndrome.[J].AmericanJournalofPhysiologyGastrointestinal&LiverPhysiology,2012,303(2):G141-54.8.ElsenbruchS,KotsisV,BensonS,etal.Neuralmechanismsmediatingtheeffectsofexpectationinvisceralplaceboanalgesia:AnfMRIstudyinhealthyplaceborespondersandnonresponders[J].Pain,2011,153(2):382-90.9.Jui-YangH,KilpatrickLA,JenniferL,etal.PatientswithChronicVisceralPainShowSex-RelatedAlterationsinIntrinsicOscillationsoftheRestingBrain[J].JournalofNeuroscience,2013,33(29):11994-12002.10.LabusJS,ArpanaG,KristenC,etal.Sexdifferencesinemotion-relatedcognitiveprocessesinirritablebowelsyndromeandhealthycontrolsubjects.[J].Pain,2013,154(10):2088–2099.11.ZhuX,ZhuX,ChenW,etal.TheApplicationofFunctionalMagneticResonanceImaginginanInfantRatModelofIrritableBowelSyndrome[J].GastroenterologyResearch&Practice,2014,2014(5):637-645.12.TownerRA,SmithN,SaundersD,etal.ContrastEnhancedMagneticResonanceImagingasaDiagnosticTooltoAssessBladderPermeabilityandAssociatedColonCrossTalk:PreclinicalStudiesinaRatModel[J].JournalofUrology,2014,193(4):1394-1400.13.X.Liu,A.Silverman,M.Kern,etal.Excessivecouplingofthesaliencenetworkwithintrinsicneurocognitivebrainnetworksduringrectaldistensioninadolescentswithirritablebowelsyndrome:apreliminaryreport[J].Neurogastroenterology&Motility,2015.14.MakinTR,FilippiniN,DuffEP,etal.Network-levelreorganisationoffunctionalconnectivityfollowingarmamputation[J].Neuroimage,2015,28:217–225.15.IcenhourA,LanghorstJ,BensonS,etal.Neuralcircuitryofabdominalpain-relatedfearlearningandreinstatementinirritablebowelsyndrome[J].Neurogastroenterology&Motility,2015,27(1):114–127.16.SegerdahlAR,MelvinM,OkellTW,etal.Thedorsalposteriorinsulasubservesafundamentalroleinhumanpain.[J].NatureNeuroscience,2015,18(4).17.SchmidJ,BingelU,RitterC,etal.Neuralunderpinningsofnocebohyperalgesiainvisceralpain:AfMRIstudyinhealthyvolunteers.[J].Neuroimage,2015,120:114–122.18.KeJ,QiR,LiuC,etal.Abnormalregionalhomogeneityinpatientswithirritablebowelsyndrome:Aresting-statefunctionalMRIstudy[J].Neurogastroenterology&Motility,2015.19SchmidJ,LanghorstJ,Ga?F,etal.Placeboanalgesiainpatientswithfunctionalandorganicabdominalpain:AfMRIstudyinIBS[J].Gut,2014,64(3).20.C.S.Hubbard,J.Hong,Z.Jiang,etal.Increasedattentionalnetworkfunctioningrelatedtosymptomseveritymeasuresinfemaleswithirritablebowelsyndrome[J].Neurogastroenterology&Motility,2015,27(9):1282–1294.21.肖偉波,張強,張曄,等.第一疼痛和第二疼痛的神經(jīng)影像學(xué)研究[J].中國疼痛醫(yī)學(xué)雜志,2011(6):366-369.22.PetersenGL,FinnerupNB,KasperG,etal.Expectationsandpositiveemotionalfeelingsaccompanyreductionsinongoingandevokedneuropathicpainfollowingplacebointerventions.[J].Pain,2014,155(12):2687–2698.23.KatjaW,MarkusP,IreneT.Neurocognitiveaspectsofpainperception[J].TrendsinCognitiveSciences,2008,12(8):306–313.24.VincentK,WarnabyC,StaggCJ,etal.Brainimagingrevealsthatengagementofdescendinginhibitorypainpathwaysinhealthywomeninalowendogenousestradiolstatevarieswithtestosterone[J].Pain,