Study on the changes of cortical excitability in patients with postherpetic neuralgia evaluated by transcranial magnetic stimulation
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摘要:
目的 采用经颅磁刺激技术(TMS)探讨带状疱疹后遗神经痛患者(PHN)和健康人大脑运动皮层兴奋和抑制性的差异及其与症状严重程度的关系。 方法 选取2022年8月—2023年3月在广东药科大学附属第一医院门诊部就诊的PHN患者30例，另选取年龄、性别匹配的健康人30名设为对照组，采用单脉冲和成对脉冲TMS检测双侧运动皮层兴奋抑制性，检测指标包括静息运动阈值(RMT)，最佳刺激点运动诱发电位(MEPs)的平均波幅，皮质静息期(SP)；采用了3种不同的刺激强度(CS=70%/80%/90%AMT)，间隔时间为2 ms观察皮质内抑制(SICI)以及刺激间隔为12 ms皮质内易化(SICF)指标。采用病程、视觉模拟评分量表(VAS)评估PHN病情程度。 结果 PHN患侧支配区运动皮层RMT测量值(60.91±5.52)高于健康对照组(55.25±5.05, P < 0.05)，而2组受试者双侧运动皮层的最佳刺激点MEPs平均波幅、SP、SICF比较，差异无统计学意义(均P>0.05)。刺激强度为70%AMT条件下，PHN组患侧支配区运动皮层SICI测量值(0.81±0.09)高于健康对照组(0.73±0.08, P < 0.05)。相关性分析发现，PHN组患侧支配区皮层SICI测量值与病程呈正相关关系(r=0.323, P < 0.05)。 结论 PHN患者患侧支配区运动皮层兴奋性减弱，患侧支配区皮层抑制功能受损，受损程度与病程存在相关性。 Abstract:Objective To explore differences of cortical excitability assessed by transcranial magnetic stimulation (TMS) between patients with postherpetic neuralgia (PHN) and healthy controls, and to examine their relationships with pain symptoms severity. Methods A total of 30 PHN patients and 30 age-and sex-matched healthy controls underwent single- and paired-pulse TMS applied to the left and right motor cortex in Outpatient Department of the First Affiliated Guangdong Pharmaceutical University from August 2022 to March 2023. The test indexes included resting motor threshold (RMT), mean wave amplitude of motor evoked potentials (MEPs) at the optimal stimulation point, and cortical resting period (SP). Three different stimulation intensities (CS=70%/80%/90% AMT) with an interval of 2 ms were used to observe the intracortical inhibition (SICI) and the stimulation interval of 12 ms intracortical ease (SICF) index. The extent of PHN disease was assessed using the disease course, visual analog scoring scale (VAS). Results Compared with healthy controls (55.25±5.05), patients with PHN demonstrated significantly increased RMT values (60.91±5.52) in contralateral hemisphere (P < 0.05), while average MEPs, SP and SICF showed no significant differences between PHN patients and healthy controls (P>0.05). SICI measurements in the motor cortex of the affected dominant area were higher in the PHN group (0.81±0.09) than that in the healthy control group (0.73±0.08, P < 0.05) under the stimulation intensity of 70% AMT. Correlation analysis revealed a positive correlation between SICI measurements in the affected dominant cortical area and disease duration in the PHN group (r=0.323, P < 0.05). Conclusion Patients with PHN have diminished motor cortical excitability in the affected dominant area and impaired cortical inhibition in the affected dominant area, and the degree of impairment correlates with the duration of the disease. -
表 1 2组受试者双侧皮层静息运动阈值比较(x±s)
Table 1. Comparison of RMT, average MEPs and SP of bilateral cortex between the two groups (x±s)
组别 例数 CH-RMT
(%)IH-RMT
(%)CH-MEPs
(AVE)IH-MEPs
(AVE)CH-SP
(ms)IH-SP
(ms)PHN组 30 60.91±5.52 61.04±8.58 1.02±0.13 1.04±0.14 21.14±1.26 20.74±0.98 健康对照组 30 55.25±5.05 59.65±7.91 1.00±0.99 1.03±0.12 21.47±1.11 21.31±1.32 t值 4.016 0.652 0.110 0.768 1.076 1.899 P值 0.002 0.517 0.913 0.297 0.286 0.063 注：CH为患侧支配区的运动皮层(contralateral hemisphere)；IH为患侧同侧的运动皮层(ipsilateral hemisphere)；MEPs(AVE)为最佳刺激点的平均波幅。 
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表 2 2组受试者双侧皮层内抑制指标SICI比较(x±s)
Table 2. Comparison of bilateral cortex inhibitory index SICI between the two groups (x±s)
组别 例数 CH-CS70%AMT CH-CS80%AMT CH-CS90%AMT IH-CS70%AMT IH-CS80%AMT IH-CS90%AMT PHN组 30 0.81±0.09 0.64±0.14 0.60±0.13 0.80±0.15 0.70±0.13 0.79±0.18 健康对照组 30 0.73±0.08 0.65±0.17 0.63±0.13 0.82±0.12 0.67±0.17 0.79±0.15 t值 3.639 0.249 0.894 0.571 0.768 0.001 P值 0.006 0.805 0.375 0.570 0.446 0.998
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表 3 2组受试者双侧皮层内易化指标SICF比较(x±s)
Table 3. Comparison of the facilitation index SICF in bilateral cortex between the two groups (x±s)
组别 例数 CH-CS70%AMT CH-CS80%AMT CH-CS90%AMT IH-CS70%AMT IH-CS80%AMT IH-CS90%AMT PHN组 30 1.34±0.13 1.59±0.31 1.40±0.35 1.46±0.38 1.43±0.56 1.54±0.41 健康对照组 30 1.40±0.23 1.34±0.50 1.50±0.49 1.39±0.27 1.47±0.43 1.48±0.42 t值 1.244 1.887 0.910 0.822 0.310 0.560 P值 0.219 0.064 0.367 0.414 0.754 0.578
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表 4 皮层兴奋性指标与PHN病情程度相关性
Table 4. Correlation between cortical excitability and the severity of PHN
检测方法 PHN病程(月) 疼痛程度(VAS) r值 P值 r值 P值 单脉冲TMS CH-RMT -0.113 0.478 0.125 0.351 IH-RMT -0.047 0.923 -0.290 0.073 CH-MEP(AVE) 0.176 0.345 -0.284 0.076 IH-MEP(AVE) -0.287 0.079 0.197 0.223 CH-静息期 0.187 0.243 0.159 0.269 IH-静息期 -0.201 0.207 0.207 0.101 双脉冲TMSSICI CH-CS70%AMT 0.323 0.042 0.235 0.105 CH-CS80%AMT -0.036 0.851 0.034 0.837 CH-CS90%AMT -0.057 0.892 0.127 0.361 IH-CS70%AMT 0.113 0.342 0.131 0.302 IH-CS70%AMT 0.125 0.311 0.149 0.329 IH-CS70%AMT 0.147 0.321 0.129 0.317 双脉冲TMSSICF CH-CS70%AMT 0.079 0.629 -0.257 0.092 CH-CS70%AMT 0.132 0.313 -0.057 0.882 CH-CS70%AMT 0.115 0.302 -0.071 0.588 IH-CS70%AMT -0.079 0.629 0.223 0.142 IH-CS70%AMT -0.008 0.975 0.127 0.314 IH-CS70%AMT -0.248 0.109 0.146 0.291
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