大脑感知在GERD相关NCCP发病中作用的初步研究

PRELIMINARY STUDY ON EFFECT OF CEREBRAL SENSATION AND PERCEPTION ON THE PATHOGENESIS OF GERD ASSOCIATED NCCP

摘要:

目的：初步探讨胃食管反流病（GERD）相关非心源性胸痛（NCCP）患者大脑功能区激活的特点，了解内脏高敏感在其发病中的作用。方法：4名正常对照及8名诊断为GRED相关NCCP患者，行食管内酸灌注，灌注前、中、后行功能性磁共振扫描，寻找与食管内刺激相关的脑功能区。结果：（1）静息状态下，正常对照组及GERD相关NCCP组中均观察到部分脑区活跃。（2）在食管内酸刺激时，正常对照组及GERD相关NCCP组患者较静息态时均存在PFC、ACC、IC及丘脑区的明显激活。（3）对两组激活的各脑区进行分析，采用中位数（范围）法，结果发现GERD相关NCCP组丘脑区激活较明显，但两组受试者在上述四个区域激活上无显著统计学差异（P〉0．05）。（4）在GERD相关NCCP亚组中，NERD＋组PFC区BA10激活较明显，NERD-SI-组IC激活较明显。结论：PFC、ACC、IC及丘脑可能是调节GERD相关NCCP患者食管内脏感知的重要脑功能区；GERD相关NCCP患者各亚组可能通过不同的高级皮层调节内脏感觉。

Abstract:

Objective: To study the activation of GERD associated NCCP patients.Methods: Four normal subjects and eight GERD associated NCCP were employed.GERD associated NCCP were divided into 3 subgroups as NERD+, NERD-SI-,and RE according to the result of endoscope and pH monitoring.A gastric tube was planted in the esophagus 5cm above LES and 0.1 N HCL was perfused in the esophagus for 5 minutes.fMRI images were obtained during baseline and HCL perfusion.Statistical parametric mapping(SPM) analysis identified activation differences between baseline and HCL perfusion within-group and between groups.Results:(1)Activations were partly detected among control and GERD associated NCCP groups in rest.(2)PFC,ACC,IC and thalamus were actived significantly in both control and GERD associated NCCP groups during acid stimulus in esophagus.(3)Thalamus seemed to be more active in GERD associated with NCCP than that in normal,but there's no significant difference.(4) BA10 and IC were significantly actived in NERD+ and NERD-SI-patients respectively.Conclusion: PFC,ACC,IC and thalamus play an important roles in visceral sensation and perception of GERD associated NCCP patients.NCCP subgroups may adjust visceral sensation and perception through different brain stuctures.