The Relation Between Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Acquired During Operations Enduring Freedom and Iraqi Freedom
The Relation Between Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Acquired During Operations Enduring Freedom and Iraqi Freedom
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DOI：
10.1097/htr.0b013e318256d3d3
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发表时间：
2013-01-01
影响因子：
2.4
通讯作者：
Zhong, Jianhui
中科院分区：
文献类型：
--
作者：
Bazarian, Jeffrey J.;Donnelly, Kerry;Zhong, Jianhui
目的：了解轻度创伤性脑损伤（TBI）、冲击波暴露、脑白色结构与创伤后应激障碍（PTSD）严重程度的关系。设计：采用多变量分析的巢式队列研究。参会人员：对2001年至2008年期间在作战地区服役的52名“持久自由行动”/“法语国家组织”退伍军人在最后一次服役后约4年进行了研究。主要措施：创伤后应激障碍检查表-军事;战斗经验调查，关于爆炸暴露和TBI症状的访谈问题;解剖磁共振成像（MRI）和弥散张量成像（DTI）大脑扫描。结果如下：PTSD的严重程度与DTI的平均扩散系数的第一百分位数较高（回归系数[r] = 4.2，P = 0.039）、MRI异常（r = 13.3，P = 0.046）和暴露于战斗事件的严重程度（r = 5.4，P = 0.007）相关。轻度TBI与PTSD严重程度无显著相关性。冲击波暴露与DTI上各向异性分数的第一百分位数较低相关（比值比[OR] = 0.38/SD; 95%置信区间[CI]，0.15-0.92），MRI正常（OR = 0.00，95%似然比检验CI，0.00-0.09）和创伤事件暴露的严重程度（OR = 3.64/SD; 95% CI，1.40-9.43）。结论：创伤后应激障碍的严重程度与战斗压力的严重程度以及MRI和DTI上潜在的脑结构变化有关，但与轻度TBI的临床诊断无关。爆炸暴露和异常DTI之间的关系表明，亚临床TBI可能发挥作用的创伤后应激障碍的发生在战斗环境中。
Objective: To understand the relations of mild traumatic brain injury (TBI), blast exposure, and brain white matter structure to severity of posttraumatic stress disorder (PTSD). Design: Nested cohort study using multivariate analyses. Participants: Fifty-two OEF/OIF veterans who served in combat areas between 2001 and 2008 were studied approximately 4 years after the last tour of duty. Main Measures: PTSD Checklist-Military; Combat Experiences Survey, interview questions concerning blast exposure and TBI symptoms; anatomical magnetic resonance imaging (MRI), and diffusion tensor imaging (DTI) scanning of the brain. Results: PTSD severity was associated with higher 1st percentile values of mean diffusivity on DTI (regression coefficient [r] = 4.2, P = .039), abnormal MRI (r = 13.3, P = .046), and the severity of exposure to combat events (r = 5.4, P = .007). Mild TBI was not significantly associated with PTSD severity. Blast exposure was associated with lower 1st percentile values of fractional anisotropy on DTI (odds ratio [OR] = 0.38 per SD; 95% confidence interval [CI], 0.15-0.92), normal MRI (OR = 0.00, 95% likelihood ratio test CI, 0.00-0.09), and the severity of exposure to traumatic events (OR = 3.64 per SD; 95% CI, 1.40-9.43). Conclusions: PTSD severity is related to both the severity of combat stress and underlying structural brain changes on MRI and DTI but not to a clinical diagnosis of mild TBI. The observed relation between blast exposure and abnormal DTI suggests that subclinical TBI may play a role in the genesis of PTSD in a combat environment.