中枢介导的腹痛综合征患者大脑多模态磁共振成像研究

Centrally meditated abdominal pain syndrome (CAPS), formerly named as functional abdominal pain syndrome, is characterized by continuous or frequently recurrent abdominal pain that cannot be explained by a structural or metabolic disease, and is relative independent from motility disturbances. Patients with FAPS were severely troubled by the persistent abdominal pain, as well as other functional somatic symptoms and psychological distress, which leaded to significant adverse impact on their quality of life and social function. However, so far, the centrally mediated pathological mechanisms can only be inferred from the findings of other functional gastrointestinal disorders with abdominal pain. That is the persistent abdominal pain may be related to the dysfunctional interactions between different neuronal systems. Nevertheless, since the impact of the imminent and physiological visceral afferent input from the digestive tract was remarkably small in CAPS, the brain structural and functional network disturbance was unclear. Therefore, this project is planned to explore the characteristics of the whole brain large-scale structural and functional network connectivity, the changes of the topological model of the brain functional network caused by the stress-related emotional activation task, and their correlations with clinical symptoms and psychological characteristics based on the data from the multimodal magnetic resonance imaging and complex network analysis. This is meaningful for illustrating the pathological mechanisms of CAPS, providing objective neuroimaging markers for this functional disorder, and promoting a deeper understanding of the structural and functional network of human brain and their relationship in the future.

中枢介导的腹痛综合征，即功能性腹痛综合征，是指缺乏器质性疾病基础且与肠道功能无关的持续性或频发的腹部疼痛。除持续的腹痛困扰外，患者常同时伴随其他躯体不适及精神心理问题，生活质量和社会功能常受到显著影响。但是其中枢参与的病理机制迄今只能借鉴对伴腹痛症状的其它功能性胃肠病研究结果进行推测，即持续的腹痛可能与不同神经元系统间相互作用的紊乱有关。然而，由于CAPS中消化道来源的时相性、生理性内脏传入的作用明显较小，其中枢结构和功能损伤的方式尚未可知。因此，本课题拟基于大脑多模态磁共振数据和复杂网络分析方法探索CAPS全脑大尺度结构和功能网络连接损伤特征，及其受应激相关情绪激活任务驱动后脑功能网络的拓扑模式的变化，和与临床症状和精神心理特征的相关性。这对阐明CAPS这一功能性疾病的病理机制、提供客观神经影像学标记物、也促使未来更深入地理解人脑结构和功能网络及其相互关联具有重要意义。

功能性腹痛是指排除器质性或代谢性疾病的持续性或频发的腹部疼痛，常见于功能性腹痛综合征、功能性消化不良或肠易激综合征等功能性胃肠病。本课题基于前期工作基础，提出总体假设：功能性腹痛患者大脑结构和功能模块的连接模式很可能有一定程度的异常，这种异常并可能受到应激相关情绪激活任务的影响，且与患者临床精神心理特征具有一定相关性。.本研究共纳入符合罗马IV诊断标准的功能性腹痛患者，及与其匹配的健康对照者和抑郁症患者各40例，采集其人口学信息、腹痛及伴随躯体症状、抑郁焦虑程度、生活质量、患病观念等精神心理和认知行为特征，并使用多模态磁共振成像技术（结构、扩散、功能磁共振成像及虚拟投球任务）采集相应数据，构建个体水平全脑大尺度结构和功能网络连接。.经对三组患者精神心理和认知行为特征分析，本研究发现与健康对照相比，功能性腹痛患者的其它躯体不适负担较重、对疾病的负性认知和担心较多、抑郁焦虑及睡眠维度评分较高，生活质量受到一定影响，且既往童年期虐待事件、焦虑特质和述情障碍等均显著增加。但相较于抑郁症患者，以上负性精神心理特征较轻。通过对多模态磁共振数据的初步分析，本研究发现功能性腹痛患者与抑郁症患者在静息态和社交排斥任务下可能存在共同的异常功能连接，这在一定程度上可以解释其共同疾病特征。.以上结果说明，即使排除共患抑郁焦虑疾病，功能性腹痛患者仍然存在较高的负性精神心理认知和行为特征，且生活质量受到一定损害，这一特征与典型的抑郁症患者存在相似之处。大脑多模态磁共振结果支持功能性腹痛患者存在脑功能网络连接损伤，这种异常可能与患者对疼痛的感知有关。这将对进一步理解功能性腹痛及其他内脏疼痛疾病模型的病理生理机制起到重要的提示作用，为这一功能性疾病的提供潜在客观神经影像学标记物。