Altered Brain Structure in Irritable Bowel Syndrome: Potential Contributions of Pre-Existing and Disease-Driven Factors
Altered Brain Structure in Irritable Bowel Syndrome: Potential Contributions of Pre-Existing and Disease-Driven Factors
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DOI：
10.1053/j.gastro.2009.12.043
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发表时间：
2010-05-01
期刊：
影响因子：
29.4
通讯作者：
Davis, Karen D.
中科院分区：
文献类型：
--
作者：
Blankstein, Udi;Chen, Jerry;Davis, Karen D.
背景与目的：脑成像研究已经确定了肠易激综合征（IBS）患者的异常直肠诱发反应和皮质变薄。然而，目前尚不清楚这些异常是预先存在的还是由于长期IBS而发展的。因此，我们测试了IBS中异常结构灰质完整性是否与个体疾病症状、IBS持续时间或疼痛灾难化的个性特征相关。方法：11例IBS患者和16名年龄匹配的健康受试者进行结构磁共振成像。基于体素的形态测量和皮质厚度分析被用来确定异常的皮质下和皮质区域，分别和它们的相关性，以个人的特点。研究结果：与对照组相比，IBS组下丘脑灰质和前中扣带回皮质变薄，背外侧前额叶皮质厚度与疼痛灾难化之间存在强烈的负相关性，前额叶皮质厚度与疼痛持续时间之间存在正相关性。在IBS中，短期IBS患者的皮质变薄，但长期IBS疼痛与更正常的皮质厚度相关。结论：我们的研究结果提供了新的见解肠易激综合征和慢性疼痛通过证据的结构变化，可能符合功能异常。我们报告IBS患者下丘脑灰质增加，这可能与IBS、应激和下丘脑-垂体-肾上腺轴之间的关联有关。此外，我们已经确定了一些可能是预先存在的，并有助于脆弱性，和其他可能随着时间的推移，可能是因为慢性异常输入发展的脊髓上的异常。
BACKGROUND & AIMS: Brain imaging studies have identified abnormal rectal-evoked responses and cortical thinning in patients with irritable bowel syndrome (IBS). However, it is not known whether these abnormalities are pre-existing or develop as result of long-term IBS. Therefore, we tested whether abnormal structural gray matter integrity in IBS correlates with individual disease symptoms, duration of the IBS, or the personality characteristic of pain catastrophizing. METHODS: Eleven IBS patients and 16 age-matched healthy subjects underwent structural magnetic resonance imaging. Voxel-based morphometry and cortical thickness analysis were used to identify abnormalities in subcortical and cortical regions, respectively, and their correlation to individual characteristics. RESULTS: The IBS group showed increased hypothalamic gray matter and cortical thinning in the anterior midcingulate cortex compared with controls, a strong negative correlation between dorsolateral prefrontal cortex thickness and pain catastrophizing, and a positive correlation between anterior insula thickness and pain duration. In the insula, there was cortical thinning in patients with short-term IBS, but long-term IBS pain was associated with a more normal insula thickness. CONCLUSIONS: Our findings provide new insight into IBS and chronic pain through evidence for structural changes that could fit with functional abnormalities. We report that patients with IBS have increased hypothalamic gray matter, which may be related to the association among IBS, stress, and the hypothalamic-pituitary-adrenal axis. Furthermore, we have identified some supraspinal abnormalities that may be pre-existing and contribute to vulnerability, and others that may develop over time, possibly because of chronic abnormal inputs.