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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 歸家豪 | 頑固性膀胱疼痛症候群/間質性膀胱炎：功能性腦部核磁共振的角色 | 2020/9/30 下午 04:04:31 | 0 |
| 原 文 | 題 目 | REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS: THE ROLE OF FUNCTIONAL BRAIN MRI |
| 作 者 | Pedro Abreu-Mendes*, Francisca Magno, Pereira Pedro, Luis Vale, Guilherme Bastos Silva, Dias da Costa, J. M. R. Fonseca, Francisco Cruz, Paulo Dinis, and Rui Pinto | |
| 出 處 | Journal of Urology | |
| 出版日期 | Volume 203, 01 April 2020 | |
| 評 論 |
間質性膀胱炎/膀胱疼痛症候群患者常抱怨當脹尿時下腹疼痛，排尿後才能獲得改善。而目前在臨床診斷實務上，我們能依靠的多是靠排除法及問卷調查。雖然膀胱鏡檢查可幫助診斷，但畢竟是侵入性，對患者來說，不適感和尿路感染的風險都較多。而在影像檢查方面，目前並沒有一個很好的方法來幫助診斷。 近幾年，因為影像設備大幅進步，功能性的腦部核磁共振檢查也日趨廣泛。 本文作者招集了六位平均年齡在45左右患有間質性膀胱炎/膀胱疼痛症候群的婦女，分別對他們進行了2次的腦部核磁共振檢查。分別是在室溫下膀胱灌注食鹽溶液前(將患者膀胱排空的時候)，以及食鹽水灌注後(患者出現恥骨上疼痛和/或膀胱最大容量的情況)。作者利用大腦軟件庫（FSL）功能性核磁共振影像的MELODIC工具，根據獨立成分分析的方法處理數據，之後再進行半定量分析。間質性膀胱炎/膀胱疼痛症候群是一種膀胱慢性發炎的疾病，此疾病會導致膀胱產生的神經信號傳入大腦功能區域發生變化，例如疼痛感放大，腦部活動增加和沈默性傷害神經元的活化以及特定大腦區域的敏感化。 默認模式神經網路（DMN）是一組在平時生理情況穩定時會活耀，而在特定期間卻被禁止的神經網路，它以反映了大腦的固有活動。 而另一方面，感覺運動神經網路（SMN）的活躍，則是表示結構性神經被改變，這代表患者處於慢性疼痛的情況。而6位患者的DMN無論是在膀胱排空或是脹滿的情況下皆處於活化狀態，這代表了即使是脹滿，也無法抑制大腦的神經訊號，改變了原本排胱信號的傳遞模式，另一方面，所有的患者在膀胱排空時SMN仍然相當活耀，這代表患者神經結構被改變，而會長期處於疼痛狀態。這項研究結果跟之前其他慢性發炎疼痛症候群的研究結果相同。但這又顯示另一個問題，如果患者不單是只有BPS/IC，而且又有其他慢性疼痛疾病，那這樣的影像檢查不就失去其特異性了嗎? 本次研究同時也發現，對於間質性膀胱炎特有的漢納氏病灶(Hunnar’s ulcer)的存在與神經網路活動模式之間沒有關聯性，這一點倒是跟臨床上Hunnar’s ulcer 跟疼痛度沒有關聯性相符合。讀者非常期待將來能有更多這方面的研究，畢竟，找到非侵入又高鑑別度的診斷方式，這正是病友們所盼望的。 |
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| abstract |
INTRODUCTION AND OBJECTIVE: Bladder pain syndrome/Interstitial cystitis (BPS/IC) as a pro-inflammatory chronic bladder state leads to functional changes in bladder afferent pathways like pain amplification, increased activity and recruitment of silent nociceptive neurons and sensitization of specific brain areas. Default Mode Network (DMN) is a set of regions activated during resting state, usually barred during specific tasks, reflecting the intrinsic activity of the brain. On the other hand, the sensorimotor network (SMN) plays a key role in structural neuroplasticity, usually present in chronic pain conditions. Our aim was to assess brain DMN and SMN in BPS/IC patients with and without noxious bladder stimuli using functional brain MRI (fMRI). METHODS: Six BPS/IC female patients, previously evaluated with a physical examination, bladder diary and bladder-pain related scores underwent 3 Tesla fMRI brain scanner. Acquisitions consisted of 10-minute blood oxygen level-dependent echo-planar imaging at rest. The first acquisition with an empty bladder state and a second one with suprapubic pain and/or bladder maximum capacity, after instillation of saline solution at room temperature, were performed. Data was processed based on the method of the independent component analysis using the MELODIC tool from Functional magnetic resonance imaging of the Brain Software Library (FSL). A semi-quantitative analysis was performed afterward. RESULTS: Patients mean age was 42.6 years (±5); mean VAS was 7±0.7; mean OSS was 24.8±1.9 mean day frequency and night frequency were 9.2±2.2 and 2.8±1.0 respectively; mean bladder maximum capacity was 260±54 ml and mean value for QoL (0-6) was 5±1. Four patients had Hunner’s lesions. All patients showed a comparable DMN activation in both empty and full bladder states and all of them presented a higher sensorimotor network (SMN) activation at an empty bladder state. There was no correlation between the presence of Hunners’ lesions and the pattern of network activity. CONCLUSIONS: Overlapping DMN activation at both empty and full bladder state, and consistently SMN deactivation with pain supports the relevant role of these networks in BPS/IC, as previously reported in other chronic pain syndromes |
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