带状疱疹慢性化转变为带状疱疹后神经痛会引起大脑活动和灰质体积变化。
Herpes zoster chronification to postherpetic neuralgia induces brain activity and grey matter volume change.
作者信息
Cao Song, Qin Bangyong, Zhang Yi, Yuan Jie, Fu Bao, Xie Peng, Song Ganjun, Li Ying, Yu Tian
机构信息
Department of Pain Medicine, The First Affiliated Hospital of Zunyi Medical UniversityZunyi, Guizhou, China.
Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical UniversityZunyi, Guizhou, China.
出版信息
Am J Transl Res. 2018 Jan 15;10(1):184-199. eCollection 2018.
OBJECTIVE
Herpes zoster (HZ) can develop into postherpetic neuralgia (PHN), which is a chronic neuropathic pain (NP). Whether the chronification from HZ to PHN induced brain functional or structural change is unknown and no study compared the changes of the same brains of patients who transited from HZ to PHN. We minimized individual differences and observed whether the chronification of HZ to PHN induces functional and pain duration dependent grey matter volume (GMV) change in HZ-PHN patients.
METHODS
To minimize individual differences induced error, we enrolled 12 patients with a transition from HZ to PHN. The functional and structural changes of their brains between the two states were identified with resting-state functional MRI (rs-fMRI) technique (i.e., the regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF) method) and the voxel based morphometry (VBM) technology respectively. The correlations between MRI parameters (i.e., ΔReHo, ΔfALFF and ΔVBM) and Δpain duration were analyzed too.
RESULTS
Compared with HZ brains, PHN brains exhibited abnormal ReHo, fALFF and VBM values in pain matrix (the frontal lobe, parietal lobe, thalamus, limbic lobe and cerebellum) as well as the occipital lobe and temporal lobe. Nevertheless, the activity of vast area of cerebellum and frontal lobe significantly increased while that of occipital lobe and limbic lobe showed apparent decrease when HZ developed to PHN. In addition, PHN brain showed decreased GMV in the frontal lobe, the parietal lobe and the occipital lobe but increased in the cerebellum and the temporal lobe. Correlation analyses showed that some of the ReHo, fALFF and VBM differential areas (such as the cerebellum posterior lobe, the thalamus extra-nuclear and the middle temporal gyrus) correlated well with Δpain duration.
CONCLUSIONS
HZ chronification induced functional and structural change in cerebellum, occipital lobe, temporal lobe, parietal lobe and limbic lobe. These changes may be correlated with HZ-PHN chronification. In addition, these changes could be reasons of refractory chronic pain of PHN.
目的
带状疱疹（HZ）可发展为带状疱疹后神经痛（PHN），这是一种慢性神经病理性疼痛（NP）。HZ向PHN的病程演变是否会引起脑功能或结构改变尚不清楚，且尚无研究比较同一患者从HZ转变为PHN后脑的变化。我们尽量减少个体差异，观察HZ向PHN的病程演变是否会导致HZ-PHN患者的功能及与疼痛持续时间相关的灰质体积（GMV）变化。
方法
为尽量减少个体差异导致的误差，我们纳入了12例从HZ转变为PHN的患者。分别采用静息态功能磁共振成像（rs-fMRI）技术（即局部一致性（ReHo）和低频振幅分数（fALFF）法）及基于体素的形态学测量（VBM）技术，确定其脑在两种状态下的功能和结构变化。还分析了磁共振成像参数（即ΔReHo、ΔfALFF和ΔVBM）与Δ疼痛持续时间之间的相关性。
结果
与HZ状态下的脑相比，PHN状态下的脑在疼痛相关脑区（额叶、顶叶、丘脑、边缘叶和小脑）以及枕叶和颞叶表现出异常的ReHo、fALFF和VBM值。然而，当HZ发展为PHN时，小脑和额叶大面积区域的活动显著增加，而枕叶和边缘叶的活动则明显减少。此外，PHN状态下的脑额叶、顶叶和枕叶的GMV减少，而小脑和颞叶的GMV增加。相关性分析表明，部分ReHo、fALFF和VBM差异区域（如小脑后叶、丘脑外侧核和颞中回）与Δ疼痛持续时间具有良好的相关性。
结论
HZ病程演变导致小脑、枕叶、颞叶、顶叶和边缘叶发生功能和结构变化。这些变化可能与HZ向PHN的病程演变相关。此外，这些变化可能是PHN难治性慢性疼痛的原因。
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