The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Gastroenterology. 2011 Aug;141(2):499-506. doi: 10.1053/j.gastro.2011.05.003. Epub 2011 May 17.
BACKGROUND & AIMS: Abnormal processing of visceral sensation at the level of the central nervous system is believed to be involved in functional dyspepsia. However, compared with studies of stimulation-related changes in brain activity, few studies have focused on resting brain activity, which also is important in pathogenesis. We mapped changes in resting brain glucometabolism of patients with functional dyspepsia, compared with healthy subjects, and attempted to correlate abnormal brain activity with symptom severity. METHODS: We performed fluorodeoxyglucose positron emission tomography-computed tomography on 40 patients with functional dyspepsia and 20 healthy subjects who were in resting states. The symptom index of dyspepsia and the Nepean dyspepsia index were used to determine symptom severity. The positron emission tomography-computed tomography data were analyzed using statistical parametric mapping software. RESULTS: Compared with healthy subjects, patients with functional dyspepsia had higher levels of glycometabolism in the bilateral insula, anterior cingulate cortex (ACC), middle cingulate cortex (MCC), cerebellum, thalamus, prefrontal cortex, precentral gyrus, postcentral gyrus, middle temporal gyrus, superior temporal gyrus, putamen, right parahippocampal gyrus, claustrum, and left precuneus (P < .001). The signal increase in the ACC, insula, thalamus, MCC, and cerebellum was correlated with symptom index of dyspepsia scores and Nepean dyspepsia index scores (P < .01). The glycometabolism in ACC, insula, thalamus, MCC, and cerebellum of patients with more severe functional dyspepsia was significantly higher than that of patients with less severe functional dyspepsia (P < .005). CONCLUSIONS: In patients with functional dyspepsia, resting cerebral glycometabolism differs significantly from that of healthy subjects. The ACC, insula, thalamus, MCC, and cerebellum might be the key regions that determine the severity of symptoms.
背景与目的:中枢神经系统内脏感觉处理异常被认为与功能性消化不良有关。然而,与研究大脑活动的刺激相关变化相比,很少有研究关注静息脑活动,而静息脑活动在发病机制中也很重要。我们对功能性消化不良患者与健康受试者的静息脑葡萄糖代谢进行了映射,并试图将异常脑活动与症状严重程度相关联。
方法:我们对 40 例功能性消化不良患者和 20 例健康受试者进行了氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描。使用消化不良症状指数和 Nepean 消化不良指数来确定症状严重程度。使用统计参数映射软件对正电子发射断层扫描-计算机断层扫描数据进行分析。
结果:与健康受试者相比,功能性消化不良患者双侧岛叶、前扣带回皮质(ACC)、中扣带回皮质(MCC)、小脑、丘脑、前额叶、中央前回、中央后回、颞中回、颞上回、壳核、右侧海马旁回、屏状核和左侧楔前叶的糖代谢水平较高(P<0.001)。ACC、岛叶、丘脑、MCC 和小脑的信号增加与消化不良症状指数评分和 Nepean 消化不良指数评分相关(P<0.01)。症状更严重的功能性消化不良患者的 ACC、岛叶、丘脑、MCC 和小脑的糖代谢明显高于症状较轻的患者(P<0.005)。
结论:功能性消化不良患者的静息脑糖代谢与健康受试者有显著差异。ACC、岛叶、丘脑、MCC 和小脑可能是决定症状严重程度的关键区域。
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