Weight restoration therapy rapidly reverses cortical thinning in anorexia nervosa: A longitudinal study
Weight restoration therapy rapidly reverses cortical thinning in anorexia nervosa: A longitudinal study
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DOI：
10.1016/j.neuroimage.2016.02.003
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发表时间：
2016-04-15
期刊：
影响因子：
5.7
通讯作者：
Ehrlich, Stefan
中科院分区：
文献类型：
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作者：
Bernardoni, Fabio;King, Joseph A.;Ehrlich, Stefan
结构磁共振成像研究证明，神经性厌食症急性患者的灰质减少在体重恢复后至少可以部分逆转。然而，纵向研究很少，而且这些结构变化的潜在机制尚不清楚。特别是，在重新调整过程中大脑结构正常化的相对速度和完整性仍然未知。在此，我们报告了一项结构神经影像研究，其中包括患有急性神经性厌食症的青少年/年轻成年女性患者 (n = 47)、长期康复患者 (n = 34) 和健康对照 (n = 75) 的样本。大多数急性病患者在标准化体重恢复治疗开始时和部分体重正常化后（体重指数增加> 10％）再次进行纵向扫描（n = 35）。使用 FreeSurfer 软件的纵向流处理和分析高分辨率结构图像，以测试所选皮质下感兴趣区域的皮质厚度和体积的变化。我们发现，在短暂的体重恢复治疗（大约 3 个月）期间，急性疾病患者的整体皮质厚度迅速增加（0.06 毫米/月）。这种显着增加是通过体重恢复单独预测的，不能归因于潜在的中介因素，例如病程、水合状态或症状改善。通过将体重部分恢复的患者的皮质厚度与健康对照者的皮质厚度进行比较，我们证实皮质厚度在随访时已经正常化。这种疾病期间的瘦身和体重康复过程中快速正常化的模式在很大程度上反映在皮质下体积中。总之，我们的研究结果表明，如果在神经性厌食症变成慢性之前进行成功的干预措施，饥饿造成的结构性脑损伤可能会以比以前想象的快得多的速度逆转。这提供了证据，使先前推测的机制（例如脱水和神经发生）受到质疑，并表明神经元和/或神经胶质重塑（包括大分子含量的变化）可能是神经性厌食症中观察到的灰质改变的基础。 (C) 2016 Elsevier Inc. 保留所有权利。
Structural magnetic resonance imaging studies have documented reduced gray matter in acutely ill patients with anorexia nervosa to be at least partially reversible following weight restoration. However, few longitudinal studies exist and the underlying mechanisms of these structural changes are elusive. In particular, the relative speed and completeness of brain structure normalization during realimentation remain unknown. Here we report from a structural neuroimaging study including a sample of adolescent/young adult female patients with acute anorexia nervosa (n=47), long-term recovered patients (n=34), and healthy controls (n=75). The majority of acutely ill patients were scanned longitudinally (n=35): at the beginning of standardized weight restoration therapy and again after partial weight normalization (> 10% body mass index increase). High-resolution structural images were processed and analyzed with the longitudinal stream of FreeSurfer software to test for changes in cortical thickness and volumes of select subcortical regions of interest. We found globally reduced cortical thickness in acutely ill patients to increase rapidly (0.06mm/month) during brief weight restoration therapy (approximate to 3 months). This significant increase was predicted by weight restoration alone and could not be ascribed to potentially mediating factors such as duration of illness, hydration status, or symptom improvements. By comparing cortical thickness in partially weight-restored patients with that measured in healthy controls, we confirmed that cortical thickness had normalized already at follow-up. This pattern of thinning in illness and rapid normalization during weight rehabilitation was largely mirrored in subcortical volumes. Together, our findings indicate that structural brain insults inflicted by starvation in anorexia nervosa may be reversed at a rate much faster than previously thought if interventions are successful before the disorder becomes chronic. This provides evidence drawing previously speculated mechanisms such as (de-) hydration and neurogenesis into question and suggests that neuronal and/or glial remodeling including changes in macromolecular content may underlie the gray matter alterations observed in anorexia nervosa. (C) 2016 Elsevier Inc. All rights reserved.