Haley Robert W, Spence Jeffrey S, Carmack Patrick S, Gunst Richard F, Schucany William R, Petty Frederick, Devous Michael D, Bonte Frederick J, Trivedi Madhukar H
Epidemiology Division, Departments of Internal Medicine and Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Psychiatry Res. 2009 Mar 31;171(3):207-20. doi: 10.1016/j.pscychresns.2008.05.004. Epub 2009 Feb 20.
Several case definitions of chronic illness in veterans of the 1991 Persian Gulf War have been linked epidemiologically with environmental exposure to cholinesterase-inhibiting chemicals, which cause chronic changes in cholinergic receptors in animal models. Twenty-one chronically ill Gulf War veterans (5 with symptom complex 1, 11 with complex 2, and 5 with complex 3) and 17 age-, sex- and education-matched controls, underwent an 99mTc-HMPAO-SPECT brain scan following infusion of saline and >48 h later a second scan following infusion of physostigmine in saline. From each SPECT image mean normalized regional cerebral blood flow (nrCBF) from 39 small blocks of correlated voxels were extracted with geostatistical spatial modeling from eight deep gray matter structures in each hemisphere. Baseline nrCBF in symptom complex 2 was lower than controls throughout deep structures. The change in nrCBF after physostigmine (challenge minus baseline) was negative in complexes 1 and 3 and controls but positive in complex 2 in some structures. Since effects were opposite in different groups, no finding typified the entire patient sample. A hold-out discriminant model of nrCBF from 17 deep brain blocks predicted membership in the clinical groups with sensitivity of 0.95 and specificity of 0.82. Gulf War-associated chronic encephalopathy in a subset of veterans may be due to neuronal dysfunction, including abnormal cholinergic response, in deep brain structures.
1991年海湾战争退伍军人慢性病的几种病例定义在流行病学上与环境接触胆碱酯酶抑制化学物质有关，这些化学物质在动物模型中会导致胆碱能受体发生慢性变化。21名患有慢性病的海湾战争退伍军人（5名患有症状复合体1，11名患有复合体2，5名患有复合体3）以及17名年龄、性别和教育程度匹配的对照者，在输注生理盐水后接受了一次99mTc-HMPAO-SPECT脑扫描，48小时后在输注毒扁豆碱生理盐水后进行了第二次扫描。从每个SPECT图像中，通过地统计空间建模从每个半球的八个深部灰质结构的39个相关体素小区域中提取平均标准化区域脑血流量（nrCBF）。在整个深部结构中，症状复合体2的基线nrCBF低于对照组。毒扁豆碱后nrCBF的变化（激发值减去基线值）在复合体1和3以及对照组中为负，但在复合体2的某些结构中为正。由于不同组的结果相反，没有任何发现能代表整个患者样本。来自17个深部脑区的nrCBF的留一法判别模型预测临床组的成员身份，敏感性为0.95，特异性为0.82。一部分退伍军人中与海湾战争相关的慢性脑病可能是由于深部脑结构中的神经元功能障碍所致，包括异常的胆碱能反应。
