焦虑增强颞下颌关节疼痛的脑功能磁共振成像研究

doi:10.3969/j.issn.1674-8115.2025.03.011

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (3): 342-348.doi: 10.3969/j.issn.1674-8115.2025.03.011

焦虑增强颞下颌关节疼痛的脑功能磁共振成像研究

孙一丹(), 杨鑫()

上海交通大学医学院附属新华医院口腔科，上海 200092

收稿日期:2024-10-28 接受日期:2024-11-19 出版日期:2025-03-28 发布日期:2025-03-28
通讯作者: 杨　鑫，主治医师，博士；电子信箱： yangxin@xinhuamed.com.cn。
作者简介:孙一丹（1997—），女，满族，住院医师，硕士；电子信箱： 923030392@qq.com。
基金资助:
上海市卫生健康委员会临床研究专项(20214Y0123);上海交通大学医学院附属新华医院学科攀峰计划(XKPF2024B500)

Functional MRI study on anxiety-enhanced temporomandibular joint pain

SUN Yidan(), YANG Xin()

Department of Stomatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China

Received:2024-10-28 Accepted:2024-11-19 Online:2025-03-28 Published:2025-03-28
Contact: YANG Xin, E-mail: yangxin@xinhuamed.com.cn.
Supported by:
Clinical Research Project of Shanghai Municipal Health Commission(20214Y0123);Construction Project of the “Discipline Peak-Climbing Plan” of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine(XKPF2024B500)

摘要/Abstract

摘要：

目的·利用功能磁共振成像探讨焦虑情绪刺激颞下颌关节紊乱病疼痛患者的脑功能变化。方法·纳入2021年11月—2023年9月在上海交通大学医学院附属新华医院口腔科就诊的颞下颌关节疼痛活动期患者30例，对其给予从国际情感图片系统中选取的负性情绪图片和中性情绪图片组成的任务程序进行焦虑情绪刺激，并进行功能磁共振成像扫描。通过FSL 5.0.6软件进行一般线性模型处理找出激活的脑区。分别通过视觉模拟评分法（Visual Analogue Scale，VAS）和状态-特质焦虑量表（State-Trait Anxiety Inventory，STAI）记录受试者焦虑刺激前后的疼痛程度和焦虑程度，并使用SPSS 20.0软件对焦虑刺激前后的疼痛程度和焦虑程度进行配对 t检验。结果·负性情绪图片刺激后，颞下颌关节紊乱病受试者焦虑程度显著增加（ P<0.001），并且疼痛程度加重（ P<0.001）；功能磁共振成像扫描过程中，颞下颌关节疼痛程度随着负性情绪图片的不断刺激而加重，随着中性情绪图片的出现而缓解。在刺激过程中，主要激活的脑区包括杏仁核、海马、前扣带回、丘脑、枕叶皮层和岛叶；去除中性对照情绪后主要激活的脑区包括枕叶皮层、前扣带回和杏仁核。结论·颞下颌关节疼痛患者受到焦虑情绪刺激后，疼痛程度显著增强。并且受试者以海马为中心的痛觉过敏通路相关脑区和痛及情绪调节网络相关的丘脑-边缘系统功能脑区存在显著激活。

关键词: 颞下颌关节紊乱病, 疼痛, 焦虑情绪, 功能核磁共振成像

Abstract:

Objective ·To detect the active brain regions in patients experiencing pain associated with temporomandibular disorder under anxiety emotion stimulation by using functional magnetic resonance imaging (fMRI). Methods ·A total of 30 temporomandibular disorder patients with spontaneous pain were included, who visited the Department of Stomatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, from November 2021 to September 2023. A task program consisting of negative and medium pictures chosen from the International Affective Picture System (IAPS) was used to stimulate anxiety in the volunteers during fMRI scanning. The activated brain regions were identified by processing the data with the general linear model using FSL 5.0.6 software. The pain levels and anxiety levels of the subjects before and after anxiety stimulation were recorded by using the Visual Analogue Scale (VAS) and State-Trait Anxiety Inventory (STAI). Paired t-tests were then conducted by using SPSS 20.0 software. Results ·After stimulation with negative pictures, the anxiety levels of the subjects with temporomandibular disorder significantly increased ( P<0.001), and the pain levels also worsened ( P<0.001). The degree of temporomandibular joint pain aggravated with the stimulation of negative emotional pictures and improved with the neutral pictures. The main brain regions activated during the task included amygdala, hippocampus, anterior cingulate gyrus, thalamus, occipital cortex, and insula. Among them, the occipital cortex, anterior cingulate gyrus, and amygdala were the main brain regions activated after removing neutral control stimulation. Conclusion ·The aggravation of anxiety can increase the temporomandibular joint pain level in patients with temporomandibular disorder. There is significant activation in the brain regions related to the hippocampus-centered hyperalgesia reaction and the thalamic-limbic system and the thalamic-limbic system, which are involved in pain and emotion regulation networks.

Key words: temporomandibular disorder, pain, anxiety, functional magnetic resonance imaging (fMRI)

中图分类号:

R782.6

孙一丹, 杨鑫. 焦虑增强颞下颌关节疼痛的脑功能磁共振成像研究[J]. 上海交通大学学报（医学版）, 2025, 45(3): 342-348.

SUN Yidan, YANG Xin. Functional MRI study on anxiety-enhanced temporomandibular joint pain[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(3): 342-348.

图/表 5

图1 焦虑图片和中性图片刺激对 TMD患者疼痛状态的影响

Fig 1 Effect of negative and neutral picture stimulation on temporomandibular joint pain in TMD patients

图2 焦虑情绪下 TMD疼痛患者的脑区冠状面、矢状面激活图Note： A. The activated brain regions in the coronal plane. The highlighted area is the amygdala. B. The activated brain regions in the coronal plane. The highlighted area is the hippocampus and parahippocampus gyrus. C. The activated brain regions in the coronal plane. The highlighted area is the anterior cingulate gyrus. D. The activated brain regions in the coronal plane. The highlighted area is the thalamus. E. The activated brain regions in the sagittal plane. The highlighted area is the occipital cortex. F. The activated brain regions in the coronal plane. The highlighted area is the insular.

Fig 2 Active brain regions in TMD patients with temporomandibular joint pain under anxiety in the coronal and sagittal plane

表1 焦虑情绪下 TMD疼痛患者的激活脑区

Tab 1 Active brain regions in TMD patients with temporomandibular joint pain under anxiety

Active brain region	Cluster extreme point (MNI coordinate)			Cluster extremum( Z-max)	P value
Active brain region	X	Y	Z	Cluster extremum( Z-max)	P value
Left anterior cingulate cortex	-6	12	42	4.71	<0.001
Right amygdala	22	-4	-16	4.75	<0.001
Left amygdala	-20	-6	-18	4.74	<0.001
Left insula, temporal pole	-44	12	-8	4.61	<0.001
Left orbital frontal cortex, temporal pole	-30	12	-20	4.64	<0.001
Right insula, orbital frontal cortex	40	16	-8	4.68	<0.001
Right thalamus	4	-18	0	4.79	<0.001
Left thalamus	-10	-22	-2	4.81	<0.001
Left temporal pole, orbital frontal cortex, parahippocampal gyrus	-30	8	-22	4.68	<0.001
Right hippocampus, parahippocampal gyrus	24	-22	-16	4.02	<0.001

图3 TMD疼痛患者群体水平上的脑区冠状面激活图Note： The activation of brain regions associated with anxiety during the task state was determined by subtracting the activation induced by neutral emotion from that induced by anxiety. Each brain slice displays the activation status of brain regions at different layers in the coronal plane.

Fig 3 Active brain regions of TMD patients with temporomandibular joint pain in the coronal plane

图4 TMD疼痛和焦虑共病机制

Fig 4 Comorbidity mechanism of TMD pain and anxiety

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焦虑增强颞下颌关节疼痛的脑功能磁共振成像研究

Functional MRI study on anxiety-enhanced temporomandibular joint pain

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