De Bellis Michael D, Keshavan Matcheri S, Shifflett Heather, Iyengar Satish, Beers Sue R, Hall Julie, Moritz Grace
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pennsylvania, USA.
Biol Psychiatry. 2002 Dec 1;52(11):1066-78. doi: 10.1016/s0006-3223(02)01459-2.
Previous investigations suggest that maltreated children evidence alterations of chemical mediators of stress and adverse brain development. Previous anatomical magnetic resonance imaging (MRI) brain studies have not controlled for socioeconomic status.
In this study, 28 psychotropic naïve children and adolescents with maltreatment-related posttraumatic stress disorder (PTSD) and 66 sociodemographically similar healthy control subjects underwent comprehensive clinical assessments and anatomical MRI brain scans.
Compared with control subjects, subjects with PTSD had smaller intracranial, cerebral, and prefrontal cortex, prefrontal cortical white matter, and right temporal lobe volumes and areas of the corpus callosum and its subregions (2, 4, 5, 6, and 7), and larger frontal lobe cerebrospinal fluid (CSF) volumes than control subjects. The total midsagittal area of corpus callosum and middle and posterior regions remained smaller in subjects with PTSD, whereas right, left, and total lateral ventricles and frontal lobe CSF were proportionally larger than in control subjects, after adjustment for cerebral volume. Brain volumes positively correlated with age of onset of PTSD trauma and negatively correlated with duration of abuse. Significant gender x group effect demonstrated greater lateral ventricular volume increases in maltreated male subjects with PTSD than maltreated female subjects with PTSD. No hippocampal differences were seen.
These data provide further evidence to suggest that maltreatment-related PTSD is associated with adverse brain development. These data also suggest that male children may be more vulnerable to these effects.
先前的调查表明，受虐待儿童存在应激化学介质改变和大脑发育不良的证据。先前的大脑解剖磁共振成像（MRI）研究未对社会经济地位进行控制。
在本研究中，28名未接受过精神药物治疗、患有与虐待相关创伤后应激障碍（PTSD）的儿童和青少年以及66名社会人口统计学特征相似的健康对照受试者接受了全面的临床评估和大脑解剖MRI扫描。
与对照受试者相比，PTSD受试者的颅内、大脑、前额叶皮质、前额叶皮质白质、右侧颞叶体积以及胼胝体及其亚区域（2、4、5、6和7）的面积较小，额叶脑脊液（CSF）体积比对照受试者大。在调整脑体积后，PTSD受试者胼胝体的总矢状面面积以及中部和后部区域仍然较小，而右侧、左侧和总侧脑室以及额叶CSF比对照受试者成比例地更大。脑体积与PTSD创伤发病年龄呈正相关，与虐待持续时间呈负相关。显著的性别×组效应表明，患有PTSD的受虐待男性受试者的侧脑室体积增加幅度大于患有PTSD的受虐待女性受试者。未观察到海马体差异。
这些数据提供了进一步的证据，表明与虐待相关的PTSD与大脑发育不良有关。这些数据还表明，男童可能更容易受到这些影响。
