作者：Allison Gandey
出處：WebMD醫學新聞
November 12, 2008 — 研究者發現纖維肌痛（Fibromyalgia）與腦部灌注異常而造成患者失能的有關證據。這篇分子影像研究結果登載於11月的核子醫學期刊中。
主要研究者、法國de Biophysique et de M?decine Nucl?aire服務中心的Eric Guedj醫師在新聞稿中表示，纖維肌痛可能和腦部處理疼痛的腦半球失能有關。
他指出，本研究顯示，這些病患存在有健康者所沒有的腦部灌注問題，再次強調纖維肌痛是個實際的異常。
研究團隊顯示，腦部異常與病患的焦慮及憂鬱無關；Guedj醫師向Medscape Neurology & Neurosurgery表示，他對研究發現不感驚訝，相信纖維肌痛與中樞基底有關。
Guedj醫師指出，不過，以前這類病患的影像研究顯示，腦部有些區域有正常值以上的血液流注，而有些區域則是血液流注低於正常。
現在這個研究中，研究者檢視了20名診斷有纖維肌痛的婦女和10名健康婦女，她們都進行單一電子發射電腦斷層掃描(single-photon-emission computed tomography，SPECT)。
Guedj醫師解釋，研究對象進行全腦掃描之後，我們使用統計分析來研究腦部某一小區域之功能活性與各種有關疼痛、失能、焦慮和憂鬱等參數之間的關係。
研究者發現，纖維肌痛影響問卷(Fibromyalgia Impact Questionnaire)與雙側顱頂輸注(bilateral parietal perfusion)有正向關係，包括中央後皮質(postcentral cortex)。
【體感覺血流增加與纖維肌痛的嚴重度有關】
研究者確認纖維肌痛病患的灌注異常；顯示顱頂皮質和中央前後皮質的雙側血流增加與纖維肌痛影響問卷分數有強烈關聯。左前顳葉皮質之血流減少與有此疾病的病患強烈相關。
這是首次有研究者觀察發現體感覺血流增加與纖維肌痛臨床嚴重度之間的關係。研究者強調，這強化了促感受性假設。
Guedj醫師在訪問中表示，這是第一步。結果顯示出與健康對象明顯不同的異常。我們現在必須指出，和其他疼痛疾病相比，此功能性模式特定於纖維肌痛。
研究者指出他們的一些研究限制。該研究樣本少，實驗組和對照組的病患人數差太多。
他們寫道，本研究選用的問卷廣泛用於纖維肌痛的研究；不過，我們應該討論是否有其他適合的問卷。同時，未能由獨立的研究者評估Tubingen Pain Behavior Scale 這個量表。
一般認為纖維肌痛影響問卷是臨床試驗中最合理之評估功能狀態的方法。Guedj 醫師等人結論表示，這些發現再度強調於控制研究中使用腦部灌注SPECT來客觀評估治療結果的觀念。
Bristol-Myers Squibb 贊助原始報告之圖表的再度上色。研究者宣稱沒有相關資金上的往來。
Fibromyalgia Associated With Functional Brain Abnormalities
By Allison Gandey
Medscape Medical News
November 12, 2008 — Researchers have uncovered evidence that fibromyalgia is linked to brain-perfusion abnormalities that relate to the disability of the disease. Results from the molecular imaging study appear in the November issue of the Journal of Nuclear Medicine.
Fibromyalgia may be related to a global dysfunction of cerebral pain-processing.
"Fibromyalgia may be related to a global dysfunction of cerebral pain processing," lead investigator Eric Guedj, MD, from the Service Central de Biophysique et de Medecine Nucleaire, in Marseille, France, said in a news release.
"This study demonstrates that these patients exhibit modifications of brain perfusion not found in healthy subjects and reinforces the idea that fibromyalgia is a real disorder," he noted.
The research team shows that brain abnormalities are independent of the patient's anxiety and depression status. Dr. Guedj told Medscape Neurology & Neurosurgery that he was not surprised by the findings and believes fibromyalgia is associated with a central substrate.
"Past imaging studies of patients with the syndrome, however, have shown above-normal cerebral blood flow in some areas of the brain and below-normal [blood flow] in other areas," Dr. Guedj noted.
In the current study, investigators looked at 20 women diagnosed with fibromyalgia and 10 healthy women. Subjects underwent single-photon-emission computed tomography (SPECT).
"After performing whole-brain scans on the participants," Dr. Guedj explained, "we used a statistical analysis to study the relationship between functional activity in even the smallest area of the brain and various parameters related to pain, disability, anxiety, and depression."
The researchers found that the Fibromyalgia Impact Questionnaire was positively correlated with bilateral parietal perfusion, including in the postcentral cortex.
Somatosensory Hyperperfusion Linked to Severity of Fibromyalgia
The researchers confirmed the presence of perfusion abnormalities in patients with fibromyalgia.
They showed that bilateral hyperperfusion of the parietal cortex and of the pre- and postcentral cortices are strongly correlated with the Fibromyalgia Impact Questionnaire score. Hypoperfusion of the left anterior temporal cortex was also strongly correlated in patients with disease.
This is reportedly the first time investigators have observed a relationship between somatosensory hyperperfusion and the clinical severity of fibromyalgia. "This reinforces the sensitization hypothesis," the researchers emphasize.
This reinforces the sensitization hypothesis.
"It's a first step," Dr. Guedj said during an interview. "We demonstrated significant abnormalities in comparison with healthy subjects. We now have to demonstrate that this functional pattern is specific to fibromyalgia in comparison with other painful diseases."
The researchers point to a number of limitations to their work. The study had a small sample and there was a large difference between the number of patients and the number of participants in the control group.
"The questionnaires chosen for our study are largely used in fibromyalgia," they write. "We should, however, discuss whether they are appropriate for such use. Also, the Tubingen Pain Behavior Scale was not evaluated by independent, masked investigators."
It has been suggested that the Fibromyalgia Impact Questionnaire is the most logical measure to evaluate functional status in clinical trials. Dr. Guedj and his team conclude that "these findings reinforce the concept of using brain-perfusion SPECT to objectively evaluate therapeutic results in controlled studies."
Bristol-Myers Squibb sponsored the color reproduction of the figures in the original paper. The researchers have disclosed no relevant financial relationships.
J Nucl Med. 2008;49:1798-1803.
[ 本帖最後由 goodcat1111 於 2008-11-23 21:50 編輯 ] |
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