慢性颞下颌关节紊乱病患者的脑信号变异性和 COMT 基因型异常。

Aberrant Brain Signal Variability and COMT Genotype in Chronic TMD Patients.

机构信息

Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA.

Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA.

出版信息

J Dent Res. 2021 Jul;100(7):714-722. doi: 10.1177/0022034521994089. Epub 2021 Feb 23.

Abstract

The analysis of brain signal variability is a promising approach to understand pathological brain function related to chronic pain. This study investigates whether blood-oxygen-level-dependent signal variability (BOLD) in specific frequency bands is altered in temporomandibular disorder (TMD) and correlated to its clinical features. Twelve patients with chronic myofascial TMD and 24 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. The BOLD was measured as the standard deviation of the BOLD time series at each voxel and compared between groups. We also examined the potential relationship between the BOLD and the catechol--methyltransferase () ValMet polymorphism. We assessed sensory-discriminative pain in the craniofacial region, pain sensitivity to sustained masseteric pain challenge, and TMD pain frequency for clinical correlation. Patients displayed reduced BOLD in the dorsolateral prefrontal cortex (dlPFC) as compared with HC in all frequency bands. In the slow-3 band, patients also showed reduced BOLD in the medial dorsal thalamus, primary motor cortex (M1), and primary somatosensory cortex (S1) and heightened BOLD in the temporal pole. Notably, we found a significant correlation between lower BOLD (slow-3) in the orofacial M1/S1 regions and higher clinical pain (intensity/area) and higher sensitivity of the masseter muscle pain. Moreover, lower BOLD (slow-3) in the dlPFC and ventrolateral PFC was associated with a higher TMD pain frequency. Participants who had the Met substitution exhibited lower BOLD in the dlPFC and higher BOLD in the temporal pole as compared with participants without the Met substitution. An increasing number of Met alleles was associated with lower dlPFC and greater temporal pole BOLD in both HC and TMD groups. Together, we demonstrated that chronic TMD patients exhibit aberrant BOLD in the top-down pain modulatory and sensorimotor circuits associated with their pain frequency and severity. ValMet polymorphism might affect clinical symptoms in association with regional brain signal variability, specifically involved in cognitive and emotional regulation of pain.

摘要

脑信号变异性分析是理解与慢性疼痛相关的病理性大脑功能的一种很有前途的方法。本研究旨在探讨特定频带的血氧水平依赖信号变异性(BOLD)是否在颞下颌关节紊乱(TMD)中发生改变,并与 TMD 的临床特征相关。12 例慢性肌筋膜 TMD 患者和 24 例健康对照者(HCs)接受静息态功能磁共振成像。BOLD 作为每个体素的 BOLD 时间序列的标准差进行测量,并在组间进行比较。我们还检查了 BOLD 与儿茶酚-O-甲基转移酶(COMT)ValMet 多态性之间的潜在关系。我们评估了颅面部区域的感觉辨别性疼痛、持续咀嚼肌疼痛挑战的疼痛敏感性以及 TMD 疼痛的频率,以进行临床相关性分析。与 HCs 相比,患者在所有频带中的背外侧前额叶皮层(dlPFC)的 BOLD 降低。在慢-3 波段,患者在背内侧丘脑、初级运动皮层(M1)和初级躯体感觉皮层(S1)的 BOLD 也降低,而在颞极的 BOLD 升高。值得注意的是,我们发现,口面部 M1/S1 区域的 BOLD(慢-3)越低,临床疼痛(强度/面积)越高,咀嚼肌疼痛的敏感性越高。此外,dlPFC 和腹外侧前额叶皮层(vlPFC)的 BOLD(慢-3)越低,TMD 疼痛的频率越高。与不携带 Met 取代的参与者相比,携带 Met 取代的参与者在 dlPFC 的 BOLD 降低,在颞极的 BOLD 升高。在 HCs 和 TMD 组中,携带更多 Met 等位基因与 dlPFC 和颞极的 BOLD 增加有关。总之,我们证明慢性 TMD 患者在与疼痛频率和严重程度相关的自上而下的疼痛调节和感觉运动回路中表现出异常的 BOLD。ValMet 多态性可能通过影响与认知和情绪相关的疼痛调节的区域大脑信号变异性来影响临床症状。

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