目的分析腰椎间盘突出症(lumbar disc herniation,LDH)静息态功能磁共振成像(resting-state functional magnetic resonance imaging,rs-fMRI)改变,探讨其可能存在的神经影像学机制.材料与方法前瞻性纳入24例LDH患者,选取30例慢性非特异性腰背痛患者(chronic nonspecific low back pain,CNLBP)及27例健康对照(health control,HC)作为对照组.对LDH组及CNLBP组进行疼痛视觉模拟量表(Visual Analogue Scale,VAS)、腰椎Oswestry功能障碍指数(Oswestry Disability Index,ODI)及日本骨科学会评分表(Japanese Orthopedic Association,JOA)评估,LDH组、CNLBP组及HC组均接受rs-fMRI扫描,比较三组间低频振幅(amplitude of low-frequency fluctuation,ALFF)差异,提取LDH组与CNLBP组差异脑区的ALFF值与VAS、ODI、JOA评分进行相关性分析.结果LDH组和CNLBP组在VAS评分间无差异,在ODI、JOA评分间存在差异,LDH组腰椎功能障碍更明显.三组间ALFF值改变的脑区为双侧距状裂周围皮层/楔叶、左侧丘脑(GRF校正,体素水平P<0.005,团块水平P<0.01).两组间比较:与HC组相比,LDH组在双侧距状裂周围皮层/楔叶的ALFF值减低,在左侧丘脑的ALFF值增高,CNLBP组在双侧距状裂周围皮层/楔叶的ALFF值减低,未发现ALFF值增高的脑区;与CNLBP组相比,LDH组在左侧丘脑的ALFF值增高,未发现ALFF值减低的脑区.相关性分析示LDH组和CNLBP组差异脑区的ALFF值与VAS、ODI、JOA评分无明显相关(P>0.05).结论LDH存在与CNLBP共有及特异的疼痛中枢调节机制,左侧丘脑功能活动强弱变化可能是LDH的中枢机制的重要特征.
Evaluation of rest-state fMRI in patients with lumbar disc herniation based on ALFF
Objective:To analyze the changes in resting-state functional magnetic resonance imaging (rs-fMRI) in patients with lumbar disc herniation (LDH) and explore potential neuroimaging mechanisms. Materials and Methods:A total of 24 LDH patients were prospectively included,along with 30 chronic nonspecific low back pain patients (CNLBP) and 27 healthy controls (HC) as the control group. First,the LDH group and CNLBP group underwent Visual Analog Scale (VAS),Oswestry Disability Index (ODI),and Japanese Orthopedic Association (JOA) assessments. Then,all three groups underwent rs-fMRI scanning,and the differences in amplitude of low-frequency fluctuation (ALFF) values among the three groups were compared. Finally,the ALFF values of the brain regions differed between the LDH group and CNLBP group were extracted and correlated with the clinical scales. Results:The clinical scale evaluation results showed that there was no difference in VAS scores between the LDH group and CNLBP group,but there were differences in ODI and JOA scores,indicating that LDH patients had more severe lumbar dysfunction. The brain regions with altered ALFF values among the three groups were bilateral calcarine/cuneus cortex,left thalamus (GRF correction,P<0.005 at voxel level,P<0.01 at cluster level). Compared with the HC group,the LDH group had decreased ALFF values in the bilateral calcarine/cuneus cortex,and increased ALFF values in the left thalamus;the CNLBP group had decreased ALFF values in the bilateral calcarine/cuneus cortex but no increased ALFF values. Compared with the CNLBP group,the LDH group had increased ALFF values in the left thalamus but no decreased ALFF values. No correlation was found between the ALFF values of the brain regions differed between the LDH group and CNLBP group and the clinical scales. Conclusions:Patients with LDH have both shared and unique pain central regulatory mechanisms with CNLBP patients.The change of left thalamic functional activity may be an important characteristic of the LDH central mechanism.
lumbar disc herniationchronic nonspecific low back painresting-state functional magnetic resonance imagingmagnetic resonance imagingamplitude of low-frequency fluctuation
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