Evidence for acquired pregenual anterior cingulate gray matter loss from a twin study of combat-related posttraumatic stress disorder
Evidence for acquired pregenual anterior cingulate gray matter loss from a twin study of combat-related posttraumatic stress disorder
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DOI：
10.1016/j.biopsych.2007.06.022
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发表时间：
2008-03-15
影响因子：
10.6
通讯作者：
Pitman, Roger K.
中科院分区：
文献类型：
--
作者：
Kasai, Kiyoto;Yamasue, Hidenori;Pitman, Roger K.
背景：关于创伤后应激障碍（PTSD）患者局部脑容量减少的性质和起源存在争议。争论的焦点是，这些减少是否代表了在创伤暴露后发展PTSD的预先存在的脆弱性因素，或者由于导致PTSD的创伤应激或患有该疾病的慢性应激（或两者兼而有之）而获得的PTSD迹象。我们采用了一个病例对照设计，在同卵双胞胎对不一致的战斗暴露，以解决预先存在的与后天起源的脑形态测量异常的创伤后应激障碍。我们使用基于体素的形态测量学来搜索磁共振成像（MRI）数据中的灰质密度降低，这些数据是在先前的一项研究中获得的，该研究是关于越战老兵双胞胎（n = 18）与无双胞胎（n = 23）的比较。PTSD和他们的“高风险”与“低风险”（分别）相同的战斗未暴露cotwin.Results：与战斗暴露的双胞胎没有PTSD相比，战斗暴露的双胞胎PTSD表现出显着的灰质密度减少，在四个预测的大脑区域：右海马，膝前扣带皮层（ACC），和左，右岛。有一个显着的创伤后应激障碍诊断X战斗暴露互动pregenual ACC中，战斗暴露的创伤后应激障碍双胞胎有较低的灰质密度比自己的战斗未暴露的cotwin，以及比战斗暴露的双胞胎没有创伤后应激障碍和他们的cotwin.Conclusions：结果点灰质体积减少边缘系统和边缘系统结构的创伤后应激障碍。膝前扣带回的结果表明，该区域的灰质减少代表了与压力引起的损失一致的创伤后应激障碍的获得性体征。
Background: Controversy exists over the nature and origin of reduced regional brain volumes in posttraumatic stress disorder (PTSD). At issue is whether these reductions represent preexisting vulnerability factors for developing PTSD upon traumatic exposure or acquired PTSD signs due to the traumatic stress that caused the PTSD or the chronic stress of having the disorder (or both). We employed a case-control design in monozygotic twin pairs discordant for combat exposure to address the preexisting versus acquired origin of brain morphometric abnormalities in PTSD.Methods: We used voxel-based morphometry to search for gray matter density reductions in magnetic resonance imaging (MRI) data obtained in a previous study of combat-exposed Vietnam veteran twins with (n = 18) versus without (n = 23) PTSD and their "high-risk" versus "low-risk" (respectively) identical combat-unexposed cotwins.Results: Compared with the combat-exposed twins without PTSD, the combat-exposed twins with PTSD showed significant gray matter density reductions in four predicted brain regions: right hippocampus, pregenual anterior cingulate cortex (ACC), and left and right insulae. There was a significant PTSD Diagnosis X Combat Exposure interaction in pregenual ACC in which combat-exposed PTSD twins had lower gray matter density than their own combat-unexposed cotwins as well as than the combat-exposed twins without PTSD and their cotwins.Conclusions: The results point to gray matter volume diminutions in limbic and paralimbic structures in PTSD. The pattern of results obtained for pregenual ACC suggests that gray matter reduction in this region represents an acquired sign of PTSD consistent with stress-induced loss.