臂丛神经撕脱伤后慢性疼痛患者脑区葡萄糖代谢的研究

臂丛神经撕脱伤后慢性疼痛是一种临床上顽固性神经病理性疼痛.然而,对于其潜在的中枢机制还知之甚少.为了进一步探讨臂丛神经撕脱伤后慢性疼痛的相关脑区活动,利用18F-脱氧葡萄糖(FDG)正电子断层扫描(PET)技术观察臂丛神经撕脱后慢性疼痛患者的脑葡萄糖代谢.选择左侧臂丛神经撕脱伤后慢性疼痛行脊髓后根入髓区(DREZ)切开术后疼痛减轻>75%的患者,共5例,分别在术前和术后14天行PET扫描采集数据,同时行视觉模拟评分(VAS),汉密尔顿(Hamilton)抑郁和焦虑评分.用统计参数图(SPM2)软件分析数据.与术前疼痛状态下相比,术后葡萄糖代谢明显减低的脑区有双侧尾状核,眶额回(OFC)(BA11),对侧扣带下回(BA25)和同侧前额叶背外侧区域(DLPFC)(BA46/47).葡萄糖代谢明显增高的脑区有对侧丘脑,枕核和同侧项叶(BA7).研究结果提示,涉及情绪、注意和疼痛内在调节的脑区在臂丛神经撕脱伤后慢性疼痛的调制中发挥重要作用.

Brain Glucose Metabolic Changes in Patients With Chronic Pain Due to Brachial Plexus Avulsion: a Positron Emission Tomography Study

Chronic pain due to brachial plexus avulsion (BPA) is a kind of refractory neuropathic pain, yet there is a lack of knowledge regarding underlying brain activity. To further identify brain regions involved in chronic pain due to BPA, fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) was used to observe brain glucose metabolic changes in those patients. Five patients with chronic pain due to left-BPA, whose pain reduced more than 75% after dorsal root entry zoneotomy (DREZotomy) were selected. The visual analog scale (VAS) , Hamilton depression scale, Hamilton anxiety scale and ¹⁸F-FDG PET of brain were recorded before and 14 days after DREZotomy respectively. Statistical parametric mapping 2 (SPM2) was applied for data analysis. Comparing with PET during pain before DREZotomy, PET after DREZotomy showed significant glucose metabolism decreases in bilateral caudate, orbitofrontal cortex (OFC) (BA11), contralateral subgenual cingulate (BA25) and ipsilateral dorsolateral prefrontal cortex (DLPFC) (BA46/47), and significant glucose metabolism increases in contralateral thalamus, pulvinar and ipsilateral parietal lobe (BA7). The results suggested that the brain areas involved in emotion, attention and internal modulation of pain play an important role in the modulation of chronic pain due to BPA.