Department of Neurosciences, Psychiatry Division, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
Am J Gastroenterol. 2010 Apr;105(4):913-24. doi: 10.1038/ajg.2010.39. Epub 2010 Feb 16.
During gastric distension in hypersensitive functional dyspepsia (FD), activation was found in somatosensory cortex (SI/SII) and ventrolateral prefrontal cortex (vlPFC) but, contrary to controls, not in pregenual anterior cingulate (pACC). The aims of this article were to study (i) cortical activations and deactivations during distension and sham compared with baseline in FD, regardless of sensitivity status; (ii) differences in brain activity between health and FD during "no distension" conditions; and (iii) the relationship between anxiety and brain activity in FD.
Brain H(2)(15)O-PET was performed in 25 FD patients (13 hypersensitive) during three conditions: baseline, distension at discomfort threshold, and sham. Brain activity was compared against healthy controls using SPM2.
Discomfort threshold was lower; sensation scores in all conditions were higher in patients than controls. (i) Activations were similar to controls, except for a lack of pACC activation during distension in FD. Patients showed no dorsal pons and amygdala deactivation during distension and sham, respectively. (ii) Comparing baseline or sham activity showed the following differences: higher activity in SII/SI, insula, midcingulate (MCC), dorsolateral and ventrolateral PFC in controls; and higher activity in occipital cortex in FD. Differences in left lateral PFC were specific to sham. (iii) Anxiety correlated negatively with pACC and MCC and positively with dorsal pons activity.
FD patients failed to activate pACC, to deactivate dorsal pons during distension, and to deactivate amygdala during sham; this may represent arousal-anxiety-driven failure of pain modulation. During baseline and sham, differences between patients and controls were found in sensory as well as affective-cognitive areas.
在高敏感功能性消化不良（FD）患者胃扩张期间，发现躯体感觉皮层（SI/SII）和腹外侧前额叶皮层（vlPFC）被激活，但与对照组不同的是，前扣带回（pACC）的吻侧没有被激活。本文旨在研究：（i）FD 患者在扩张和模拟扩张与基线相比时的皮层激活和去激活，无论其敏感性状态如何；（ii）在“无扩张”状态下健康者和 FD 患者之间的大脑活动差异；（iii）FD 患者的焦虑与大脑活动之间的关系。
对 25 例 FD 患者（13 例为高敏感）进行 H（2）（15）O-PET 脑扫描，在三种条件下进行：基线、不适感阈值扩张和模拟扩张。使用 SPM2 比较健康对照组的脑活动。
FD 患者的不适感阈值较低，所有条件下的感觉评分均高于对照组。（i）与对照组相比，FD 患者在扩张期间的 pACC 激活缺失，除了没有 pACC 激活，其他激活与对照组相似。在扩张和模拟扩张期间，FD 患者分别没有背侧脑桥和杏仁核的去激活。（ii）与基线或模拟扩张活动比较，结果显示：对照组的 SII/SI、岛叶、中扣带回（MCC）、背外侧和腹外侧前额叶皮质的活动较高；FD 患者的枕叶皮质的活动较高。左侧外侧前额叶皮质的差异是模拟扩张特有的。（iii）焦虑与 pACC 和 MCC 呈负相关，与背侧脑桥活动呈正相关。
FD 患者在扩张期间未能激活 pACC，未能在扩张时使背侧脑桥去激活，在模拟扩张时未能使杏仁核去激活，这可能代表了由觉醒-焦虑驱动的疼痛调节失败。在基线和模拟扩张期间，FD 患者和对照组之间在感觉以及情感-认知区域都存在差异。
