基于rs-fMRI技术研究膝骨关节炎患者tDCS镇痛的神经调控机制

Neuroregulatory mechanism of tDCS for chronic pain in patients with knee osteoarthritis: A resting-state functional magnetic resonance imaging study

摘要:

目的：观察经颅电刺激（transcranial direct current stimulation，tDCS）膝骨关节炎（knee osteoarthritis，KOA）患者脑区的局部一致性（regional homogeneity，ReHo），探究治疗缓解疼痛和焦虑的脑机制。方法：对tDCS试验组（n=17）和对照组（n=19）分别于第1天治疗前（T0）、第10天治疗后（T1）进行静息态功能磁共振（resting-state functional magnetic resonance imaging，rs-fMRI）扫描、汉密尔顿焦虑量表评分（Hamilton anxiety scale，HAMA）和疼痛视觉模拟评分（visual analogue scale，VAS），并在治疗后一个月（T2）进行随访调查。结果：试验组相对于对照组ReHo显著增强的脑区有右岛盖部额下回、右脑岛、右中央沟盖、右中央前回、右颞极颞上回、三角部额下回、右梭状回、右颞下回、左颞上回、左中央沟盖和左岛盖部额下回；ReHo显著降低的脑区是左楔叶。另外，右脑岛ReHo值的增加与VAS 评分差值呈正相关。左楔叶ReHo 值的减低与VAS 评分差值呈负相关。结论：tDCS可以从疼痛感觉、情绪、认知多维度发挥镇痛作用，改善 KOA 患者疼痛与焦虑症状。

Abstract:

Objective: To observe the regional homogeneity (ReHo) of brain regions in patients with knee osteoarthritis (KOA) treated with transcranial direct current stimulation (tDCS) and to explore the brain mechanisms underlying pain relief and anxiety reduction. Methods: Resting-state functional magnetic resonance imaging (rs-fMRI), Hamilton Anxiety Scale (HAMA) scores, and visual analogue scale (VAS) pain scores were collected for the tDCS experimental group (n=17) and the control group (n=19) before treatment on day 1 (T0) and after treatment on day 10 (T1). A follow-up assessment was also conducted one month after treatment (T2). Results: Compared to the control group, the experimental group showed significantly increased ReHo in the right frontal inferior gyrus (opercular part), right insula, right Rolandic operculum, right precentral gyrus, right temporal pole superior temporal gyrus, right frontal inferior gyrus (triangular part), right fusiform gyrus, right inferior temporal gyrus, left superior temporal gyrus, left Rolandic operculum, and left frontal inferior gyrus (opercular part). A significant decrease in ReHo was observed in the left cuneus. Additionally, the increase in ReHo values in the right insula was positively correlated with the difference in VAS scores, while the decrease in ReHo values in the left cuneus was negatively correlated with the difference in VAS scores. Conclusion: tDCS can exert analgesic effects through multiple dimensions, including pain sensation, emotion, and cognition, thereby improving pain and anxiety symptoms in KOA patients.