基于fMRI-sEMG的运动训练提高慢性腰痛大脑调控效能的作用机制研究

骨骼肌肉疼痛在三大慢性疾病中排第一，腰痛终生患病率高达84%，严重影响工作生活。但其确切病因尚不清楚，理清发病机理及开发有效治疗手段非常迫切。研究表明慢性腰痛（cLBP）默认网络失衡，前额叶、岛叶与扣带回功能连接异常，即疼痛导致中枢编码加工通路及认知执行功能异常。我们预实验发现：cLBP多裂肌肌电AEMG与扣带回、额叶激活显著相关，提示疼痛刺激下大脑无法及时通过反馈调节机制控制和协调核心稳定肌收缩，肌肉激活延迟，疼痛加重。运动训练可强化大脑-身体连接，提高中枢对腰部肌肉协调控制能力，形成精确肌肉协同激活方式。本项目拟用脑功能成像fMRI分析cLBP脑内各区域及重要网络活动变化揭示大脑效能下降，再结合神经电生理sEMG分析中枢调控核心稳定肌运动的神经机制，以运动训练为载体分析脑可塑性变化对脊柱肌肉功能的影响，阐明运动训练提高cLBP大脑调控效能的作用机理，为制定精准有效康复方案提供科学依据。

Musculoskeletal pain ranks first among three major chronic diseases in human beings. Low back pain (LBP) is one of the most common reasons for physician visits, with a lifetime prevalence of 80% and decreased work ability and quality of life. However, the etiology and pathogenesis of LBP is still unknown. Previous studies have revealed that chronic LBP (cLBP) demonstrated abnormal spontaneous brain activity in the default mode network and functional connectivity changes in the prefrontal cortex, insular cortex and cingulate cortex, suggested that persistent pain is related to the impaired function of cerebral cortex which perform abnormal coding and processing for perception and action planning. Our preliminary studies showed that average electromyography (AEMG) of deep multifidus was positively correlated with functional activity of the cingulate cortex and frontal cortex, suggested that the brain failed to control and coordinate the contraction of core stabilizing muscles through the feedback regulation mechanisms. cLBP is associated with altered EMG signals of the deep lumbar multifidus with delayed anticipatory activation, pain may persist, worsen, or subside. Physical exercise can strengthen the connection between brain and body, improve the ability of central nervous system to coordinate and control lumbar muscles and return muscle coactivation on lumbar spine stability. Thus, this project firstly intends to use resting-state functional magnetic resonance imaging (fMRI) and functional connectivity methods to investigate alterations of distributed correlated cortical networks in pain modulation and the integration of sensory, affective and cognitive components. Then physical training is used to improve the ability of posture control and coactivation on corticomotor excitability of core muscles to identify changes associated with brain plasticity. Lastly, based on the electromyography signals recorded from surface electromyography (sEMG) and fine-wire/surface electrodes identified the changes in neuromuscular activation of the deep multifidus and erector spinae muscles (including the variation of linear and nonlinear parameters), to analyze the central integration mechanism of brain functional networks participating in postural movement of interspinal stabilization and clarify the effects of physical exercise on brain regulation efficiency, providing a proper basis for effective cLBP treatment.