Chang Lin, Berman Steve, Mayer Emeran A, Suyenobu Brandall, Derbyshire Stuart, Naliboff Bruce, Vogt Brent, FitzGerald Leah, Mandelkern Mark A
C.N.S. Center for Neurovisceral Sciences & Women's Health, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Am J Gastroenterol. 2003 Jun;98(6):1354-61. doi: 10.1111/j.1572-0241.2003.07478.x.
Symptoms of irritable bowel syndrome (IBS) and fibromyalgia (FM) commonly coexist. We hypothesized that one of the mechanisms underlying this comorbidity is increased activation of brain regions concerned with the processing and modulation of visceral and somatic afferent information, in particular subregions of the anterior cingulate cortex (ACC).
Regional cerebral blood flow (rCBF) was assessed in age-matched female IBS (n = 10) and IBS + FM (n = 10) subjects using H(2)(15)O positron emission tomography during noxious visceral (rectal) and somatic pressure stimuli.
GI symptom severity was significantly higher in the IBS patients compared with the IBS + FM patients (p < 0.05). In addition, IBS + FM patients rated somatic pain as more intense than their abdominal pain (p < 0.05). Whereas the somatic stimulus was less unpleasant than the visceral stimulus for IBS patients without FM, the somatic and visceral stimuli were equally unpleasant in the IBS + FM group. Group differences in regional brain activation were entirely within the middle subregion of the ACC. There was a greater rCBF increase in response to noxious visceral stimuli in IBS patients and to somatic stimuli in IBS + FM patients.
Chronic stimulus-specific enhancement of ACC responses to sensory stimuli in both syndromes may be associated with cognitive enhancement of either visceral (IBS) or somatic (IBS + FM) sensory input and may play a key pathophysiologic role in these chronic pain syndromes.
肠易激综合征（IBS）和纤维肌痛（FM）的症状常同时存在。我们推测这种共病的潜在机制之一是与内脏和躯体传入信息处理及调节相关的脑区，特别是前扣带回皮质（ACC）的亚区激活增加。
在年龄匹配的女性IBS患者（n = 10）和IBS + FM患者（n = 10）中，使用H(2)(15)O正电子发射断层扫描技术评估在有害内脏（直肠）和躯体压力刺激期间的局部脑血流量（rCBF）。
与IBS + FM患者相比，IBS患者的胃肠道症状严重程度显著更高（p < 0.05）。此外，IBS + FM患者将躯体疼痛评为比腹痛更强烈（p < 0.05）。对于无FM的IBS患者，躯体刺激比内脏刺激的不适感轻，而在IBS + FM组中，躯体和内脏刺激的不适感相同。脑区激活的组间差异完全在ACC的中间亚区内。IBS患者对有害内脏刺激的rCBF增加更大，而IBS + FM患者对躯体刺激的rCBF增加更大。
在这两种综合征中，ACC对感觉刺激的慢性刺激特异性增强可能与内脏（IBS）或躯体（IBS + FM）感觉输入的认知增强有关，并可能在这些慢性疼痛综合征中起关键的病理生理作用。
