慢性偏头痛患者超敏性疼痛的病理生理机制研究

目的:利用血氧水平依赖(BOLD)功能核磁成像探讨慢性偏头痛患者产生皮肤超敏性疼痛(CA)的病理生理机制。方法:采用前瞻性研究方法,将研究对象分为四组。A组(n=29):伴有一侧前臂(颈8支配区)CA和/或同时有V1区和/或C2-C3区CA者;B组(n=31):伴有一侧额区(三叉神经第一支)和/或伴有一侧颈区(C2-C3支配区)CA者;C组(n=30):不伴CA者;D组(n=30):正常对照。采用BOLD功能核磁成像技术研究慢性偏头痛患者诱发CA时三叉神经感觉系统不同级别神经元激活情况。结果:在诱发CA时,A组的三叉神经节、三叉神经脊束核和丘脑的神经元均被激活致敏,B组的三叉神经节、三叉神经脊束核受到激活致敏,C组则只有三叉神经节受到激活致敏,D组则三级神经元均未激活致敏。结论:慢性偏头痛出现的头痛和躯体不同部位的CA与三叉神经感觉系统不同级别神经元受到激活致敏有关。

The Pathophysiologic Mechanism Research of Cutaneous Allodynia in Patients with Chronic Migraine

Objective：To investigate the pathophysiologic mechanism of cutaneous allodynia （CA） used by blood oxygen level dependent functional magnetic resonance imaging （BOLD） in patients with chronic migraine. Methods： We conducted a case-control prospectively study and the subjects were divided into four groups. Group A （n=29）： chronic migraine with CA on the medial forearm （C8） and/or frontal （V1） and/or posterior cervical （C2-C3）, group B （n=31）： chronic migraine with CA on the frontal （V1） and/or posterior cervical （C2-C3）, group C（n=30）： chronic migraine without CA, group D （n=30） ： healthy-control, The sensitization of the different order neurons in trigeminal sensory system was assessed by the image of BOLD-fMRI. Results： The neurons of the trigeminal ganglion, trigeminal nucleus and thalamus were sensitized in group A. The neurons of the trigeminal ganglion and trigeminal nucleus were sensitized in group B. The neurons of the trigeminal ganglion were sensitized in group C. No neurons of the trigeminal ganglion, trigeminal nucleus and thalamus were sensitized in group D. Conclusion： The headache pain and CA of different areas of the body in chronic migraine is associated with sensitization of the different order neurons in trigeminal sensory system.