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利用神经学统计图像分析软件NEUROSTAT分析健康志愿者和逼尿肌过度活动患者的SPECT图像,探讨膀胱贮尿的大脑控制区及其控制机理。15例健康志愿者(Ⅰ组)和25例下尿道尿储存功能障碍患者接受了SPECT扫描。25例中19例患者为逼尿肌过度活动症(Ⅱ组),6例患者逼尿肌功能正常(Ⅲ组)。所有受检者均在排空膀胱的静息状态和控尿状态接受SPECT扫描。控尿状态的图像用第二次扫描后的图像减去第一次的图像获得。用NEUROSTAT对比分析3组受检者在静息状态下的脑血流(rCBF)情况及各组受检者控尿状态与静息状态rCBF的差异,进行多重对照校正。静息状态下Ⅱ组与Ⅲ组相比脑血流差异无统计学意义(P>0.05)。Ⅰ组和Ⅲ组控尿状态与静息状态相比,两侧额下回和右侧颞中回rCBF明显增高,其中右侧额下回在Z-值和病灶范围方面均最为明显(多重对照校正P<0.05,Ⅰ组对应Z-值>4.476,Ⅲ组对应Z-值>4.414)。Ⅱ组控尿状态与静息状态相比,仅左侧颞中回和额中回rCBF明显增高(多重对照校正P<0.05,Ⅱ组对应Z-值>4.35)。3组结果中,没有任何病灶脑血流降低达统计学标准。本研究结果表明两侧额下回和右侧颞中回与膀胱贮尿功能的大脑控制有关,特别是右侧额下回在膀胱贮尿的大脑控制中起重要作用,抑制控尿期逼尿肌的收缩。
Neurological statistical analysis software NEUROSTAT was used to analyze the SPECT images of healthy volunteers and patients with detrusor overactivity to explore the brain control region of urinary bladder and its control mechanism. Fifteen healthy volunteers (group Ⅰ) and 25 patients with lower urinary tract urinary storage dysfunction underwent SPECT. Twenty-nine of the 25 patients were detrusor hyperactivity (group Ⅱ) and 6 patients had normal detrusor function (group Ⅲ). All subjects underwent SPECT scans at rest and bladder control in emptying the bladder. The image of the urine control state is obtained by subtracting the first image from the image after the second scan. The NEUROSTAT was used to compare the cerebral blood flow (rCBF) in resting group and the difference of rCBF between control group and control group. There was no significant difference in cerebral blood flow between group Ⅱ and group Ⅲ at rest (P> 0.05). Compared with rest state, the rCBF in the inferior frontal gyrus and the right temporal gyrus in both groups were significantly higher in group Ⅰ and group Ⅲ, with the right inferior frontal gyrus being the most obvious in terms of Z-score and focal extent (multiple control Correction P <0.05, group Ⅰ corresponding to the Z-value> 4.476, group Ⅲ corresponding to the Z-value> 4.414). In group Ⅱ, the rCBF was significantly higher in left middle temporal gyrus and middle frontal gyrus than in resting state (multiple control corrected P <0.05, and group II corresponded to Z-value> 4.35). In the three groups, no focal cerebral blood flow was reduced to a statistical level. The results of this study show that both the inferior frontal gyrus and the right temporal gyrus are associated with brain control of urinary bladder storage. In particular, the right inferior frontal gyrus plays an important role in bladder control of urinary bladder and inhibits urinary bladder detrification Muscle contraction.