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目的应用血氧水平依赖性功能性磁共振(BOLD fMRI)技术研究肠易激综合征(irritablebowelsyndrome ,IBS)患者颅内痛觉功能区的变化及临床意义并比较与正常人的差异。方法2 0 0 2年1月～2 0 0 4年2月期间,参照罗马II诊断标准纳入67例肠易激综合征患者和10例正常志愿者,其中腹泻型肠易激综合征44例,男19例,女2 5例。年龄3 4～73岁,平均年龄5 3 0 7±8 44岁。便秘型肠易激综合征2 3例,其中男12例,女11例,年龄2 1～74岁,平均年龄46 2 2±14 64岁。直肠注气试验记录感觉阈值和感觉评分;功能性磁共振(fMRI)分析直肠扩张3 0ml、60ml、90ml和12 0ml时颅内痛觉功能区扣带前皮质(ACC)、脑岛皮质(IC)、额前皮质(PFC)及丘脑(THAL)的激活面积和强度。结果腹泻型IBS患者排便急迫和疼痛阈值显著低于便秘型患者和正常志愿者(P <0 0 5 ) ;腹泻型IBS患者在直肠注气90ml和12 0ml时视觉模拟评分(VAS)显著高于正常志愿者(P <0 0 5 ) ;便秘型IBS患者直肠扩张12 0ml时额前皮质、右侧丘脑兴奋面积较正常对照组显著增高(P <0 0 5 ) ,腹泻型IBS患者直肠扩张12 0ml时右侧脑岛皮质、额前皮质和右侧丘脑的兴奋面积较正常对照组显著增高(P <0 0 5 ) ;所有IBS患者直肠扩张90ml时脑岛皮质、直肠扩张12 0ml时脑岛皮质、额前皮质和丘脑
Objective To study the changes and clinical significance of intracranial pain function area in patients with irritable bowel syndrome (IBS) by using the blood oxygen level-dependent functional magnetic resonance (BOLD fMRI) technique and to compare the differences with those in normal subjects. Methods From January 2002 to February 2004, 67 patients with irritable bowel syndrome and 10 normal volunteers were enrolled according to the Roman II diagnostic criteria, including 44 cases of irritable bowel syndrome of diarrhea, 19 males and 25 females. Age 34 ~ 73 years old, mean age 5370 ± 8 44 years old. Constipation type irritable bowel syndrome 23 cases, including 12 males and 11 females, aged 21 to 74 years, with an average age of 462 2 ± 14 64 years. The sensory threshold and sensory score were recorded by rectal gas injection test. The anterior cingulate cortex (ACC), cerebral ischial cortex (IC) in intracranial hyperalgesia were evaluated by functional magnetic resonance imaging (fMRI) at rectum of 30ml, 60ml, 90ml and 120ml. , Prefrontal cortex (PFC) and thalamus (THAL) activation area and intensity. Results The threshold of defecation urgency and pain in diarrhea-predominant IBS patients was significantly lower than that in constipation patients and normal volunteers (P <0.05). The diarrhea-predominant IBS patients had significantly higher visual analogue scale (VAS) at rectal gas injections of 90ml and 120ml Normal volunteers (P <0.05). The convalescent areas of prefrontal cortex and right thalamus in constipation-type IBS patients were significantly higher than those in normal control group (P <0.05) The excitatory area of right cerebral cortex, prefrontal cortex and right thalamus in 0ml group was significantly higher than that in normal control group (P <0.05). When all the IBS patients were rectum dilated 90ml, Cortex, prefrontal cortex and thalamus