Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention
Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention
复制标题
DOI：
10.1016/s0016-5085(00)70170-3
复制
发表时间：
2000-05-01
期刊：
影响因子：
29.4
通讯作者：
Kessler, R
中科院分区：
文献类型：
--
作者：
Mertz, H;Morgan, V;Kessler, R
背景与目的：肠易激综合征(IBS)以内脏高敏感性为特征，可能与脑-肠道通讯异常有关，正电子发射断层扫描提示IBS内脏痛处理过程中中枢神经系统(CNS)异常，本研究旨在确定(1)功能磁共振成像(FMRI)是否检测到疼痛和非疼痛内脏刺激时中枢神经系统的活动；(2)IBS的CNS疼痛中枢是否有异常反应。方法：对18例IBS患者和16例正常对照进行非痛性和痛性直肠扩张时的fMRI检查。结果：直肠刺激使大多数受试者的前扣带回(33/34)、前额叶(32/34)、岛叶皮质(33/34)和丘脑(32/34)的活动增加。在IBS受试者中，但不是对照组，疼痛导致前扣带皮质(ACC)比非疼痛刺激更大的激活。与对照组相比，IBS患者ACC中激活的像素数更多，报告的55 mm Hg扩张时的疼痛强度也更大。结论：IBS患者对疼痛的直肠刺激的反应比对照组更大程度地激活了ACC，这是一个关键的中枢疼痛中心。与以前的报道相反，这些数据表明IBS患者脑肠轴的疼痛敏感性增强，具有正常的激活模式。
Background & Aims: Irritable bowel syndrome (IBS) is characterized by visceral hypersensitivity, possibly related to abnormal brain-gut communication, Positron emission tomography imaging has suggested specific central nervous system (CNS) abnormalities in visceral pain processing in IBS, This study aimed to determine (1) if functional magnetic resonance imaging (fMRI) detects CNS activity during painful and nonpainful visceral stimulation; and (2) if CNS pain centers in IBS respond abnormally. Methods: fMRI was performed during nonpainful and painful rectal distention in 18 patients with IBS and 16 controls. Results: Rectal stimulation increased the activity of anterior cingulate (33/34), prefrontal (32/34), insular cortices (33/34), and thalamus (32/34) in most subjects. In IBS subjects, but not controls, pain led to greater activation of the anterior cingulate cortex (ACC) than did nonpainful stimuli. IBS patients had a greater number of pixels activated in the ACC and reported greater intensity of pain at 55-mm Hg distention than controls, Conclusions: IBS patients activate the ACC, a critical CNS pain center, to a greater extent than controls in response to a painful rectal stimulus. Contrary to previous reports, these data suggest heightened pain sensitivity of the brain-gut axis in IBS, with a normal pattern of activation.