利用静态功能磁共振技术探索MTrPs所致疼痛的脑功能活动及调控机制

Pain induced by myofascial trigger points (MTrPs) severely affects human health. However, it remains unclear whether MTrPs are associated with peripheral or central nervous system dysfunction. The study conducted recently by the applicant revealed that, drug injection into the intramuscular area with densely distributed nerve branches effectively alleviated MTrPs-induced pain, but the treatment effectiveness gradually diminished as the follow-up time increased. This finding implied the possibility that the injected drug might inhibit the activity of MTrPs and temporarily disrupt the mechanism of its regulation by the central nervous system. This preliminary finding prompts us to further investigate functional changes in brain associated with MTrPs-induced pain and clarify the role of the central nervous system in the regulation of MTrPs. These are very important scientific questions that urgently need to be addressed in order to understand and clarify the pathophysiological mechanism underlying MTrPs. In recent years, reating-state functional magnetic resonance imaging (rsfMRI) has become an important technique to detect changes in brain functional activity in patients with pain. Based on the previous research findings and expertise in this area, this research project will apply rsfMRI to explore: 1) whether there are any functional changes in brain before and after the treatment of patients with MTrPs-induced pain; 2) whether the central nervous system is involved in the regulation of MTrPs and the mechanism of this regulation. Answers to these questions could help to provide an explanation of the pathophysiological mechanism underlying the pathogenesis and treatment outcomes of MTrPs from the perspective of brain function. The goal of this project is to provide systematic scientific evidence for treatment selection and prognosis prediction of MTrPs-induced pain by identifying objective imaging indicators.

肌筋膜扳机点(MTrPs)所致疼痛严重危害人类健康，然而，MTrPs到底是外周还是中枢现象仍不清楚。申请人最近研究发现肌内神经密集区注射药物治疗能有效缓解MTrPs所致疼痛，但随访时间延长治疗效果也逐渐减弱，提示是否为药物抑制了MTrPs的活性暂时阻断中枢的调控？前期结果促使我们进一步思考MTrPs所致疼痛的脑功能改变及可能的中枢调控机制，这是当前理解和阐明MTrPs的病理生理机制亟需解决的重要科学问题。近年来，静态功能磁共振技术已成为疼痛领域研究患者脑功能改变的重要手段。本课题拟在前期研究的基础上，采用静态功能磁共振技术探索:(1)MTrPs所致疼痛治疗前后是否存在脑功能改变? (2)中枢是否参与MTrPs的调控及其机制？上述问题的解决将有助于从脑功能角度提供MTrPs发病及治疗转归的基本信息，希望通过相对客观的影像学指标为MTrPs所致疼痛的治疗选择、预后判断提供较为系统的科学依据。

肌筋膜扳机点(MTrPs)所致慢性疼痛严重危害人类健康，然而，MTrPs到底是外周还是中枢现象仍不清楚。本项目采用静态功能磁共振技术探索：(1)MTrPs所致疼痛治疗前后是否存在脑结构和功能改变？(2)中枢是否参与MTrPs的调控及其机制？通过相对客观的影像学指标为MTrPs所致疼痛的治疗选择、预后判断提供较为系统的科学依据。脑结构方面：相对于健康对照组，慢性肌筋膜疼痛患者的脑灰质微结构发生异常，主要分布于边缘系统和疼痛矩阵所涉及的脑区。右侧前扣带回和内侧前额叶皮质的灰质微结构的异常与病程和疼痛强度呈显著负相关。脑功能方面：与健康健康对照组比较，慢性肌筋膜疼痛患者的右侧丘脑、右侧海马、右侧前扣带回、右侧楔前叶、右侧后扣带回、右侧额上回的ALFF值显著增高，而右侧岛叶的ALFF值降低。此外，本项目还发现右侧丘脑和前扣带回皮层的ALFF均值分别与VAS评分、疼痛持续时间呈显著正相关。与治疗前比较，慢性肌筋膜疼痛患者治疗后2月，虽然VAS评分显著降低，但额上回、前扣带回皮层以及丘脑的ALFF值仍增高。本项目进一步采用静息态的脑血流量(CBF)和功能连接强度(FCS)耦合分析方法观察慢性肌筋膜疼痛患者的神经血管耦合状态，发现肌筋膜疼痛患者的全脑灰质脑血流量-功能连接强度(CBF-FCS)耦合降低。肌筋膜疼痛患者的CBF/FCS比值降低脑区位于双侧颞上回、右侧海马旁回、右侧海马、尾状核、右内侧前额叶和中脑导水管周围灰质（PAG），而CBF/FCS比值升高的脑区位于双侧舌回、后扣带回和双侧顶下小叶。此外，肌筋膜疼痛患者PAG的CBF/FCS比值与疼痛评分和疼痛持续时间呈显著负相关。本项目首次证实MTrPs所致慢性疼痛患者的脑灰质微结构、脑功能及神经血管耦合存在异常，MTrPs产生的病理生理学机制可能有中枢和外周共同作用的结果，研究结果将为后续制定合理的治疗策略提供新视窗。. 本项目共发表7篇论文，其中SCI论文4篇。执行期间项目负责人入选“全国重症青年科学家”、“全国白求恩式的好医生”。培养5名研究生，2017年参加国际形态学大会，论文摘要被SCI杂志Annal of Anatomy收录。

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