无先兆偏头痛患者大脑结构与功能异常的磁共振影像学研究
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摘要
作为一种主要的头痛疾病，偏头痛会导致患者和社会巨大的负担。频繁的偏头痛发作可以引起疼痛、敏感和失能，甚至可能增加患精神疾病例如抑郁的风险。现代神经影像学技术已经被用来研究偏头痛患者大脑的结构和功能改变。在本文中主要关注无先兆偏头痛患者大脑静息状态功能异常和白质结构异常，以及无先兆偏头痛患者中的抑郁症状对其的影响。主要工作如下：
1、之前的研究已经发现了无先兆偏头痛患者大脑结构和任务相关功能的异常。然而，很少有研究关注无先兆偏头痛患者静息状态下的异常。我们使用一种数据驱动的方法，局部一致性，来分析无先兆偏头痛患者大脑静息状态自发波动信号的异常。和健康被试比较，无先兆偏头痛患者在包括右侧喙部前扣带皮质、前额皮质、眶额叶皮层和辅助运动区表现出明显降低的局部一致性值。另外，相关分析结果表明在右侧前额皮质和喙部前扣带皮质的平均局部一致性值和无先兆偏头痛患者的病程之间存在明显的负相关。这些结果说明这些大脑区域的静息态异常可能和无先兆偏头痛患者疼痛处理的功能损伤有关系。
2、多种弥散张量成像参数的基于纤维束的空间统计方法（TBSS）分析（分数各向异性、平均弥散率、轴向弥散系数和径向弥散系数可以帮助推断无先兆偏头痛患者白质变化的病理生理类型并且提供更加明确的生物学标记。和健康被试相比，无先兆偏头痛患者在多个脑区表现出明显降低的分数各向异性、平均弥散率和轴向弥散系数。另外，这些脑区的平均弥散参数和无先兆偏头痛患者的病程和发作频率存在明显相关性。我们的研究发现降低的轴向弥散系数，可能意味着在无先兆偏头痛患者大脑白质中出现了轴突损失。
3、之前的研究已经发现了在偏头痛和抑郁之间存在着双向的联系。然而很少有研究关注无先兆偏头痛患者大脑白质完整性如何受到抑郁状态的影响。四十名无先兆偏头痛患者按照他们的自评抑郁量表（SDS）评分被分为两组，包括高抑郁症状（SDS+）组（自评抑郁量表评分SDS>49）和低抑郁症状（SDS）组（自评抑郁量表评分SDS≤49）。多种弥散张量成像参数的基于纤维束的空间统计方法（TBSS）分析被用来研究在整个无先兆偏头痛组，高抑郁症状（SDS+）组，低抑郁症状（SDS）组和健康被试之间的白质差异。和健康被试比较，降低的轴向弥散系数在整个无先兆偏头痛组，高抑郁症状（SDS+）组和低抑郁症状（SDS）组的多个白质脑区被发现。另外和低抑郁症状（SDS）组相比，高抑郁症状（SDS+）组在多个白质脑区表现出降低的分数各向异性和增加的平均弥散率、径向弥散系数，这和之前抑郁研究的发现相似。另外，这些脑区的平均分数各向异性和径向弥散系数和自评抑郁量表（SDS）评分表现出明显的相关关系。这说明无先兆偏头痛患者大脑白质可能被偏头痛（和轴向弥散系数更敏感）和抑郁症状（和径向弥散系数更敏感）同时影响。这可能作为无先兆偏头痛患者抑郁症状严重程度的一个生物学标记。
4、基于和上述相似的假设，无先兆偏头痛患者大脑静息态异常如何受到抑郁状态的影响也被考察了。和之前的实验设计相似，发现和健康被试比较，无先兆偏头痛组，高抑郁症状（SDS+）组和低抑郁症状（SDS-）组的几个相似的脑区都表现出了降低的局部一致性值。值得注意的是尾状核在低抑郁症状（SDS-）组和健康被试比较时表现出了升高的局部一致性值，而当高抑郁症状（SDS+）组和低抑郁症状（SDS-）组比较时表现出了降低的局部一致性值。另外尾状核平均局部一致性值和自评抑郁量表（SDS）评分存在负相关而和病程存在正相关。这说明无先兆偏头痛患者大脑静息态局部一致性可能被偏头痛和抑郁症状同时影响，而尾状核局部一致性可能作为无先兆偏头痛患者抑郁症状严重程度的一个生物学标记。
综上所述，无先兆偏头痛患者大脑的静息态局部一致性和白质完整性改变能够为偏头痛的病理生理学研究提供更多依据，并可能作为生物学标记来反映偏头痛的疾病进程或者伴随抑郁症状的严重程度。我们希望我们的发现能够为提升对偏头痛病理生理学机制的研究提供更多帮助。
As a primary headache disorder, migraine causes a significant individual and socialburden. Frequent migraine attacks may produce pain, sensitivities and productivity loss,and even increase the risk of psychiatric disorders with a variety of psychologicalcharacteristics such as depressive symptoms. Advanced neuroimaging approaches havebeen employed to investigate structural and functional brain changes in migrainepatients. This dissertation is mainly concerned with the abnormalities during the restingstate or in the white matter of migraine patients without aura (MWoA) and the influenceaffected by depressive symptoms. The author’s major contributions are outlined asfollows:
1. Previous studies provided evidence of structural and task-related functionalchanges in the brain of migraine patients without aura. However, few studies focused onthe resting state abnormalities in migraine patients without aura. We employed adata-driven method, regional homogeneity (ReHo), to analyze the local features ofspontaneous brain activity in migraine patients without aura during the resting state.Compared with healthy controls, migraine patients without aura showed a significantdecrease in ReHo values in the right rostral anterior cingulate cortex (rACC), theprefrontal cortex (PFC), the orbitofrontal cortex (OFC) and the supplementary motorarea (SMA). Additionally, we found that ReHo values were negatively correlated withduration of disease in the right rACC and PFC. Our results suggested that the restingstate abnormalities of these regions may be associated with functional impairments inpain processing in migraine patients without aura.
2. Tract-based spatial statistics (TBSS) with multiple diffusion tensor imaging(DTI) derived indices, including fractional anisotropy (FA), mean diffusivity (MD),radial diffusivity (RD) and axial diffusivity (AD), may help to deduce thepathophysiological type of white matter (WM) changes and provide more specificbiomarkers of WM neuropathology in the whole brain of MWoA. Compared withhealthy controls, MWoA showed significantly lower FA, MD and AD in multiple brainregions, while no difference in RD was observed. Additionally, some of the WMfindings were significantly correlated with duration and headache frequency inMWoA.Given that decreased AD may suggest axonal loss, our findings may revealaxonal loss in MWoA.
3. Previous studies proved that migraine and depression are bidirectionally linked.However, few studies investigated WM integrity affected by depressive symptoms in MWoA. Forty MWoA were divided into two groups according to their self-ratingdepression scale (SDS) score in the present study, including20in the SDS (+)(SDS>49) group and20in the SDS (-)(SDS≤49) group. TBSS analyses with multipleDTI-derived indices (FA, MD, RD, AD) were employed collectively to investigated theWM integrity among all MWoA, SDS (-) group, SDS (+) group and healthy controls.Compared with healthy controls, decreased AD was similarly shown in several WMtracts of the whole MWoA group, SDS (-) group and SDS (+) group. In addition,compared with the SDS (-) group, the SDS (+) group showed decreased FA andincreased MD and RD with conserved AD in multiple WM tracts, which were similarwith previous findings in depression disorder. Furthermore, mean FA and RD in theseWM tracts in the SDS (+) group were significantly correlated with SDS scores. Ourresults might suggest that white matter integrity might be affected by both depressionsymptoms (more sensitive as RD) and migraine (more sensitive as AD). The findingsmay serve as a sensitive biomarker to reflect depression severity in MWoA.
4. Based on similar hypothesis as above mentioned, the resting state abnormalitiesaffected by depressive symptoms in MWoA were investigated. Through similar desion,compared with healthy controls, decreased ReHo in similar regions were shown in theMWoA group and subgroups. It is noteworthy that the caudate showed increased ReHoin the SDS (-) group compared with healthy controls, and decreased ReHo in the SDS(+) group compared with the SDS (-) group. Moreover, the average ReHo values of thecaudate were significantly negatively correlated with the SDS scores and positivelycorrelated with duration. Our results suggested that ReHo patterns in migraine patientsmay be affected by depressive symptoms and serve as a biomarker to reflect depressionseverity in MWoA.
In summary, ReHo changes and WM changes in MwoA may provide morescientific evidence for the role in the pathology of migraine, which may serve as asensitive biomarker to reflect disease progression and depression severity of migrainewithout aura. We hope that our results could improve the understanding of migrainepathophysiology.
1、之前的研究已经发现了无先兆偏头痛患者大脑结构和任务相关功能的异常。然而，很少有研究关注无先兆偏头痛患者静息状态下的异常。我们使用一种数据驱动的方法，局部一致性，来分析无先兆偏头痛患者大脑静息状态自发波动信号的异常。和健康被试比较，无先兆偏头痛患者在包括右侧喙部前扣带皮质、前额皮质、眶额叶皮层和辅助运动区表现出明显降低的局部一致性值。另外，相关分析结果表明在右侧前额皮质和喙部前扣带皮质的平均局部一致性值和无先兆偏头痛患者的病程之间存在明显的负相关。这些结果说明这些大脑区域的静息态异常可能和无先兆偏头痛患者疼痛处理的功能损伤有关系。
2、多种弥散张量成像参数的基于纤维束的空间统计方法（TBSS）分析（分数各向异性、平均弥散率、轴向弥散系数和径向弥散系数可以帮助推断无先兆偏头痛患者白质变化的病理生理类型并且提供更加明确的生物学标记。和健康被试相比，无先兆偏头痛患者在多个脑区表现出明显降低的分数各向异性、平均弥散率和轴向弥散系数。另外，这些脑区的平均弥散参数和无先兆偏头痛患者的病程和发作频率存在明显相关性。我们的研究发现降低的轴向弥散系数，可能意味着在无先兆偏头痛患者大脑白质中出现了轴突损失。
3、之前的研究已经发现了在偏头痛和抑郁之间存在着双向的联系。然而很少有研究关注无先兆偏头痛患者大脑白质完整性如何受到抑郁状态的影响。四十名无先兆偏头痛患者按照他们的自评抑郁量表（SDS）评分被分为两组，包括高抑郁症状（SDS+）组（自评抑郁量表评分SDS>49）和低抑郁症状（SDS）组（自评抑郁量表评分SDS≤49）。多种弥散张量成像参数的基于纤维束的空间统计方法（TBSS）分析被用来研究在整个无先兆偏头痛组，高抑郁症状（SDS+）组，低抑郁症状（SDS）组和健康被试之间的白质差异。和健康被试比较，降低的轴向弥散系数在整个无先兆偏头痛组，高抑郁症状（SDS+）组和低抑郁症状（SDS）组的多个白质脑区被发现。另外和低抑郁症状（SDS）组相比，高抑郁症状（SDS+）组在多个白质脑区表现出降低的分数各向异性和增加的平均弥散率、径向弥散系数，这和之前抑郁研究的发现相似。另外，这些脑区的平均分数各向异性和径向弥散系数和自评抑郁量表（SDS）评分表现出明显的相关关系。这说明无先兆偏头痛患者大脑白质可能被偏头痛（和轴向弥散系数更敏感）和抑郁症状（和径向弥散系数更敏感）同时影响。这可能作为无先兆偏头痛患者抑郁症状严重程度的一个生物学标记。
4、基于和上述相似的假设，无先兆偏头痛患者大脑静息态异常如何受到抑郁状态的影响也被考察了。和之前的实验设计相似，发现和健康被试比较，无先兆偏头痛组，高抑郁症状（SDS+）组和低抑郁症状（SDS-）组的几个相似的脑区都表现出了降低的局部一致性值。值得注意的是尾状核在低抑郁症状（SDS-）组和健康被试比较时表现出了升高的局部一致性值，而当高抑郁症状（SDS+）组和低抑郁症状（SDS-）组比较时表现出了降低的局部一致性值。另外尾状核平均局部一致性值和自评抑郁量表（SDS）评分存在负相关而和病程存在正相关。这说明无先兆偏头痛患者大脑静息态局部一致性可能被偏头痛和抑郁症状同时影响，而尾状核局部一致性可能作为无先兆偏头痛患者抑郁症状严重程度的一个生物学标记。
综上所述，无先兆偏头痛患者大脑的静息态局部一致性和白质完整性改变能够为偏头痛的病理生理学研究提供更多依据，并可能作为生物学标记来反映偏头痛的疾病进程或者伴随抑郁症状的严重程度。我们希望我们的发现能够为提升对偏头痛病理生理学机制的研究提供更多帮助。
As a primary headache disorder, migraine causes a significant individual and socialburden. Frequent migraine attacks may produce pain, sensitivities and productivity loss,and even increase the risk of psychiatric disorders with a variety of psychologicalcharacteristics such as depressive symptoms. Advanced neuroimaging approaches havebeen employed to investigate structural and functional brain changes in migrainepatients. This dissertation is mainly concerned with the abnormalities during the restingstate or in the white matter of migraine patients without aura (MWoA) and the influenceaffected by depressive symptoms. The author’s major contributions are outlined asfollows:
1. Previous studies provided evidence of structural and task-related functionalchanges in the brain of migraine patients without aura. However, few studies focused onthe resting state abnormalities in migraine patients without aura. We employed adata-driven method, regional homogeneity (ReHo), to analyze the local features ofspontaneous brain activity in migraine patients without aura during the resting state.Compared with healthy controls, migraine patients without aura showed a significantdecrease in ReHo values in the right rostral anterior cingulate cortex (rACC), theprefrontal cortex (PFC), the orbitofrontal cortex (OFC) and the supplementary motorarea (SMA). Additionally, we found that ReHo values were negatively correlated withduration of disease in the right rACC and PFC. Our results suggested that the restingstate abnormalities of these regions may be associated with functional impairments inpain processing in migraine patients without aura.
2. Tract-based spatial statistics (TBSS) with multiple diffusion tensor imaging(DTI) derived indices, including fractional anisotropy (FA), mean diffusivity (MD),radial diffusivity (RD) and axial diffusivity (AD), may help to deduce thepathophysiological type of white matter (WM) changes and provide more specificbiomarkers of WM neuropathology in the whole brain of MWoA. Compared withhealthy controls, MWoA showed significantly lower FA, MD and AD in multiple brainregions, while no difference in RD was observed. Additionally, some of the WMfindings were significantly correlated with duration and headache frequency inMWoA.Given that decreased AD may suggest axonal loss, our findings may revealaxonal loss in MWoA.
3. Previous studies proved that migraine and depression are bidirectionally linked.However, few studies investigated WM integrity affected by depressive symptoms in MWoA. Forty MWoA were divided into two groups according to their self-ratingdepression scale (SDS) score in the present study, including20in the SDS (+)(SDS>49) group and20in the SDS (-)(SDS≤49) group. TBSS analyses with multipleDTI-derived indices (FA, MD, RD, AD) were employed collectively to investigated theWM integrity among all MWoA, SDS (-) group, SDS (+) group and healthy controls.Compared with healthy controls, decreased AD was similarly shown in several WMtracts of the whole MWoA group, SDS (-) group and SDS (+) group. In addition,compared with the SDS (-) group, the SDS (+) group showed decreased FA andincreased MD and RD with conserved AD in multiple WM tracts, which were similarwith previous findings in depression disorder. Furthermore, mean FA and RD in theseWM tracts in the SDS (+) group were significantly correlated with SDS scores. Ourresults might suggest that white matter integrity might be affected by both depressionsymptoms (more sensitive as RD) and migraine (more sensitive as AD). The findingsmay serve as a sensitive biomarker to reflect depression severity in MWoA.
4. Based on similar hypothesis as above mentioned, the resting state abnormalitiesaffected by depressive symptoms in MWoA were investigated. Through similar desion,compared with healthy controls, decreased ReHo in similar regions were shown in theMWoA group and subgroups. It is noteworthy that the caudate showed increased ReHoin the SDS (-) group compared with healthy controls, and decreased ReHo in the SDS(+) group compared with the SDS (-) group. Moreover, the average ReHo values of thecaudate were significantly negatively correlated with the SDS scores and positivelycorrelated with duration. Our results suggested that ReHo patterns in migraine patientsmay be affected by depressive symptoms and serve as a biomarker to reflect depressionseverity in MWoA.
In summary, ReHo changes and WM changes in MwoA may provide morescientific evidence for the role in the pathology of migraine, which may serve as asensitive biomarker to reflect disease progression and depression severity of migrainewithout aura. We hope that our results could improve the understanding of migrainepathophysiology.
引文
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