围绝经期妇女急性痛信息处理和认知调控的功能磁共振研究

Although the prevalence of migraine is very high during peri-menopause period, there exist significant individual differences in whether developing migraine among this population. However, there still lacks effective early screen system for the migraine-susceptible women during the peri-menopause period. Individual acute pain processing and its interaction with cognition as well as the underling featured functional magnetic resonance imaging (fMRI) are suitable for screening pain-susceptible individual. Actually, the featured acute pain processing and its interaction with cognition as well as fMRI alterations were reported in two previous small sample trials among pre-menopause population, however, there is no similar study on large sample peri-menopause women. We previously reported abnormal acute pain processing and decreased cognition in the experimental peri-menopause rats as well as peri-menopause women with migraine. We thus raised the current hypothesis that the acute pain processing and its interaction with cognition as well as the underling featured functional magnetic resonance imaging (fMRI) are usable for screening migraine-susceptible individuals among peri-menopause women. In the current project, we will combine pain behavior, cognitive task, fMRI analysis, psychophysiological interaction (PPI) and suitable statistical package to investigate the relationship between the above mentioned features and the occurrence of migraine and then test the efficacy of these features in predicting migraine development. We will then try to establish the screening system for migraine-susceptible individuals in peri-menopause women.

围绝经期妇女是否发生偏头痛存在明显的个体差异，目前还不能有效筛查围绝经期偏头痛易感妇女。急性痛信息处理和认知调控行为及相应的功能磁共振（fMRI）特征可用于筛选疼痛易感个体。既往小样本试验观察到绝经前期偏头痛患者存在特征性的急性痛处理和认知调控行为及fMRI改变，但尚未在围绝经期妇女中开展大样本研究。课题组前期发现围绝经期大鼠以及伴随偏头痛的围绝经期妇女急性痛信息处理方式显著改变。我们提出："结合个体的急性痛信息处理和认知调控行为及相应的fMRI特征，可以早期筛查围绝经期偏头痛易感妇女"的科学假说。拟综合疼痛行为学、认知任务测试、fMRI扫描及分析、心理生理交互作用等分析技术，横向探讨上述行为及fMRI特征与围绝经期妇女偏头痛的相关性；纵向分析其筛查围绝经期偏头痛易感妇女的效能，构建围绝经期妇女筛查系统。

目的.围绝经期妇女是否发生偏头痛存在明显的个体差异，目前还不能有效筛查围绝经期偏头痛易感妇女。急性痛信息处理和认知调控行为及相应的功能磁共振（fMRI）特征可用于筛选疼痛易感个体。课题组拟结合个体的急性痛信息处理和认知调控行为及相应的fMRI特征，早期筛查围绝经期偏头痛易感妇女。.方法.本研究纳入本研究纳入符合筛选标准的37位健康被试（11位女性），23名偏头痛患者（9名女性）并采集弥散张量成像数据，使用TBSS分析方法计算多个DTI参数值，采集血氧水平依赖成像并计算功能连接，采集动脉自旋标记信号并计算大脑血流灌注情况。使用双样本t检验进行组间比较。.结果.正常男女在左侧上纵束、左侧下纵束和胼胝体辐射线额部，男性各向异性分数（FA）值高于女性。男性左侧背部少颗粒区岛叶分别与右侧内侧和旁扣带脑回/后扣带回/楔前叶、右侧内侧和旁扣带脑回、左侧角回和左侧额中回之间的功能连接强度高于女性。偏头痛妇女脑白质纤维结构存在多种异常，表现为左侧或右侧下纵束、胼胝体辐射线枕部和两侧丘脑前辐射这些区域均显示FA值降低、平均弥散率（MD）值和径向弥散率（RD）值升高。偏头痛妇女左侧皮质脊髓束的MD值和RD值都升高，而其左侧上纵束的FA值降低同时RD值升高。相关性分析结果显示，偏头痛妇女投射在距状沟内部的白质纤维结构MD值与偏头痛病程呈正相关。基于种子点到全脑的功能连接分析发现，偏头痛妇女两侧腹部无颗粒区岛叶、两侧背部无颗粒区岛叶和左侧腹部少颗粒和颗粒区岛叶与颞叶以及边缘系统部分脑区之间的功能连接强度低于正常对照。.结论.女性大脑处理痛觉信息的脑结构与功能与男性有显著差异，可能是女性更易罹患偏头痛的原因。偏头痛患者大脑角回、缘上回等区域神经血管偶联程度显著降低，并与头痛程度成显著相关。偏头痛女性岛叶与全脑许多脑区功能连接有异常改变，提示岛叶功能连接可作为诊断预测患者偏头痛发生以及程度的重要指标。

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