下丘脑-垂体-肾上腺轴活动亢进与神经性厌食症患者的食欲下降和摄食动机神经回路的低激活有关。
Increased hypothalamic-pituitary-adrenal drive is associated with decreased appetite and hypoactivation of food-motivation neurocircuitry in anorexia nervosa.
机构信息
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bulfinch 457-D, Boston, Massachusetts 02114, USA.
出版信息
Eur J Endocrinol. 2013 Oct 1;169(5):639-47. doi: 10.1530/EJE-13-0433. Print 2013 Nov.
OBJECTIVE
Corticotrophin-releasing hormone (CRH)-mediated hypercortisolemia has been demonstrated in anorexia nervosa (AN), a psychiatric disorder characterized by food restriction despite low body weight. While CRH is anorexigenic, downstream cortisol stimulates hunger. Using a food-related functional magnetic resonance imaging (fMRI) paradigm, we have demonstrated hypoactivation of brain regions involved in food motivation in women with AN, even after weight recovery. The relationship between hypothalamic-pituitary-adrenal (HPA) axis dysregulation and appetite and the association with food-motivation neurocircuitry hypoactivation are unknown in AN. We investigated the relationship between HPA activity, appetite, and food-motivation neurocircuitry hypoactivation in AN.
DESIGN
Cross-sectional study of 36 women (13 AN, ten weight-recovered AN (ANWR), and 13 healthy controls (HC)).
METHODS
Peripheral cortisol and ACTH levels were measured in a fasting state and 30, 60, and 120 min after a standardized mixed meal. The visual analog scale was used to assess homeostatic and hedonic appetite. fMRI was performed during visual processing of food and non-food stimuli to measure the brain activation pre- and post-meal.
RESULTS
In each group, serum cortisol levels decreased following the meal. Mean fasting, 120 min post-meal, and nadir cortisol levels were high in AN vs HC. Mean postprandial ACTH levels were high in ANWR compared with HC and AN subjects. Cortisol levels were associated with lower fasting homeostatic and hedonic appetite, independent of BMI and depressive symptoms. Cortisol levels were also associated with between-group variance in activation in the food-motivation brain regions (e.g. hypothalamus, amygdala, hippocampus, orbitofrontal cortex, and insula).
CONCLUSIONS
HPA activation may contribute to the maintenance of AN by the suppression of appetitive drive.
目的
促肾上腺皮质激素释放激素（CRH）介导的皮质醇增多症已在神经性厌食症（AN）中得到证实，神经性厌食症是一种以尽管体重低但仍限制食物摄入为特征的精神障碍。虽然 CRH 具有厌食作用，但下游皮质醇会刺激饥饿感。通过使用与食物相关的功能性磁共振成像（fMRI）范式，我们已经证明，即使在体重恢复后，患有 AN 的女性的大脑中参与食物动机的区域也会出现低激活。在 AN 中，下丘脑-垂体-肾上腺（HPA）轴失调与食欲的关系以及与食物动机神经回路低激活的关联尚不清楚。我们研究了 AN 中 HPA 活性、食欲和食物动机神经回路低激活之间的关系。
设计
对 36 名女性（13 名 AN、10 名 AN 体重恢复（ANWR）和 13 名健康对照（HC））进行横断面研究。
方法
在空腹状态以及标准混合餐后 30、60 和 120 分钟时测量外周皮质醇和 ACTH 水平。使用视觉模拟量表评估稳态和享乐性食欲。在视觉处理食物和非食物刺激期间进行 fMRI，以测量餐前和餐后的大脑激活。
结果
在每个组中，血清皮质醇水平在进食后下降。与 HC 相比，AN 组的空腹、餐后 120 分钟和最低皮质醇水平均较高。与 HC 和 AN 受试者相比，ANWR 组的餐后 ACTH 水平较高。皮质醇水平与较低的空腹稳态和享乐性食欲相关，与 BMI 和抑郁症状无关。皮质醇水平也与食物动机大脑区域（例如下丘脑、杏仁核、海马体、眶额皮质和岛叶）的组间变异的激活相关。
结论
HPA 激活可能通过抑制食欲驱动来维持 AN。
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