Jeon So Yeon, Seo Seongho, Lee Jae Sung, Choi Soo-Hee, Lee Do-Hyeong, Jung Ye-Ha, Song Man-Kyu, Lee Kyung-Jun, Kim Yong Chul, Kwon Hyun Woo, Im Hyung-Jun, Lee Dong Soo, Cheon Gi Jeong, Kang Do-Hyung
Department of Neuropsychiatry, Seoul National University Hospital Department of Nuclear Medicine, Seoul National University College of Medicine Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences Institute of Radiation Medicine, Medical Research Center Department of Psychiatry, Seoul National University College of Medicine Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic of Korea.
Medicine (Baltimore). 2017 Jan;96(1):e5735. doi: 10.1097/MD.0000000000005735.
Complex regional pain syndrome (CRPS) is characterized by severe and chronic pain, but the pathophysiology of this disease are not clearly understood. The primary aim of our case-control study was to explore neuroinflammation in patients with CRPS using positron emission tomography (PET), with an 18-kDa translocator protein specific radioligand [C]-(R)-PK11195. [C]-(R)-PK11195 PET scans were acquired for 11 patients with CRPS (30-55 years) and 12 control subjects (30-52 years). Parametric image of distribution volume ratio (DVR) for each participant was generated by applying a relative equilibrium-based graphical analysis. The DVR of [C]-(R)-PK11195 in the caudate nucleus (t(21) = -3.209, P = 0.004), putamen (t(21) = -2.492, P = 0.022), nucleus accumbens (t(21) = -2.218, P = 0.040), and thalamus (t(21) = -2.395, P = 0.026) were significantly higher in CRPS patients than in healthy controls. Those of globus pallidus (t(21) = -2.045, P = 0.054) tended to be higher in CRPS patients than in healthy controls. In patients with CRPS, there was a positive correlation between the DVR of [C]-(R)-PK11195 in the caudate nucleus and the pain score, the visual analog scale (r = 0.661, P = 0.026, R = 0.408) and affective subscales of McGill Pain Questionnaire (r = 0.604, P = 0.049, R = 0.364). We demonstrated that neuroinflammation of CRPS patients in basal ganglia. Our results suggest that microglial pathology can be an important pathophysiology of CRPS. Association between the level of caudate nucleus and pain severity indicated that neuroinflammation in this region might play a key role. These results may be essential for developing effective medical treatments.
复杂性区域疼痛综合征（CRPS）的特征是严重且慢性的疼痛，但这种疾病的病理生理学尚未完全明确。我们这项病例对照研究的主要目的是使用正电子发射断层扫描（PET），借助一种18 kDa转运蛋白特异性放射性配体[C]-(R)-PK11195来探究CRPS患者的神经炎症情况。对11名CRPS患者（年龄30 - 55岁）和12名对照者（年龄30 - 52岁）进行了[C]-(R)-PK11195 PET扫描。通过应用基于相对平衡的图形分析，为每位参与者生成了分布体积比（DVR）的参数图像。CRPS患者尾状核（t(21) = -3.209，P = 0.004）、壳核（t(21) = -2.492，P = 0.022）、伏隔核（t(21) = -2.218，P = 0.040）和丘脑（t(21) = -2.395，P = 0.026）中[C]-(R)-PK11195的DVR显著高于健康对照者。苍白球的DVR（t(21) = -2.045，P = 0.054）在CRPS患者中也有高于健康对照者的趋势。在CRPS患者中，尾状核中[C]-(R)-PK11195的DVR与疼痛评分、视觉模拟量表（r = 0.661，P = 0.026，R = 0.408）以及麦吉尔疼痛问卷的情感分量表（r = 0.604，P = 0.049，R = 0.364）之间存在正相关。我们证明了CRPS患者基底节存在神经炎症。我们的结果表明小胶质细胞病变可能是CRPS重要的病理生理学机制。尾状核水平与疼痛严重程度之间的关联表明该区域的神经炎症可能起关键作用。这些结果对于开发有效的医学治疗方法可能至关重要。
